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Transportation agencies routinely make repair decisions in numerous contexts which include the timing of different repair treatments over an extended period. The timing policy may be characterized either by a standalone manner that maximizes the outcome or utility of individual treatments at a given time, or by a holistic manner that maximizes the utility of all treatments together within a given horizon period. This study begins with a hypothesis that the effect of the sum of treatment prescriptions may be different from the sum of the effect of individual treatment prescriptions. The paper discusses separate practical applications where each of these two situations is pertinent. The study is based on the use of surface roughness as the indicator of pavement performance, and therefore, the framework includes the development of treatment-specific treatment performance jump and performance loss models in terms of roughness. The framework also includes identification of the optimal roughness thresholds for each pavement treatment as a standalone activity, followed by a determination of the thresholds for each treatment from a holistic standpoint. The latter involves the establishment of an optimal repair schedule over the pavement life cycle and recording the resulting roughness thresholds at which each treatment is recommended for application within the optimal schedule. Then the paper presents a case study to demonstrate application of the framework, and to compare the optimal-schedule thresholds versus the stand-alone thresholds. The case study involved fourteen treatment types, two surface material types (rigid and flexible) and three road functional classes. The results suggest that in this context of highway management, the optimal triggers associated with individual standalone repair treatments are not necessarily the same (and yield inferior outcomes) compared to the application thresholds of those treatments when they are considered within an optimized life-cycle schedule. The results can provide guidance to agencies as they examine or update their current roughness thresholds for each standard treatment and their long-term condition-based or time-based repair schedules. The paper's framework and results can also help agencies assess the consequences of deviations from a repair timing policy (delayed or hastened applications) due to lack of funds and other causes. [ABSTRACT FROM AUTHOR]

Background Physicians face competing demands of maximizing pathogen coverage while minimizing unnecessary use of broad-spectrum antibiotics when managing sepsis. We sought to identify physicians' perceived likelihood of coverage achieved by their usual empiric antibiotic regimen, along with minimum thresholds of coverage they would be willing to accept when managing these patients. Methods We conducted a scenario-based survey of internal medicine physicians from across Canada using a 2 × 2 factorial design, varied by infection source (undifferentiated vs genitourinary) and severity (mild vs severe) denoted by the Quick Sequential Organ Failure Assessment (qSOFA) score. For each scenario, participants selected their preferred empiric antibiotic regimen, estimated the likelihood of coverage achieved by that regimen, and considered their minimum threshold of coverage. Results We had 238 respondents: 87 (36.6%) residents and 151 attending physicians (63.4%). The perceived likelihood of antibiotic coverage and minimum thresholds of coverage (with interquartile range) for each scenario were as follows: (1) severe undifferentiated, 90% (89.5%–95.0%) and 90% (80%–95%), respectively; (2) mild undifferentiated, 89% (80%–95%) and 80% (70%–89.5%); (3) severe genitourinary, 91% (87.3%–95.0%) and 90% (80.0%–90.0%); and (4) mild genitourinary, 90% (81.8%–91.3%) and 80% (71.8%–90%). Illness severity and infectious disease specialty predicted higher thresholds of coverage whereas less clinical experience and lower self-reported prescribing intensity predicted lower thresholds of coverage. Conclusions Pathogen coverage of 80% and 90% are physician-acceptable thresholds for managing patients with mild and severe sepsis from bacterial infections. These data may inform clinical guidelines and decision-support tools to improve empiric antibiotic prescribing. [ABSTRACT FROM AUTHOR]

A recent study by Jeong et al. (2023) demonstrates a puzzling disparity in self-reported sea lice data between Norwegian and Canadian fish farmers. The authors investigate the ratio of reported adult female lice to total mobile lice abundance and find a striking "cliff effect" in the Norwegian data around the maximum permissible sea lice threshold. It is suggested that intentional or unintentional under-reporting is a major reason for the observed effect. In this correspondence, we argue that the observed effect actually reflects an inherent population dynamic characteristic, arising from the frequency of delousing operations in Norwegian farms. [ABSTRACT FROM AUTHOR]

A popular framing of Goodhart's Law states, "When a measure become a target, it ceases to be a good measure". The extent to which this may be the case in the reporting of sea louse infestation on salmon farms is explored here. Due to the importance of controlling sea louse infestation on salmon farms, monitoring programmes are active in most salmon producing regions and, in many, a maximum allowable sea louse level is specified. Using publicly accessible data from Norway and BC, Canada, this study investigated the extent to which the framing of these programmes, in particular the specification of low threshold levels, may be affecting the veracity of the reported sea louse infestation data. In BC, where the threshold level is set to 3 mobile Lepeophtheirus salmonis little evidence of anomalous patterns in the data and the overall proportion of females within the adult sea lice population is around 0.43. By contrast, in Norway where lower sea louse limits are in place (at either 0.5 or 0.2 adult female L. salmonis), there is evidence of unexpected and sharp reductions in the abundance of adult females reported around these threshold values. In addition, the average proportion of females is estimated to be only around 0.20 of the total adult L. salmonis population. The unexpected observations in the data were much more evident for farms in the southern areas of Norway and over the most recent years. These findings appear to support the case that the measurement of sea lice on salmon farms can be significantly influenced by targets (particularly those which are highly demanding), and that as such, researchers and fish health professionals should be aware of potential biases within these data. In addition, regulators should carefully consider the unintended consequences of setting certain sea louse thresholds and the ways in which the potential to effectively review data quality and accuracy may be impacted by the choice of sea louse stage(s) that are reported. • Reported proportions of adult female sea lice varied markedly by region. • In Norway, abrupt changes in proportion of adult female L. salmonis occurred. • Sharp fluctuations in abundance occurred around regulated sea lice target levels. • Anomalies were not observed where more attainable sea lice targets were in place. [ABSTRACT FROM AUTHOR]

The definition of osteoporosis has always been challenging. Historically the clinical definition could only be based on the presence or occurrence of an osteoporotic fracture. However waiting for a fracture to occur before making a diagnosis has limitations, not least that high risk individuals cannot be identified for treatment prior to fracture. With the availability of bone density measurements, the definition moved to the use of T-scores. Whilst widely used, this approach has limitations that include low sensitivity and not taking into account other variables that influence bone strength and extra-skeletal risk factors. In view of the limitations of using T scores in isolation, there has been a move towards assessment of individualised risk that incorporates multiple risk factors (with or without bone density measurement) to help predict future fracture risk. This approach potentially allows identification and treatment of individuals at high risk of fracture, the condition that needs to be treated as opposed to treating low bone density. Indeed bone density (where measured) becomes one of the many risk factors without a threshold interpretation for any given value. Numerous tools are available that have varying sensitivity, specificity, utility, applicability to, and that have been validated for any given population. Of the available tools, the World Health Organisation Fracture Risk Assessment Tool (FRAX) calculator has been extensively studied. It is available more widely, with country specific utility with and without bone density measurements, which is important in regions with scarce access to bone densitometry. FRAX is the only tool available that is India specific. [ABSTRACT FROM AUTHOR]

Introduction Many people at high risk of fractures are not following traditional guidelines and not being recommended for intervention. This study aimed to propose and evaluate a new set of intervention thresholds. Methods Participants were 213,375 men and women aged ≥ 50 years living in New South Wales, Australia. Fracture Risk Assessment Paper Charts (Australia) was used to estimate the 10-year fracture risk. The standardized rates (to Australia population distribution 2007) for intervention were calculated for different thresholds: our proposed new thresholds (i.e. 10-year probability of hip fracture: ≥ 3%, 5% or 7% for 50–69, 70–79 and ≥ 80 years respectively), thresholds by the National Osteoporosis Guideline Group (NOGG) approach, UK thresholds and US thresholds. Results The NOGG, UK and US thresholds did not work well in the Australian population. For example, the NOGG and UK thresholds respectively qualified only 1 in 12 (8.1%) and 1 in 9 (11.3%) Australian men aged ≥ 70 years and the US thresholds qualified about 9 in 10 (90.6%) Australian women aged ≥ 70 years. For men or women aged ≥ 70 years, our proposed new thresholds gave more realistic treatment rates of 21.6% for men and 70.5% for women. Compared to the current Australian guidelines (i.e. T-score ≤ − 2.5 and age ≥ 70 years or a fragility fracture), our thresholds identified an additional 4.9% of men and 18.2% of women aged ≥ 70 years for treatment. Conclusion The proposed new thresholds could identify currently under-recognised high-risk individuals for treatment. It should be considered as a recommendation for osteoporosis management in Australia. [ABSTRACT FROM AUTHOR]

Introduction: Current Slovak treatment thresholds in osteoporosis are based on bone mineral density (BMD) or a previous fracture. Some patients at high risk for fractures may not be identified. FRAX (Fracture Risk Assessment Tool) is based on patient risk profile assessment and calculates 10-year fracture risks. Using FRAX, treatment initiation could be more patient-specific. Aim of study: To evaluate the risk profile with FRAX in slovak postmenopausal women, to identify those at high risk of fracture according to NOF (National Osteporosis Foundation) intervention thresholds based on FRAX and to compare this approach to current treatment thresholds. Methods: We measured BMD at lumbar spine, femoral neck, total hip and calculated 10-year absolute fracture risks with the slovak version of FRAX in 365 patients. Results: Average risk of major osteoporotic fracture was 10,39% and hip fracture 3,00%. 109 patients were eligible for treatment according to actual treatment criteria (88 based on BMD and 21 with previous fracture). In addition, 57 high risk osteopenic patients were identified by NOF thresholds using FRAX, who should be also considered for treatment. Conclusion: Using FRAX and NOF thresholds it's possible to identify high risk patients who don't fulfill current treatment criteria but may profit from treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Increased chronic therapy use and improved cystic fibrosis (CF) patient health should be accompanied by reduced pulmonary exacerbation-associated antibiotic treatment incidence. Methods: Treatment incidence rates and associated sign/symptom scores from 1995–2005 were studied in Epidemiologic Study of CF patients by route (±IV) and age (<6, 6–12, 13–17, ≥18years). Results: Overall treatment incidence rate fell 0.0165 events/patient-year/year (P =.006); IV incidence fell 0.0179 (P <.001). Non-IV incidence increased in children ≤12years (P ≤.002) while significantly decreasing in older patients. Mean IV (P =.046) and non-IV (P =.004) treatment-associated clinical scores decreased in children <6years. Non-IV (but not IV) clinical scores decreased in older patients. Conclusions: IV incidence fell for all ages from 1995–2005; non-IV incidence increased in patients ≤12years and fell in others. Average clinical treatment thresholds fell in children <6years; IV thresholds were unchanged in older patients; non-IV thresholds fell for patients ≥13years. Decreases in treatment incidence were likely partially offset by lower treatment thresholds. [Copyright &y& Elsevier]

Summary The problem of managing demand: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. Technique for managing demand: The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. Conclusion: The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure wilt be at the expense of clinical outcomes and unmet need, which wilt perpetuate financial crises. [ABSTRACT FROM AUTHOR]

The implicit valuations which dentists place on the outcomes of their treatment decisions may be a major contributory factor in dentists' decisions about when to restore teeth. This study sought to examine the relationship between dentists treatment attitudes and restorative dental treatment decision making. A group of 20 dentists were asked to indicate teeth in need of filling from 15 simulated bitewing radiographs. The dentists graded their level of certainty about their treatment decision as "definite", "probable" or "possible". Afterwards, the teeth were sectioned and examined using a microscope in order to determine how far through the tooth the caries had penetrated. The gold standard treatment criterion was that caries extending into the dentine of the tooth would require restoration. Receiver Operator Characteristic (ROC) analysis was used to examine the apparent weighting the dentists were giving to decision errors when planning treatment on the basis of bitewing radiographs. The dentists also completed a treatment attitudes questionnaire to determine their views about the relative importance of false negative and false positive treatment decisions. The results suggest that the most appropriate operating point for most of these dentists to achieve an outcome which matched their views about the relative importance of the two types of treatment error would be the point at which a filling would "definitely" be required. [ABSTRACT FROM AUTHOR]

It has been recognised for many years that treatment decision-making among dentists often shows wide variation. This study sought to examine the effect of dentists stated treatment thresholds as a source of variation between them. Twenty dentists made 360 treatment decisions about the approximal surfaces of extracted teeth seen in simulated bitewing radiographs. They also stated their personal treatment thresholds, i.e. the depth of lesion which they intended to restore. One hundred and ninety pairwise comparisons of treatment decisions showed that only 16% of the dentist pairs showed substantial agreement. Dentist pairs who reported that they held the same interventive threshold achieved exactly the same mean level of agreement in treatment decision-making as dentist pairs who disagreed about the appropriate threshold for restorative intervention. The study suggests that restorative thresholds which are reported to be used by dentists may he poorly correlated with the number of positive treatment decisions actually made. [ABSTRACT FROM AUTHOR]