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This paper addresses two seeming paradoxes in the realm of employer-provided health insurance: First, businesses consistently claim that they bear the burden of the insurance they provide for employees, despite theory and empirical evidence indicating that workers bear the full incidence. Second, benefit generosity and the percentage of premiums paid by employers have decreased in recent decades, despite the preferential tax treatment of employer-paid benefits relative to wages-trends unexplained by the standard incidence model. This paper offers a revised incidence model based on nominal wage rigidity, in an attempt to explain these paradoxes. The model predicts that when the nominal wage constraint binds, some of the burden of increasing insurance premiums will fall on firms, particularly small companies with low-wage employees. In response, firms will reduce employment, decrease benefit generosity, and require larger employee premium contributions. Using Current Population Survey data from 2000-2001, I find evidence for this kind of wage rigidity and its associated impact on the employment and premium contributions of low-wage insured workers during a period of rapid premium growth. [ABSTRACT FROM AUTHOR]

The objective of this paper is to compare the accuracy of standard, non-contrast endosonography (EAS) with contrast-enhanced endosonography (CE-EAS) in the diagnosis of anal fistulas. The group consisted of 126 patients (mean age: 43.1 years) with the clinical diagnosis of anal fistula. For anal endosonography, a Bruel & Kjaer unit with a 7.0-MHz transducer was used with a 3% solution of hydrogen peroxide as the contrast agent (1, 2, 3). In each case, EAS and CE-EAS diagnoses of the type and complexity of anal fistula, as well as the location of the internal opening, were determined. Results showed that CE-EAS was significantly more accurate in diagnosing the type of anal fistulas than NC-EAS (97 vs. 94%, respectively; P=02275), and in differentiating simple from complex tracks (92 vs. 75%, respectively; P<0.00001). CE-EAS was much more accurate in patients with recurrent fistulas (57 vs. 92%, respectively; P<0.00006), whereas in a subgroup of primary tracks, both methods were of comparable accuracy. Sensitivities of CE-EAS and EAS for internal opening were 89 and 65%, respectively. The conclusion of this paper is that CE-EAS significantly increases the accuracy of standard non-contrast EAS and is especially beneficial for the differentiation between simple and complex tracks. [ABSTRACT FROM AUTHOR]

This paper examines the effects of conversions between For-Profit and Not-For-Profit forms on quality of medical care in California hospitals. The sample includes elderly patients treated in California's private hospitals from 1990 to 1998 for Acute Myocardial Infarction and Congestive Heart Failure. The results suggest that converted hospitals have experienced quality changes before conversion and that ignoring these changes may bias the estimates of conversion effects. Both conversions are found to have some adverse consequences: Hospitals that converted to FP form show an increase in AMI mortality rates, while those converted to NFP status indicate an increase in CHF mortality outcomes. [ABSTRACT FROM AUTHOR]

The discovery of mutations in cancer genes has advanced our understanding of cancer. These results are dispersed across the scientific literature and with the availability of the human genome sequence will continue to accrue. The COSMIC (Catalogue of Somatic Mutations in Cancer) database and website have been developed to store somatic mutation data in a single location and display the data and other information related to human cancer. To populate this resource, data has currently been extracted from reports in the scientific literature for somatic mutations in four genes, BRAF, HRAS, KRAS2 and NRAS. At present, the database holds information on 66 634 samples and reports a total of 10 647 mutations. Through the web pages, these data can be queried, displayed as figures or tables and exported in a number of formats. COSMIC is an ongoing project that will continue to curate somatic mutation data and release it through the website. [ABSTRACT FROM AUTHOR]

This paper is about naming illnesses--about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come from the responses to a series of open-ended questions which tapped into people's general conceptions of nervios and ataques de nervios. These questions were incorporated into follow-up interviews to an epidemiological study of the mental health of adults in Puerto Rico. The results suggest ways to incorporate these different categories of nervios into future research and clinical work with different Latino groups in the United States and in their home countries. [ABSTRACT FROM AUTHOR]

Over a period of some years, the components of a system for discerning erosion on children's teeth have been progressively developed, for use in an extensive project seeking correlations between erosion and various perceived risk factors. The aim was the detection of minute levels of erosion, based on mappings of the palatal surfaces of the maxillary central incisors in children. Significant challenges were encountered, the primary problem being the impracticality of placing control marks that would aid the realignment of successive measurements. The paper describes the erosion detection system and initial experiences based on the results of the first 100 subjects measured after 9 months. The procedures detected the occurrence of erosion of 50 microm magnitude on about one-quarter of the teeth over the 9 month period, at a precision estimated to be +/- 15 microm. The occurrence of some anomalous incidents prevented the procedure from being fully automatic, and it necessitated human examination of a graphical diagram derived from the surface matching program, but it was nevertheless superior to current practices of examining impressions or replicas entirely by eye. [ABSTRACT FROM AUTHOR]

Purpose: There is a considerable body of literature relating to trabeculectomy, however there are no data representative of the national experience of trabeculectomy in the United Kingdom (UK). The Department of Health funded a national survey of trabeculectomy to establish current practice patterns and the outcome of trabeculectomy in the National Health Service (NHS). In this paper we present the reported complications of first-time trabeculectomy from a nationally representative cohort of patients with chronic open angle glaucoma.Methods: Cross-sectional study of consultant ophthalmologists performing trabeculectomy in the NHS. Participants recruited their four most recent consecutive first-time trabeculectomy cases with chronic open angle glaucoma according to study eligibility criteria and data were collected by self-administered questionnaire.Follow-up: one year post-trabeculectomy.Main Outcome Measures: occurrence of early and late complications.Results: Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n = 304, 24.6%), shallow anterior chamber (n = 296, 23.9%), hypotony (n = 296, 24.3%), wound leak (n = 216, 17.8%) and choroidal detachment (n = 175, 14.1%). The most frequent late complications were cataract (n = 251, 20.2%), visual loss (n = 230, 18.8%) and encapsulated bleb (n = 42, 3.4%). The occurrence of most complications was not associated with a consultant's specialist interest, level of activity, type of hospital or region. Encapsulated bleb was reported more frequently in a university hospital setting.Conclusions: The complication rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. These are similar to previous published studies and highlight in particular, the impact of trabeculectomy on visual acuity in the first year following surgery. This survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level. [ABSTRACT FROM AUTHOR]

This paper reports results from a cognitive engineering study that looked at the role of computerised monitoring in neonatal intensive care. A range of methodologies was used: interviews with neonatal staff, ward observations, and experimental techniques. The purpose was to investigate the sources of information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitoring played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often than indicated by self-reports. Factors that seemed to affect staff use of the computer were the lack (or shortage) of training on the system, the specific clinical conditions involved, and the availability of alternative sources of information. These findings have relevant repercussions for the design of computerised decision support in intensive care and suggest ways in which computerised monitoring can be enhanced, namely: by systematic staff training, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms. [ABSTRACT FROM AUTHOR]

Identification of pediatric patients with acute myeloid leukemia (AML) candidates to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) is still a matter of debate. Currently, transplantation is reserved to patients considered at high risk of relapse based on cytogenetics, molecular biology, and minimal residual disease (MRD) assessment. However, no randomized clinical trial exists in the literature comparing transplantation with other types of consolidation therapy. Here, we provide an up-to-date meta-analysis of studies comparing allo-HSCT in CR1 with chemotherapy alone as a post-remission treatment in high-risk pediatric AML. The literature search strategy identified 10 cohorts from 9 studies performing as-treated analysis. The quantitative synthesis showed improved overall survival (OS) (relative risk, 1.15; 95% confidence interval [CI], 1.06-1.24; P = 0.0006) and disease-free survival (relative risk, 1.31; 95% CI, 1.17-1.47; P = 0.0001) in the allo-HSCT group, with increased relapse rate in the chemotherapy group (relative risk, 1.26; 95% CI, 1.07-1.49; P = 0.006). Sensitivity analysis including prospective studies alone and excluding studies that reported the comparison only on intermediate-risk patients confirmed the benefit of allo-HSCT on OS. Further research should focus on individualizing allo-HSCT indications based on molecular stratification and MRD monitoring. [ABSTRACT FROM AUTHOR]

Purpose: Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated nonlinear relationships. This paper inquires into the degree of nonlinearity across the four most widely used HSU-instruments and proposes exchange rates that differ depending on the severity levels of the health state utility scale.Methods: Overall, 7933 respondents from six countries, 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of nonlinear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument.Results: Quantile regressions reveal significant nonlinear relationships across all four HSU-instruments. The degrees of nonlinearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.11, whilst at the upper end it is 0.38.Conclusion: Comparisons at different utility levels illustrate the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of nonlinear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument been used. Accounting for nonlinearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY gains have been based on different HSU-instruments. [ABSTRACT FROM AUTHOR]

Fitting the measured bioimpedance spectroscopy (BIS) data to the Cole model and then extracting the Cole parameters is a common practice in BIS applications. The extracted Cole parameters then can be analysed as descriptors of tissue electrical properties. To have a better evaluation of physiological or pathological properties of biological tissue, accurate extraction of Cole parameters is of great importance. This paper proposes an improved Cole parameter extraction based on bacterial foraging optimization (BFO) algorithm. We employed simulated datasets to test the performance of the BFO fitting method regarding parameter extraction accuracy and noise sensitivity, and we compared the results with those of a least squares (LS) fitting method. The BFO method showed better robustness to the noise and higher accuracy in terms of extracted parameters. In addition, we applied our method to experimental data where bioimpedance measurements were obtained from forearm in three different positions of the arm. The goal of the experiment was to explore how robust Cole parameters are in classifying position of the arm for different people, and measured at different times. The extracted Cole parameters obtained by LS and BFO methods were applied to different classifiers. Two other evolutionary algorithms, GA and PSO were also used for comparison purpose. We showed that when the classifiers are fed with the extracted feature sets by BFO fitting method, higher accuracy is obtained both when applying on training data and test data. [ABSTRACT FROM AUTHOR]

The use of intensive longitudinal methods (ILM)-rapid in situ assessment at micro timescales-can be overlaid on RCTs and other study designs in applied family research. Particularly, when done as part of a multiple timescale design-in bursts over macro timescales-ILM can advance the study of the mechanisms and effects of family interventions and processes of family change. ILM confers measurement benefits in accurately assessing momentary and variable experiences and captures fine-grained dynamic pictures of time-ordered processes. Thus, ILM allows opportunities to investigate new research questions about intervention effects on within-subject (i.e., within-person, within-family) variability (i.e., dynamic constructs) and about the time-ordered change process that interventions induce in families and family members beginning with the first intervention session. This paper discusses the need and rationale for applying ILM to family intervention evaluation, new research questions that can be addressed with ILM, example research using ILM in the related fields of basic family research and the evaluation of individual-based interventions. Finally, the paper touches on practical challenges and considerations associated with ILM and points readers to resources for the application of ILM. [ABSTRACT FROM AUTHOR]

There are various methods and algorithms to detect the optic discs in retinal images. In recent years, much attention has been given to the utilization of the intelligent algorithms. In this paper, we present a new automated method of optic disc detection in human retinal images using the firefly algorithm. The firefly intelligent algorithm is an emerging intelligent algorithm that was inspired by the social behavior of fireflies. The population in this algorithm includes the fireflies, each of which has a specific rate of lighting or fitness. In this method, the insects are compared two by two, and the less attractive insects can be observed to move toward the more attractive insects. Finally, one of the insects is selected as the most attractive, and this insect presents the optimum response to the problem in question. Here, we used the light intensity of the pixels of the retinal image pixels instead of firefly lightings. The movement of these insects due to local fluctuations produces different light intensity values in the images. Because the optic disc is the brightest area in the retinal images, all of the insects move toward brightest area and thus specify the location of the optic disc in the image. The results of implementation show that proposed algorithm could acquire an accuracy rate of 100 % in DRIVE dataset, 95 % in STARE dataset, and 94.38 % in DiaRetDB1 dataset. The results of implementation reveal high capability and accuracy of proposed algorithm in the detection of the optic disc from retinal images. Also, recorded required time for the detection of the optic disc in these images is 2.13 s for DRIVE dataset, 2.81 s for STARE dataset, and 3.52 s for DiaRetDB1 dataset accordingly. These time values are average value. [ABSTRACT FROM AUTHOR]

Previous studies showed that all the vascular parameters from both the morphological and topological parameters were affected with the altering of imaging resolutions. However, neither the sensitivity analysis of the vascular parameters at multiple resolutions nor the distinguishability estimation of vascular parameters from different data groups has been discussed. In this paper, we proposed a quantitative analysis method of vascular parameters for vascular networks of multi-resolution, by analyzing the sensitivity of vascular parameters at multiple resolutions and estimating the distinguishability of vascular parameters from different data groups. Combining the sensitivity and distinguishability, we designed a hybrid formulation to estimate the integrated performance of vascular parameters in a multi-resolution framework. Among the vascular parameters, degree of anisotropy and junction degree were two insensitive parameters that were nearly irrelevant with resolution degradation; vascular area, connectivity density, vascular length, vascular junction and segment number were five parameters that could better distinguish the vascular networks from different groups and abide by the ground truth. Vascular area, connectivity density, vascular length and segment number not only were insensitive to multi-resolution but could also better distinguish vascular networks from different groups, which provided guidance for the quantification of the vascular networks in multi-resolution frameworks. [ABSTRACT FROM AUTHOR]

Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of 'big data'. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital's EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com ) suitable for visualization of both human-designed and data-mined processes which can then be used for 'what-if' analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively 'deep dive' into big data. [ABSTRACT FROM AUTHOR]

There is a growing appetite for large complex databases that integrate a range of personal, socio-demographic, health, genetic and financial information on individuals. It has been argued that 'Big Data' will provide the necessary catalyst to advance both biomedical research and health economics and outcomes research. However, it is important that we do not succumb to being data rich but information poor. This paper discusses the benefits and challenges of building Big Data, analysing Big Data and making appropriate inferences in order to advance cancer care, using Cancer 2015 (a prospective, longitudinal, genomic cohort study in Victoria, Australia) as a case study. Cancer 2015 has been linked to State and Commonwealth reimbursement databases that have known limitations. This partly reflects the funding arrangements in Australia, a country with both public and private provision, including public funding of private healthcare, and partly the legislative frameworks that govern data linkage. Additionally, linkage is not without time delays and, as such, achieving a contemporaneous database is challenging. Despite these limitations, there is clear value in using linked data and creating Big Data. This paper describes the linked Cancer 2015 dataset, discusses estimation issues given the nature of the data and presents panel regression results that allow us to make possible inferences regarding which patient, disease, genomic and treatment characteristics explain variation in health expenditure. [ABSTRACT FROM AUTHOR]

Mitochondrial DNA (mtDNA) diseases are a group of neuromuscular diseases that often cause suffering and premature death. New mitochondrial replacement techniques (MRTs) may offer women with mtDNA diseases the opportunity to have healthy offspring to whom they are genetically related. MRTs will likely be ready to license for clinical use in the near future and a discussion of the ethics of the clinical introduction of MRTs is needed. This paper begins by evaluating three concerns about the safety of MRTs for clinical use on humans: (1) Is it ethical to use MRTs if safe alternatives exist? (2) Would persons with three genetic contributors be at risk of suffering? and (3) Can society trust that MRTs will be made available for humans only once adequate safety testing has taken place, and that MRTs will only be licensed for clinical use in a way that minimises risks? It is then argued that the ethics debate about MRTs should be reoriented towards recommending ways to reduce the possible risks of MRT use on humans. Two recommendations are made: (1) licensed clinical access to MRTs should only be granted to prospective parents if they intend to tell their children about their MRT conception by adulthood; and (2) sex selection should be used in conjunction with the clinical use of MRTs, in order to reduce transgenerational health risks. [ABSTRACT FROM AUTHOR]

The widespread adoption of science-based prevention requires local infrastructures for prevention service delivery. Communities That Care (CTC) is a tested prevention service delivery system that enables a local coalition of community stakeholders to use a science-based approach to prevention and improve the behavioral health of young people. This paper uses data from the Community Youth Development Study (CYDS), a community-randomized trial of CTC, to examine the extent to which better internal team functioning of CTC coalitions increases the community-wide adoption of science-based prevention within 12 communities, relative to 12 matched comparison communities. Specifically, this paper examines the potential of both a direct relationship between coalition functioning and the community-wide adoption of science-based prevention and a direct relationship between functioning and the coalition capacities that ultimately enable the adoption of science-based prevention. Findings indicate no evidence of a direct relationship between four dimensions of coalition functioning and the community-wide adoption of a science-based approach to prevention, but suggest a relationship between coalition functioning and coalition capacities (building new member skills and establishing external linkages with existing community organizations) that enable science-based prevention. [ABSTRACT FROM AUTHOR]

Background: The role of the pharmacist has undergone profound changes over the recent years. In most European countries, the tendency seems to be that pharmacists are moving from being product-oriented to service-oriented. An interesting series of papers describing care related services of pharmacy in various countries has been published in 2006, but much has changed since then. This paper aims to provide an updated view on the overall health care sector in Europe, with a special focus on services in community pharmacy.Objective: To list and compare health care and community pharmacy structure in Europe; and to discuss the facilitators and barriers that can be found in health care systems and may promote or hinder the implementation of new community pharmacy services.Setting: European community pharmacy practice.Methods: A cross-sectional study was undertaken where data were collected using an online survey sent to a purposive sample of representatives from 27 European countries. Main outcome measure variation in professional community pharmacy services across Europe.Results: Data were obtained from 22 respondents in 19 countries (70.4%). Health care is mainly provided by a form of public National Health Services in 17 of the 19 countries. Demographic criteria for founding new pharmacies were present in 17 countries. Medicines are exclusively available in pharmacies in approximately one third of the countries. Smoking cessation (93.8%), drug waste management (81.3%) and pharmaceutical care programmes for specific diseases (77.8%) were reported as the most widely disseminated services in European pharmacies.Conclusions: There are still major differences between community pharmacy practice in Europe. Differences are mostly due to the legal framework and remuneration issues, which impact on the range of services available from pharmacies to the community of each country. [ABSTRACT FROM AUTHOR]

Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density. [ABSTRACT FROM AUTHOR]

The European Biomedical Ethics Practitioner Education Project (EBEPE), funded by the BIOMED programme of the European Commission, is a five-nation partnership to produce open learning materials for healthcare ethics education. Papers and case studies from a series of twelve conferences throughout the European Union, reflecting the 'burning issues' in the participants' healthcare systems, have been collected by a team based at Imperial College, London, where they are now being edited into a series of seven activity-based workbooks for individual or group study. These draft workbooks are now being read by a network of critical readers across Europe, whose comments will be incorporated into the final versions of the workbooks. The result will be the first European-wide and Europe-centred resource for teaching students, practitioners, and members of ethics committees. Topics covered include: Resource allocation and rationing The rights of children and young people Long-term care of the elderly Mental health and mental illness Autonomy and patient choice Decisions at the end of life A study guide to using the workbooks. The collaborative nature of the project has highlighted differentiated national approaches in medical ethics. Against the British and Dutch rights-orientated approach have emerged two other alternative models: the Nordic preference for administrative resolution of entitlement disputes, and the southern European emphasis on deontological codes. A genuinely European reconstruction of autonomy and rights, using hermeneutic, feminist and narrative approaches to counterbalance individualistic models, is emerging across the workbooks. The programme has also uncovered national differences in how ethics should be taught, with the workbooks' style being an experiential approach. Thus the EBEPE project is developing new models in both substantive and pedagogic senses, about both what should be taught and how it should be presented. [ABSTRACT FROM AUTHOR]

This paper outlines recent advances in the methods of cost-benefit analysis (CBA). Economic evaluations in healthcare can be criticised for, amongst other things, the inappropriate use of incremental cost-effectiveness ratios and the reporting of benefits in terms of cost savings, such as treatment costs averted. Many such economic evaluations are, according to the ‘scientific’ definition, CBAs. The ‘balance-sheet’ (or opportunity cost) approach is a form of CBA which can be used to identify who bears the costs and who reaps the benefits from any change. Whilst the next stage in a CBA, as defined in health economics, would require that all costs and benefits be valued in monetary terms, the balance-sheet approach, however, advocates that available monetary values can be augmented by other measures of cost and benefit. As such, this approach, which has a theoretical basis, is proposed as a practical prescription for CBA and highlights the notion that unquantified benefits are important and can be included within CBAs even when monetarisation is not possible. Recent methodological developments in monetary valuation for use in CBA are the development of the technique of willingness to pay, the use of conjoint analysis (CA) to elicit willingness-to-pay (WTP) values and advances in the debate on the inclusion of production gains in CBAs. Whilst acknowledging that there have been developments in each of these areas, it is claimed there has also been progress in using CBA as a framework for evaluation, as reflected by the balance-sheet approach. The paper concludes by stating that almost all types of economic evaluation have an element of the ‘cost-benefit’ approach in them. The important issue is to focus on the policy question to be addressed and to outline the relevant costs and benefits in a manner which assists the evaluation of welfare changes resulting from changes in healthcare delivery. The focus should not be on moulding a question to fit a hybrid definition of an analytical technique. [ABSTRACT FROM AUTHOR]

The paper details the specification of an ultrasonic Doppler flowmeter intended for perivascular application and describes the elements of the design of an ultrasonic blood flow transducer. An optimised design is outlined for probes to be used on vessels in the range 5-12 mm. The design is based on the use of continuous-wave Doppler techniques and incorporates a novel polymer ultrasonic couplant. A constrained jet technique is used to test the performance of the probe in vitro and the results indicate that in use velocity profile effects are likely to lead to sensitivity changes of only 3 per cent. A companion paper details the design and performance of the electronic processing system needed for the complete flowmeter. [ABSTRACT FROM AUTHOR]

The paper describes the design and performance of a microcomputer-based system to measure and control the level of muscle relaxation during surgical procedures. A measurement system feeds the twitch response to a train-of-four stimulation pulses into a microcomputer system. The microcomputer determines the level of muscle relaxation and then calculates, according to a specified control algorithm, the minimum amount of drug necessary to achieve adequate relaxation as rapidly as possible. The drug is administered automatically to the patient in the form of bolus injections by a motordriven syringe unit on instruction from the microcomputer. This controller system has been used in 42 clinical trials using d-tubocurarine and has proved to be capable of successfully controlling muscle relaxation. [ABSTRACT FROM AUTHOR]

The estimation of muscle tension and velocity of shortening from the myoelectric signal have been considered in numerous papers. These papers consider the estimates of each variable separately, with the other appearing in the estimation as a constant parameter. The work described in this paper develops a model for the relationship between a muscle's mechanical outputs and the myoelectric signal. The model suggests that the myoelectric signal is related directly to the muscle mechanical power via a nonlinear differential equation in velocity of shortening. The model is general in that it includes as special cases the isometric and anisometric constant-velocity work of other authors and agrees with their experimental results. In this work anisometric experiments are performed on the biceps brachii muscle to verify the model. Estimates of muscle velocity of shortening and mechanical power are obtained from the myoelectric signal during anisometric contractions and the results agree well with the actual velocity and power. The model points out that the myoelectric signal is a direct measure of muscle tension only under isometric conditions. [ABSTRACT FROM AUTHOR]

This paper summarises some of the design principles adopted during the development of a microcomputer communication aid by the authors ( Holte, 1978). In such an aid, a graphic representation of selection algorithms gives rise to an objective measure of the efficiency of a communication aid. Existing communication aid designs will be discussed in this new framework. The paper concludes by noting some ways in which a communication aid may be designed to utilise the full capabilities of its intended user. [ABSTRACT FROM AUTHOR]

Objective: Despite efforts to develop electronic access to medical records, there are few data on availability of past evaluations. Typical analyses assess only availability of paper charts. We studied the availability of prior internal and external medical documentation in the preanesthetic clinic of our tertiary teaching institution, which has had access to hospital-wide electronic records for five years.Methods: Residents and clerks answered questions on availability of desired pre-existing records either in a physical chart delivered to our clinic by computer terminal, at the start of the physician interview, and on later success in obtaining desired records not available at start of interview. Patient interview lengths were calculated.Results: 397 responses from 19-9-96 through 25-10-96 were available after 718 patient encounters. The surgeon's history & physical was unavailable in 11%. For 114/397 patients (29%) the anesthesiologist desired more preexisting information than was available in either paper or electronic format. For 32/397 patients (8%), the desired information resided outside the institution ("MISSING EXTERNAL"); for 89/397 (22%), it was within the institution ("MISSING INTERNAL"). Additional information was desired for 41% of ASA 3/4 patients, and for 23% of ASA 1/2 patients. Some or all of desired information was not found for 45% of MISSING INTERNAL, and for 78% (p = 0.12 NS) of MISSING EXTERNAL. MISSING EXTERNAL of any ASA status required significantly longer evaluations (70+/-39 min) than even ASA 3/4 patients missing no information (51.4+/-35.7 min, p 0.03). The surgeries of only eight patients (2%) were postponed in the preanesthetic evaluation clinic; half of the postponements were to obtain pre-existing records.Conclusions: Anesthesiologists retrieved, and added to the perioperative evaluation, information from previous encounters for 16% of patients. Despite our hospital-wide electronic records, internal information was missing for 22% of patients. Uneven deployment, and reliance on transcription may contribute to failures. A national electronic medical records system would benefit the 8% (one out of twelve) of outpatients missing external records identified in this study. For many patients, optimal medical understanding was not achieved during the planned preanesthetic evaluation. [ABSTRACT FROM AUTHOR]

Childbearing motivation may be conceptualized as based upon psychological traits and shaped by experiences during childhood, adolescence, and early adult life. This paper explores what those traits and developmental experiences are. Two measures of childbearing motivation, one positive and the other negative, are described. Using a sample of 362 married men and 354 married women, the paper systematically examines the factors associated with these measures. In addition to a set of basic personality traits, these factors include parental characteristics, teenage experiences, and a number of variables from young adult behavior domains such as marriage, education, work, religion, and parental relationships. Stepwise multiple regression analyses lead to two final constrained, simultaneous-equation regression models. These models indicate the importance of both personality traits and diverse life-cycle experiences in the development of childbearing motivation, the differential gender distribution of predictors, and the different experiential antecedents of positive and negative motivation. [ABSTRACT FROM AUTHOR]

This paper examines the relation between unmarried cohabitation and three important determinants of fertility-frequency of sexual intercourse, contraceptive practice, and the expectation to have a child within five years. Analyses based on data from the 1982 National Survey of Family Growth show that formerly married cohabitants are similar to married women with respect to these fertility determinants, but that never married cohabitants may have lower fertility in the short run because of extremely high levels of contraceptive practice. The paper also compares self-reported data on cohabitation with an inferred measure based on household composition. [ABSTRACT FROM AUTHOR]

This paper has developed estimates of the age-specific mortality rates prevailing during the Great Irish Famine and has analyzed fertility trends during the 25 years before the Famine. Our calculations confirm that 1 million Irish people perished as a result of this disaster. This figure does not include the deaths among the 1.3 million emigrants who left Ireland during the Famine period. The Famine produced a significant drop in the fertility rate, and we estimate that more than 300,000 births did not take place as a result of the Famine. The effects were especially severe on the very young and the very old, a result echoed in the findings of demographic analyses of other famines. Our procedure permits a reconstruction of the Irish population by age and sex during the period 1821-1841. In addition, it yields year-by-year estimates of the birth rate over this period. We estimate that the rate fell by about 14 percent, a result robust to our assumptions regarding emigration. Economic historians have debated this issue, and we hope that our evidence, although preliminary, will be of assistance. Our analysis also permits year-by-year reconstruction of Irish population totals for the period 1821-1851. Two years are of particular interest. Virtually all recent writers, with the notable exception of Lee (1981), have suggested that the 1831 census returns overestimated the actual population resident in Ireland at that date. Our reconstruction supports the validity of the 1831 census figure. We obtain a total of 7,847,000, which is in good agreement with the disputed census figure of 7,767,000. But perhaps the most interesting figure is the population total for the end of 1845, the highest ever achieved in Ireland. We estimate that the population on the eve of the Great Famine was 8,525,000. Throughout the paper we have tried to highlight those areas in which the data are unreliable, unavailable, or distorted. We have tried to devise cross-checks for consistency and to test the sensitivity of the results to a range of assumptions. A case in point concerns the age-sex profile and volume of emigration to England, Scotland, and Wales. Additional work at the micro level would be helpful here. More solid evidence on Famine births would also be helpful. The parish registers we have sampled certainly provide a clue to trends, but we have only made a start in that respect. A much more comprehensive survey is needed to convey the national picture.(ABSTRACT TRUNCATED AT 400 WORDS) [ABSTRACT FROM AUTHOR]

By restricting the number of age groups to two and by introducing continued fractions, the dynamics of populations with deterministically changing vital rates are completely specified at all times. Explicit expressions for the sequence of the product of population projection matrices are given. From these, relative age distribution and reproductive values to any desired accuracy are obtained as functions of the vital rates. Thus, the results given in this paper are stronger than any existing weak ergodic theorems. [ABSTRACT FROM AUTHOR]

This paper addresses the question of whether the crude birth rate (CBR) can be used as a proxy for more refined fertility measures in cross-national models of fertility determinants. It responds to a recent claim that the CBR represents an inappropriate fertility measure for these purposes. In the analysis, several strategies are used to assess the degree to which results based on the CBR are sensitive to lack of adjustment for age structure. The paper concludes that using the CBR as a proxy has minor and unimportant effects upon conclusions regarding fertility determinants. [ABSTRACT FROM AUTHOR]

This paper discusses recent migration to North America with reference to the 1962 and 1967 Canadian immigration regulations and the 1965 United States Immigration and Nationality Act. Despite the similar emphasis on manpower and kinship criteria as the basis for the admission of immigrants, differences between Canada and the United States exist with respect to the importance of immigration for the respective economies, the organization of immigration, the formal regulations, and the size and composition of migrant streams. After an examination of the volume, origin, and occupational composition of immigration to Canada and the United States, flows between the two countries are studied. The paper concludes with a scrutiny of changes in immigration regulations which are pending in both countries. [ABSTRACT FROM AUTHOR]

This paper is concerned with medical pluralism in a Philippine setting. It reports on results of a study of four indigenous healers and their patients in Cebu City. The city is a modern medical center in the Philippines, with more than 500 practicing physicians. But its indigenous healers also treat numerous patients, and many patients utilize both physicians and healers during the course of an illness. Of the four healers discussed in this paper, two had the largest followings of any healers in the city at the time of the study, the other two had very modest practices. Significant social and medical contrasts between the clienteles of these healers are described in the paper, and the implications of these differences are discussed with respect to decisions people make about their health care in an area with diverse medical resourses. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present our results and experience in the treatment of snoring using the non-ablative Erbium: Yttrium Aluminum Garnet (Er:YAG) laser. Twenty-four patients (18 male and 6 female) with snoring problems due to soft palate hypertrophy were treated with 3 treatment procedures with Er:YAG 2940-nm laser (long pulse mode, 10 Hz, fluence 1.8-2.0 J/cm2) performed at 2-week intervals. The treatment procedures were performed in outpatient settings. One treatment session lasts 15-20 min. Subjective (questionnaires) and objective (polygraph) outcome measures were assessed at baseline and 3 months after the final laser treatment. Wilcoxon Signed Rank was used to compare before and after scores. All polygraph variables showed some improvement 3 months after the end of treatment; however, only the reduction of the number of hypopnea episodes per hour was statistically significant (p = 0.034). In 13/24 patients, snoring time accounted for less than 5% of the sleep time after the treatment compared to 6/24 patients at baseline. The questionnaire survey showed statistically significant improvement in the quality of sleep and life of the patients as well as their partners after Er:YAG treatment (p < 0.001). The assessment of daytime sleepiness using the Epworth scale also improved 3 months after the end of treatment (p = 0.010). Based on our observations, the treatment of snoring with the Er:YAG laser is an effective and non-invasive therapeutic method. Further studies with long-term follow-up and a control group are warranted to confirm the promising results obtained in case series. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to describe a model of palliative rehabilitation for newly diagnosed advanced cancer patients and present data on how it was utilised during a randomised controlled trial (RCT).Methods: We designed a highly flexible, multidisciplinary model of palliative rehabilitation consisting of a "basic offer" and tailored elements. The model was evaluated in the setting on an RCT investigating the effect of systematic referral to a palliative rehabilitation clinic concurrently with standard oncology treatment or standard treatment alone. The basic offer of palliative rehabilitation was two consultations and a 12-week possibility of contacting a palliative rehabilitation team, if needed. In addition, patients and family caregivers could be offered participation in a 12-week patient/caregiver school combined with individually tailored physical exercise in groups, individual consultations, or both. Contacts with the palliative rehabilitation team and participant evaluation were registered prospectively.Results: Between December 2014 and December 2017, 132 adults with newly diagnosed advanced cancer were seen in the palliative rehabilitation outpatient clinic. Twenty percent of the participants received the basic offer only (n = 26), 45% additionally participated in the group program (n = 59), and 35% received supplementary individual consultations without participating in the group program (n = 47). The intervention was primarily led by nurses, and the main themes of the individual consultations were coping, pain, and nutrition. When asked if they would recommend the intervention to others in the same situation, 93% of the respondents agreed, 7% partly agreed, and no one disagreed.Conclusion: The new model of palliative rehabilitation presented here had a flexibility to meet the needs of the participants and led to a very high degree of patient satisfaction. It could serve as an inspiration to other cancer centres wanting to integrate palliative care into standard oncology services. [ABSTRACT FROM AUTHOR]

The efficiency evaluation model of integrated energy system, involving many influencing factors, and the attribute values are heterogeneous and non-deterministic, usually cannot give specific numerical or accurate probability distribution characteristics, making the final evaluation result deviation. According to the characteristics of the integrated energy system, a hybrid multi-attribute decision-making model is constructed. The evaluation model considers the decision maker's risk preference. In the evaluation of the efficiency of the integrated energy system, the evaluation value of some evaluation indexes is linguistic value, or the evaluation value of the evaluation experts is not consistent. These reasons lead to ambiguity in the decision information, usually in the form of uncertain linguistic values and numerical interval values. In this paper, the risk preference of decision maker is considered when constructing the evaluation model. Interval-valued multiple-attribute decision-making method and fuzzy linguistic multiple-attribute decision-making model are proposed. Finally, the mathematical model of efficiency evaluation of integrated energy system is constructed. [ABSTRACT FROM AUTHOR]

Delivering well-coordinated care is essential for optimizing clinical outcomes, enhancing patient care experiences, minimizing costs, and increasing provider satisfaction. The Veterans Health Administration (VA) has built a strong foundation for internally coordinating care. However, VA faces mounting internal care coordination challenges due to growth in the number of Veterans using VA care, high complexity in Veterans' care needs, the breadth and depth of VA services, and increasing use of virtual care. VA's Health Services Research and Development service with the Office of Research and Development held a conference assessing the state-of-the-art (SOTA) on care coordination. One workgroup within the SOTA focused on coordination between VA providers for high-need Veterans, including (1) Veterans with multiple chronic conditions; (2) Veterans with high-intensity, focused, specialty care needs; (3) Veterans experiencing care transitions; (4) Veterans with severe mental illness; (5) and Veterans with homelessness and/or substance use disorders. We report on this workgroup's recommendations for policy and organizational initiatives and identify questions for further research. Recommendations from a separate workgroup on coordinating VA and non-VA care are contained in a companion paper. Leaders from research, clinical services, and VA policy will need to partner closely as they develop, implement, assess, and spread effective practices if VA is to fully realize its potential for delivering highly coordinated care to every Veteran. [ABSTRACT FROM AUTHOR]

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation. [ABSTRACT FROM AUTHOR]

Background: Improving care coordination is a key priority for many healthcare systems. However, initiatives to improve care coordination are complex to implement and have produced mixed results. A better understanding of how to craft and support implementation of effective care coordination strategies is needed.Objective: To identify and understand the challenges and factors encountered by Patient-Aligned Care Team (PACT) staff in performing care coordination tasks in outpatient clinics in the Veterans Health Administration (VA).Design: Qualitative study using semi-structured formative evaluation interviews.Participants: Fourteen interviews with 18 clinical frontline managers and staff from 12 clinic sites across five VA health systems.Interventions: This paper reports on baseline data collected for the Coordination Toolkit and Coaching (CTAC) project. CTAC aims to improve patients' experience of care coordination within VA primary care and between PACT and other outpatient and community settings.Approach: We conducted pre-implementation telephone interviews with frontline managers and staff, primarily nurse managers.Key Results: PACT staff described challenges in aligning care coordination priorities across different levels of the VA system, including staff, patients, and leadership. Additionally, PACT staff noted challenges coordinating care both within and outside the VA, and identified resource barriers impeding their care coordination efforts. To address these challenges, staff made several recommendations for improvement, including (1) contingency staffing to address staff burnout; (2) additional PACT training for new staff; (3) clarification of care coordination roles and responsibilities; and (4) and care coordination initiatives that align both with centrally initiated care coordination programs and frontline needs.Conclusion: In the VA and similarly complex healthcare systems, our findings suggest the need for care coordination strategies that are buttressed by a system-level vision for care coordination, backed up by clear roles and responsibilities for information exchange between primary care staff and other settings, and multidimensional accountability metrics that encompass patient-, staff-, and system-level goals. [ABSTRACT FROM AUTHOR]

Purpose: Measure Yourself Concerns and Wellbeing (MYCaW) is a validated person-centred measure of the concerns and wellbeing of people affected by cancer. Research suggests that the concerns of informal caregivers (ICs) are as complex and severely rated as people with cancer, yet MYCaW has only been used to represent cancer patients' concerns and wellbeing. This paper reports on the development of a new qualitative coding framework for MYCaW to capture the concerns of ICs, to better understand the needs of this group.Methods: This multicentred study involved collection of data from ICs receiving support from two UK cancer support charities (Penny Brohn UK and Cavendish Cancer Care). Qualitative codes were developed through a detailed thematic analysis of ICs' stated concerns.Results: Thematic analysis of IC questionnaire data identified key themes which were translated into a coding framework with two overarching sections; (1) 'informal caregiver concerns for self' and (2) 'informal caregiver concerns for the person with cancer'. Supercategories with specific accompanying codes were developed for each section. Two further rounds of framework testing across different cohorts allowed for iterative development and refinement of the framework content.Conclusions: This is the first person-centred tool specifically designed for capturing IC's concerns through their own words. This coding framework will allow for IC data to be analysed using a rigorous and reproducible method, and therefore reported in a standardised way. This may also be of interest to those exploring the needs of ICs of people in other situations. [ABSTRACT FROM AUTHOR]

Background: GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results.Methods: Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies.Results: Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed.Conclusion: An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy. [ABSTRACT FROM AUTHOR]

In Italy, the evaluation of the internal effectiveness of academic training courses has been substantiated, for over 20 years, in periodical surveys on students' opinions on teaching and related services. The first proposal to homogenize the various measurement methods adopted by the Universities was advanced by the former National Committee for the Evaluation of the University System in 2000 and it was the reference model until 2011, when the first Board of Directors of the National Evaluation of University and Research Agency (ANVUR) took over. The Agency's attempt, within the AVA (Self-assessment, Periodic Evaluation and Accreditation) methodological framework, to enrich and update the survey highlighted a number of critical issues, essentially linked to the ways and times of participation of students, compared to the modalities in which the training offers of the universities are organized. Taking a cue from these critical issues, the purpose of this paper is to propose a new, simpler and more rational evaluation model, which still maintains substantial continuity with the inspiring principles of the past plants, and tries to consolidate the monitoring efforts made by the universities to date. [ABSTRACT FROM AUTHOR]

Herbs used for medical purposes are required to meet high pharmacopoeial quality standards, whereas spices used as additives to dishes and food products do not have to meet such rigorous standards. Therefore, the aim of this paper was to compare medicinal herbs and spices of the same plant species that are applied in different areas with regard to the total phenolic content (TPC) and total antioxidant capacity (TAC) of their methanolic and water extracts. This study showed that the TPC values of both extracts prepared from medicinal herbs and spices as quantified using the Folin-Ciocalteu reagent did not differ significantly; however, the TAC values obtained by the DPPH assays of the methanol and water extracts differed significantly. No such differences were found for the same extracts when the FRAP assay was used for analysis. This study shows that the level of antioxidants is dependent on the plant species and the botanical family. Plants belonging to the Lamiaceae and Asteraceae families are richer in phenolic compounds and have stronger antioxidant potentials than those originating from the Apiaceae family. Multivariate statistical analysis indicates that the majority of medicinal herbs and spices of the same plant species are found in the same cluster. In addition, the extraction solvent was identified as one of the factors influencing the clustering of the plants on the PCA scatterplot and CA dendrogram. [ABSTRACT FROM AUTHOR]

Local anesthetics (LAs) are known to act on membrane level; however, the molecular mechanism of their activity is still not fully understood. One hypothesis holds that these drugs can incorporate into lipid membrane of nerve cells and in this way change conformation of channel proteins responsible for transport of sodium ions. However, the action of anesthetics is not limited to nerve cells. These drugs also affect other types of cells and organelles, causing severe side effects. In this paper, we applied Langmuir monolayers-as model of cellular membranes-and investigated interactions between selected amide-type local anesthetics (lidocaine prilocaine, mepivacaine and ropivacaine, in the form of hydrochlorides) and lipid components of natural membranes: cholesterol, POPC and cardiolipin (CL) and their mixtures (POPC/cholesterol and POPC/CL/cholesterol), which can serve as simplified models of nerve cell membranes, erythrocytes, and mitochondria. The influence of the drug was monitored by registering the surface pressure (π) as a function of surface area per molecule (A) in a monolayer in the presence of the drug in the subphase. The structure of lipid monolayers on subphases containing and devoid of the studied drugs were visualized with Brewster angle microscopy (BAM). Langmuir monolayer studies complemented with surface visualization technique reveal the expansion and fluidization of lipid monolayers, with the most pronounced effect observed for cardiolipin. In mixed systems, the effect of LAs was found to depend on cholesterol proportion. The observed fluidization of membranes by local anesthetics may negatively affect cells functioning and therefore can explain side effects of these drugs both on the cardiovascular and nervous systems. [ABSTRACT FROM AUTHOR]

Purpose: Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.Methods: A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.Results: The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.Conclusions: Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly. [ABSTRACT FROM AUTHOR]

This study aimed to test how different QT interval variability (QTV) indices change in patients with coronary artery disease (CAD) and congestive heart failure (CHF). Twenty-nine healthy volunteers, 29 age-matched CAD patients, and 20 age-matched CHF patients were studied. QT time series were derived from 5-min resting lead-II electrocardiogram (ECG). Time domain indices [mean, SD, and QT variability index (QTVI)], frequency-domain indices (LF and HF), and nonlinear indices [sample entropy (SampEn), permutation entropy (PE), and dynamical patterns] were calculated. In order to account for possible influence of heart rate (HR) on QTV, all the calculations except QTVI were repeated on HR-corrected QT time series (QTc) using three correction methods (i.e., Bazett, Fridericia, and Framingham method). Results showed that CHF patients exhibited increased mean, increased SD, increased LF and HF, decreased T-wave amplitude, increased QTVI, and decreased PE, while showed no significant changes in SampEn. Interestingly, CHF patients also showed significantly changed distribution of the dynamical patterns with less monotonously changing patterns while more fluctuated patterns. In CAD group, only QTVI was found significantly increased as compared with healthy controls. Results after HR correction were in common with those before HR correction except for QTc based on Bazett correction. Graphical abstract Fig. The framework of this paper. The arrows show the sequential analysis of the data. [ABSTRACT FROM AUTHOR]

TiO2 scaffolds have previously shown to have promising osteoconductive properties in previous in vivo experiments. Appropriate mechanical stimuli can further promote this osteoconductive behaviour. However, the complex mechanical environment and the mechanical stimuli enhancing bone regeneration for porous bioceramics have not yet been fully elucidated. This paper aims to compare and evaluate mechanical environment of TiO2 scaffold with three commercial CaP biomaterials, i.e. Bio-Oss, Cerabone and Maxresorb under simulated perfusion culture conditions. The solid phase and fluid phase were modelled as linear elastic material and Newtonian fluid, respectively. The mechanical stimulus was analysed within these porous scaffolds quantitatively. The results showed that the TiO2 had nearly heterogeneous stress distributions, however lower effective Young's modulus than Cerabone and Maxresorb. The permeability and wall shear stress (WSS) for the TiO2 scaffold was significantly higher than other commercial bone substitute materials. Maxresorb and Bio-Oss showed lowest permeability and local areas of very high WSS. The detailed description of the mechanical performance of these scaffolds could help researchers to predict cell behaviour and to select the most appropriate scaffold for different in vitro and in vivo performances. Graphical abstract Schematic representation of the establishment procedure. Take the establishment process of Cerabone as an example. Left shows a slice of micro-CT image from Cerabone, and 1.5 mm × 1.5 mm region of interest was shown in the red box. A 1.5-mm3 cube was cut out by Boolean operation in Mimics (Materialise, Belgium), and the cubic model was remeshed in 3-Matic 6.0 (Materialise, Belgium). The cubic model is shown in blue, and the empty space in red. [ABSTRACT FROM AUTHOR]

Introduction: Adverse drug event (ADE) detection is a vital step towards effective pharmacovigilance and prevention of future incidents caused by potentially harmful ADEs. The electronic health records (EHRs) of patients in hospitals contain valuable information regarding ADEs and hence are an important source for detecting ADE signals. However, EHR texts tend to be noisy. Yet applying off-the-shelf tools for EHR text preprocessing jeopardizes the subsequent ADE detection performance, which depends on a well tokenized text input.Objective: In this paper, we report our experience with the NLP Challenges for Detecting Medication and Adverse Drug Events from Electronic Health Records (MADE1.0), which aims to promote deep innovations on this subject. In particular, we have developed rule-based sentence and word tokenization techniques to deal with the noise in the EHR text.Methods: We propose a detection methodology by adapting a three-layered, deep learning architecture of (1) recurrent neural network [bi-directional long short-term memory (Bi-LSTM)] for character-level word representation to encode the morphological features of the medical terminology, (2) Bi-LSTM for capturing the contextual information of each word within a sentence, and (3) conditional random fields for the final label prediction by also considering the surrounding words. We experiment with different word embedding methods commonly used in word-level classification tasks and demonstrate the impact of an integrated usage of both domain-specific and general-purpose pre-trained word embedding for detecting ADEs from EHRs.Results: Our system was ranked first for the named entity recognition task in the MADE1.0 challenge, with a micro-averaged F1-score of 0.8290 (official score).Conclusion: Our results indicate that the integration of two widely used sequence labeling techniques that complement each other along with dual-level embedding (character level and word level) to represent words in the input layer results in a deep learning architecture that achieves excellent information extraction accuracy for EHR notes. [ABSTRACT FROM AUTHOR]

Oxazolidine derivatives (OxD) are five ring-membered compounds that contain at least one oxygen and nitrogen in their molecular structure. OxD are known due to several therapeutic activities such as anticancer and antibiotic properties. In this paper, we performed a thermodynamic analysis of the mixed films composed by dipalmitoylphosphatidylglycerol (DPPG), dipalmitoylphosphoethanolamine (DPPE), dipalmitoyl phosphatidylcholine (DPPC) or L-α phosphatidylcholine (PC) with a novel oxazolidine derivate (OxD). Relevant thermodynamic parameters such as excess areas (ΔAE), excess free energies (ΔG), and Gibbs free energy of mixing (AGmix) were derived from the surface pressure data. The topographical analysis was performed using atomic force microscopy. Based on the calculated values of the thermodynamic parameters, we observed that the miscibility of the mixed films was directly dependent on their composition. DPPG/OxD and DPPE/OxD systems present the best-mixed character at low pressures at OxD molar fraction equivalent to 0.25. [ABSTRACT FROM AUTHOR]