WorldWideScience

Sample records for baseline treatment preference

  1. Treatment preference in hypochondriasis.

    Science.gov (United States)

    Walker, J; Vincent, N; Furer, P; Cox, B; Kjernisted, K

    1999-12-01

    Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early stages of evaluation. Little is known about the treatment preferences and opinions of individuals seeking help for this problem. In this exploratory study, 23 volunteers from the community with a DSM-IV diagnosis of hypochondriasis were recruited through a newspaper advertisement. Participants were presented with a survey which included balanced descriptions of both a medication and a cognitive-behavioral treatment for intense illness concerns (hypochondriasis). The brief descriptions of the treatments discussed the time commitment required as well as the major advantages and disadvantages of each. Results showed that, relative to medication treatment, cognitive-behavioral treatment was predicted to be more effective in both the short and long terms and was rated as more acceptable. Psychological treatment was indicated as the first choice by 74% of respondents, medication by 4%, and 22% indicated an equal preference. Forty-eight percent of respondents would only accept the psychological treatment.

  2. Hazard Baseline Downgrade Effluent Treatment Facility

    International Nuclear Information System (INIS)

    Blanchard, A.

    1998-01-01

    This Hazard Baseline Downgrade reviews the Effluent Treatment Facility, in accordance with Department of Energy Order 5480.23, WSRC11Q Facility Safety Document Manual, DOE-STD-1027-92, and DOE-EM-STD-5502-94. It provides a baseline grouping based on the chemical and radiological hazards associated with the facility. The Determination of the baseline grouping for ETF will aid in establishing the appropriate set of standards for the facility

  3. Global Nuclear Energy Partnership Waste Treatment Baseline

    International Nuclear Information System (INIS)

    Gombert, Dirk; Ebert, William; Marra, James; Jubin, Robert; Vienna, John

    2008-01-01

    The Global Nuclear Energy Partnership (GNEP) program is designed to demonstrate that a proliferation-resistant and sustainable integrated nuclear fuel cycle can be commercialized and used internationally. Alternative stabilization concepts for byproducts and waste streams generated by fuel recycling processes were evaluated and a baseline set of waste forms was recommended for the safe disposition of waste streams. Specific waste forms are recommended based on the demonstrated or expected commercial practicability and technical maturity of the processes needed to make the waste forms, and expected performance of the waste form materials when disposed. Significant issues remain in developing technologies to process some of the wastes into the recommended waste forms, and a detailed analysis of technology readiness may lead to the choice of a different waste form than what is recommended herein. Evolving regulations could also affect the selection of waste forms. (authors)

  4. Global Nuclear Energy Partnership Waste Treatment Baseline

    Energy Technology Data Exchange (ETDEWEB)

    Gombert, Dirk; Ebert, William; Marra, James; Jubin, Robert; Vienna, John [Idaho National laboratory, 2525 Fremont Ave., Idaho Falls, ID 83402 (United States)

    2008-07-01

    The Global Nuclear Energy Partnership (GNEP) program is designed to demonstrate that a proliferation-resistant and sustainable integrated nuclear fuel cycle can be commercialized and used internationally. Alternative stabilization concepts for byproducts and waste streams generated by fuel recycling processes were evaluated and a baseline set of waste forms was recommended for the safe disposition of waste streams. Specific waste forms are recommended based on the demonstrated or expected commercial practicability and technical maturity of the processes needed to make the waste forms, and expected performance of the waste form materials when disposed. Significant issues remain in developing technologies to process some of the wastes into the recommended waste forms, and a detailed analysis of technology readiness may lead to the choice of a different waste form than what is recommended herein. Evolving regulations could also affect the selection of waste forms. (authors)

  5. Global Nuclear Energy Partnership Waste Treatment Baseline

    Energy Technology Data Exchange (ETDEWEB)

    Dirk Gombert; William Ebert; James Marra; Robert Jubin; John Vienna

    2008-05-01

    The Global Nuclear Energy Partnership program (GNEP) is designed to demonstrate a proliferation-resistant and sustainable integrated nuclear fuel cycle that can be commercialized and used internationally. Alternative stabilization concepts for byproducts and waste streams generated by fuel recycling processes were evaluated and a baseline of waste forms was recommended for the safe disposition of waste streams. Waste forms are recommended based on the demonstrated or expected commercial practicability and technical maturity of the processes needed to make the waste forms, and performance of the waste form materials when disposed. Significant issues remain in developing technologies to process some of the wastes into the recommended waste forms, and a detailed analysis of technology readiness and availability may lead to the choice of a different waste form than what is recommended herein. Evolving regulations could also affect the selection of waste forms.

  6. Treatment preferences in Parkinson's disease

    NARCIS (Netherlands)

    Weernink, Marieke Geertruida Maria

    2017-01-01

    The objective of this dissertation was to investigate the influence of process-utility (which is the value attached to the process and convenience of care without reference to the outcome) on the relative value of treatments in Parkinson’s Disease (PD). The main treatment modalities (processes) in

  7. Network meta-analysis of disconnected networks: How dangerous are random baseline treatment effects?

    Science.gov (United States)

    Béliveau, Audrey; Goring, Sarah; Platt, Robert W; Gustafson, Paul

    2017-12-01

    In network meta-analysis, the use of fixed baseline treatment effects (a priori independent) in a contrast-based approach is regularly preferred to the use of random baseline treatment effects (a priori dependent). That is because, often, there is not a need to model baseline treatment effects, which carry the risk of model misspecification. However, in disconnected networks, fixed baseline treatment effects do not work (unless extra assumptions are made), as there is not enough information in the data to update the prior distribution on the contrasts between disconnected treatments. In this paper, we investigate to what extent the use of random baseline treatment effects is dangerous in disconnected networks. We take 2 publicly available datasets of connected networks and disconnect them in multiple ways. We then compare the results of treatment comparisons obtained from a Bayesian contrast-based analysis of each disconnected network using random normally distributed and exchangeable baseline treatment effects to those obtained from a Bayesian contrast-based analysis of their initial connected network using fixed baseline treatment effects. For the 2 datasets considered, we found that the use of random baseline treatment effects in disconnected networks was appropriate. Because those datasets were not cherry-picked, there should be other disconnected networks that would benefit from being analyzed using random baseline treatment effects. However, there is also a risk for the normality and exchangeability assumption to be inappropriate in other datasets even though we have not observed this situation in our case study. We provide code, so other datasets can be investigated. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Women Veterans' Treatment Preferences for Disordered Eating.

    Science.gov (United States)

    Breland, Jessica Y; Donalson, Rosemary; Dinh, Julie; Nevedal, Andrea; Maguen, Shira

    2016-01-01

    Disordered eating, which includes subclinical and clinical maladaptive eating behaviors, is common among women, including those served by the Veterans Health Administration (VA). We used qualitative methods to determine whether and how women veterans want to receive treatment for disordered eating. Women veterans participated in one of seven focus groups/interviews and completed in-person demographic and psychological questionnaires. We used thematic analysis of focus groups/interviews to understand preferences for disordered eating treatment. Participants (n = 20) were mostly women of color (55%); mean age was 48 (SD = 15) and 65% had significant psychological symptoms. Few participants described being assessed for disordered eating, but all thought VA should provide treatment for disordered eating. Through thematic analysis, we identified six preferences: 1) treatment for disordered eating should be provided in groups, 2) treatment for disordered eating should provide concrete skills to facilitate the transition out of structured military environments, 3) treatment for disordered eating should address the relationship between eating and mental health, 4) disordered eating can be treated with mindfulness and cognitive-behavioral therapy, 5) disordered eating treatment providers should be experienced and take an interactive approach to care, but can come from diverse disciplines, and 6) referrals to treatment for disordered eating should be open ended, occur early, and allow for ongoing, flexible access to treatment. Women veterans are interested in treatment for disordered eating. Preferred treatments align with existing treatments, could be offered in conjunction with weight loss or primary care services, and should provide social support and interactive learning. Published by Elsevier Inc.

  9. Treatment preferences of psychotherapy patients with chronic PTSD.

    Science.gov (United States)

    Markowitz, John C; Meehan, Kevin B; Petkova, Eva; Zhao, Yihong; Van Meter, Page E; Neria, Yuval; Pessin, Hayley; Nazia, Yasmin

    2016-03-01

    Patient treatment preference may moderate treatment effect in major depressive disorder (MDD) studies. Little research has addressed preference in posttraumatic stress disorder (PTSD); almost none has assessed actual patients' PTSD psychotherapy preferences. From a 14-week trial of chronic PTSD comparing prolonged exposure, relaxation therapy, and interpersonal psychotherapy, we report treatment preferences of the 110 randomized patients, explore preference correlates, and assess effects on treatment outcome. Patients recruited between 2008 and 2013 with chronic DSM-IV PTSD (Clinician-Administered PTSD Scale [CAPS] score ≥ 50) received balanced, scripted psychotherapy descriptions prerandomization and indicated their preferences. Analyses assessed relationships of treatment attitudes to demographic and clinical factors. We hypothesized that patients randomized to preferred treatments would have better outcomes, and to unwanted treatment worse outcomes. Eighty-seven patients (79%) voiced treatment preferences or disinclinations: 29 (26%) preferred prolonged exposure, 29 (26%) preferred relaxation therapy, and 56 (50%) preferred interpersonal psychotherapy (Cochran Q = 18.46, P psychotherapy (Cochran Q = 22.71, P psychotherapy preferences to outcome. Despite explanations emphasizing prolonged exposure's greater empirical support, patients significantly preferred interpersonal psychotherapy. Preference subtly affected psychotherapy outcome; depression appeared an important moderator of the effect of unwanted treatment on outcome. Potential biases to avoid in future research are discussed. ClinicalTrials.gov identifier: NCT00739765. © Copyright 2015 Physicians Postgraduate Press, Inc.

  10. Hepatitis C treatment response kinetics and impact of baseline predictors

    DEFF Research Database (Denmark)

    Lindh, M; Arnholm, B; Eilard, A

    2011-01-01

    Summary. The optimal duration of treatment for hepatitis C virus (HCV) infections is highly variable but critical for achieving cure (sustained virological response, SVR). We prospectively investigated the impact of age, fibrosis, baseline viraemia and genotype on the early viral kinetics...... above 400 000 IU/mL were strongly associated with slower second phase declines of HCV RNA. Genotype 2/3 infections responded more rapidly than genotype 1, reaching week 4 negativity (RVR) in 59%vs 22%. We conclude that baseline response predictors such as age, fibrosis and viral load were well reflected...... by the early viral kinetics as assessed by repeated HCV RNA quantifications. The kinetic patterns and the high relapse rate in genotype 2/3 patients without RVR suggest that this group might benefit from treatment durations longer than 24 weeks....

  11. Depression Treatment Preferences in Older Primary Care Patients

    Science.gov (United States)

    Gum, Amber M.; Arean, Patricia A.; Hunkeler, Enid; Tang, Lingqi; Katon, Wayne; Hitchcock, Polly; Steffens, David C.; Dickens, Jeanne; Unutzer, Jurgen

    2006-01-01

    Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older…

  12. Treatment of bone metastases with palliative radiotherapy: Patients' treatment preferences

    International Nuclear Information System (INIS)

    Szumacher, Ewa; Llewellyn-Thomas, Hillary; Franssen, Edmee; Chow, Edward; Boer, Gerrit de; Danjoux, Cyril; Hayter, Charles; Barnes, Elizabeth; Andersson, Lourdes

    2005-01-01

    Purpose: To determine the proportion of patients undergoing palliative radiotherapy (RT) for bone pain who would like to participate in the decision-making process, and to determine their choice of palliative RT regimen (2000 cGy in five fractions vs. 800 cGy in one fraction) for painful bone metastases. Methods and Materials: Eligible patients were approached and all patients agreeing to participate provided written informed consent. Patients' decisional preferences were studied using a five-statement preference instrument. A decision board was used to help patients decide their preferred palliative RT regimen. Factors influencing patients' choices were studied using a visual analog scale. Results: A total of 101 patients were enrolled in the study (55 women and 46 men). The preferences for decision-making were as follows: 30 active, 47 collaborative, and 24 passive. Most (55 [76%] of 72) patients favored one fraction of palliative RT (95% confidence interval, 65-86%). Patients were more likely to select the 800 cGy in one fraction because of the convenience of the treatment plan (odds ratio, 1.024; 95% confidence interval, 1.004-1044) but were less likely to choose it because of the chance of bone fracture (odds ratio, 0.973; 95% confidence interval, 0.947-1.000) compared with 2000 cGy in five fractions. Conclusion: Most participating patients preferred to decide either by themselves or with the radiation oncologists which treatment option they preferred. An 800-cGy-in-one-fraction regimen was favored, independent of the treated site. The convenience of the treatment plan and the likelihood of bone fracture were the most important factors influencing patients' choice

  13. Clinician preferences and the estimation of causal treatment differences

    OpenAIRE

    Korn, Edward L.; Baumrind, Sheldon

    1998-01-01

    Clinician treatment preferences affect the ability to perform randomized clinical trials and the ability to analyze observational data for treatment effects. In clinical trials, clinician preferences that are based on a subjective analysis of the patient can make it difficult to define eligibility criteria for which clinicians would agree to randomize all patients who satisfy the criteria. In addition, since each clinician typically has some preference for the choice of treatment for a given ...

  14. Treatment preferences of patients with binge eating disorder.

    Science.gov (United States)

    Brody, Michelle L; Masheb, Robin M; Grilo, Carlos M

    2005-05-01

    The current study examined the treatment preferences of obese patients with binge eating disorder (BED). Participants were 103 consecutive patients with BED who responded to advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." In addition to completing comprehensive assessment batteries, participants were provided descriptions of cognitive-behavioral therapy (CBT) and behavioral weight loss therapy (BWL) after which they were asked to choose and rate their preferred treatment. Sixty-three percent of participants stated they preferred CBT. Treatment preferences were not associated with (1) histories of obesity, dieting, binge eating, or weight cycling, (2) current obesity or eating disorder features, or (3) psychological features such as depression or self-esteem levels. In contrast, participants' stated treatment preferences were aligned with their perception of their primary problem (eating disorder vs. obesity) and their primary goals for treatment (stop binge eating vs. lose weight). The patients who preferred CBT based their treatment selection more on their problem perception than on their primary treatment goal, whereas the patients who preferred BWL selected treatment based more on their primary treatment goal (weight loss) than on their problem perception. Obese patients with BED express treatment preferences that are not associated with variability in their clinical characteristics but are aligned with their perception of their primary problem and with their primary goals for treatment. Copyright 2005 by Wiley Periodicals, Inc

  15. Autonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome.

    Science.gov (United States)

    Carter, Jacqueline C; Kelly, Allison C

    2015-03-01

    This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment. Another limitation is that this was a correlational study and it is therefore important

  16. Patient preferences in the treatment of diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Wirostko B

    2011-05-01

    Full Text Available Barbara Wirostko1, Kathleen Beusterien2, Jessica Grinspan2, Thomas Ciulla3, John Gonder4, Alexandra Barsdorf1, Andreas Pleil51Pfizer, New York, NY, USA; 2Oxford Outcomes, Bethesda, MD, USA; 3Midwest Eye Institute, Indianapolis, IN, USA; 4Ivey Eye Institute, London, Ontario, Canada; 5Pfizer Inc, San Diego, CA, USAObjective: Accounting for patient preferences may be especially important in diabetes mellitus, given the challenge in identifying factors associated with treatment adherence. Although preference studies have been performed in diabetes, none have examined treatments used in diabetic retinopathy (DR. The objective of this study was to elicit patient preferences for attributes associated with antivascular endothelial growth factor, focal and panretinal laser, and steroid therapy used in DR management.Methods: A cross-sectional conjoint survey was administered to DR patients at three Canadian eye centers. The survey involved making tradeoffs among 11 DR treatment attributes, including the chance of improving vision and risks of adverse events over a 1-year treatment period. Attribute utilities were summed for each product profile to determine the most preferred treatment.Results: Based on the results from 161 patients, attributes affecting visual functioning, including improving visual acuity and reducing adverse events (eg, chance of cataracts, were more important than those not directly affecting vision (eg, administration. Overall, 52%, 20%, 17%, and 11% preferred the product profiles matching to the antivascular endothelial growth factor, steroid, focal laser, and panretinal laser therapies. Preferences did not vary substantially by previous treatment experience, age, or type of DR (macular edema, proliferative DR, both or neither, with the exception that more macular edema only patients preferred focal laser over steroid treatment (19% versus 14%, respectively.Conclusions: When considering the potential effects of treatment over a 1

  17. Veteran preferences for romantic partner involvement in depression treatment.

    Science.gov (United States)

    Hershenberg, Rachel; Mavandadi, Shahrzad; Klaus, Johanna R; Oslin, David W; Sayers, Steven L

    2014-01-01

    The objective was to examine Veterans' preferences for romantic partner involvement in depression treatment and patient characteristics that are associated with the likelihood of preferred involvement. One hundred seventy-nine Veterans who met criteria for major or minor depression reported if they wanted their partners to give them medication reminders, accompany them to appointments, and speak with their treatment provider. Greater depression severity and wanting a partner to be less critical and more encouraging were associated with greater preferences for involvement. Veterans may view their partners' involvement in depression treatment as one opportunity for partners to decrease blame or understand more about their problems. Published by Elsevier Inc.

  18. Preferences for 'New' Treatments Diminish in the Face of Ambiguity.

    Science.gov (United States)

    Harrison, Mark; Marra, Carlo A; Bansback, Nick

    2017-06-01

    New products usually offer advantages over existing products, but in health care, most new drugs are 'me-too', comparable in effectiveness and side effects to existing drugs, but with a more ambiguous evidence base around adverse effects. Despite this, new treatments drive increased health care spending, suggesting a preference for 'newness' in this setting. We explore (1) whether preferences for treatments labeled 'new' exist and (2) persist once the ambiguity in the evidence base reflecting newness is described. We use a Canadian general population sample (n = 2837) characterized by their innovativeness in adopting new products in normal markets. We found that innovators/early adopters (n = 173) had significant preferences for 'newer' treatments (B = 0.162, p = 0.038) irrespective of comparable benefits and side effects and all respondents had significant preferences for less ambiguity in benefit/side effect estimates. Notably, when 'newness' was combined with ambiguity, no significant preferences for new treatments were observed regardless of respondent innovativeness. We conclude that preferences for new products exist for some people in health care markets but disappear when the implication of ambiguity in the evidence base for new treatments is communicated. Physicians should avoid describing treatments as 'new' or be mindful to qualify the implications of 'new' treatments in terms of evidence ambiguity. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Preference for pharmaceutical formulation and treatment process attributes

    Directory of Open Access Journals (Sweden)

    Stewart KD

    2016-07-01

    Full Text Available Katie D Stewart,1 Joseph A Johnston,2 Louis S Matza,1 Sarah E Curtis,2 Henry A Havel,3 Stephanie A Sweetana,3 Heather L Gelhorn1 1Outcomes Research, Evidera, Bethesda, MD, USA; 2Global Patient Outcomes & Real World Evidence, 3Small Molecule Design and Development, Eli Lilly & Company, Indianapolis, IN, USA Purpose: Pharmaceutical formulation and treatment process attributes, such as dose frequency and route of administration, can have an impact on quality of life, treatment adherence, and disease outcomes. The aim of this literature review was to examine studies on preferences for pharmaceutical treatment process attributes, focusing on research in diabetes, oncology, osteoporosis, and autoimmune disorders.Methods: The literature search focused on identifying studies reporting preferences for attributes of the pharmaceutical treatment process. Studies were required to use formal quantitative preference assessment methods, such as utility valuation, conjoint analysis, or contingent valuation. Searches were conducted using Medline, EMBASE, Cochrane Library, Health Economic Evaluation Database, and National Health Service Economic Evaluation Database (January 1993–October 2013.Results: A total of 42 studies met inclusion criteria: 19 diabetes, nine oncology, five osteoporosis, and nine autoimmune. Across these conditions, treatments associated with shorter treatment duration, less frequent administration, greater flexibility, and less invasive routes of administration were preferred over more burdensome or complex treatments. While efficacy and safety often had greater relative importance than treatment process, treatment process also had a quantifiable impact on preference. In some instances, particularly in diabetes and autoimmune disorders, treatment process attributes had greater relative importance than some or all efficacy and safety attributes. Some studies suggested that relative importance of treatment process depends on disease (eg

  20. Cultural Beliefs and Mental Health Treatment Preferences of Ethnically Diverse Older Adult Consumers in Primary Care

    Science.gov (United States)

    Jimenez, Daniel E.; Bartels, Stephen J.; Cardenas, Veronica; Daliwal, Sanam S.; Alegría, Margarita

    2011-01-01

    Background Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics. Method Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. Conclusions This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services. PMID:21992942

  1. Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care.

    Science.gov (United States)

    Jimenez, Daniel E; Bartels, Stephen J; Cardenas, Veronica; Dhaliwal, Sanam S; Alegría, Margarita

    2012-06-01

    Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts. This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1) beliefs on the cause of mental illness, 2) preferences for type of treatment, and 3) provider characteristics. Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness questionnaire, developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study, a multisite randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1,257 non-Latino whites, 536 African Americans, 112 Asian Americans, and 303 Latinos. African Americans, Asian Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.

  2. Patients' preferences for headache acute and preventive treatment.

    Science.gov (United States)

    Mitsikostas, Dimos D; Belesioti, Ioanna; Arvaniti, Chryssa; Mitropoulou, Euthymia; Deligianni, Christina; Kasioti, Elina; Constantinidis, Theodoros; Dermitzakis, Manolis; Vikelis, Michail

    2017-10-06

    We aimed to explore patients' preferences for headache treatments with a self-administered questionnaire including the Q-No questionnaire for nocebo. Questionnaires from 514 outpatients naïve to neurostimulation and monoclonal antibodies were collected. Patients assessed that the efficacy of a treatment is more important than safety or route of administration. They preferred to use an external neurostimulation device for both acute (67.1%) and preventive treatment (62.8%). Most patients preferred to take a pill (86%) than any other drug given parenterally for symptomatic pharmaceutical treatment. For preventive pharmaceutical treatment, most patients preferred to take a pill once per day (52%) compared to an injection either subcutaneously or intravenously each month (9% and 4%), or three months (15% and 11%). 56.6% of all participants scored more than 15 in Q-No questionnaire indicating potential nocebo behaviors that contributed significantly in their choices. These patient preferences along with efficacy and safety data may help physicians better choose the right treatment for the right person.

  3. Treatment Preferences for CAM in Children with Chronic Pain

    OpenAIRE

    Tsao, Jennie C. I.; Meldrum, Marcia; Kim, Su C.; Jacob, Margaret C.; Zeltzer, Lonnie K.

    2006-01-01

    CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years ± 2.4; range = 8–18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examin...

  4. Personality does not predict treatment preference, treatment experience does: a study of four complementary pain treatments.

    Science.gov (United States)

    Blasche, Gerhard; Melchart, Herbert; Leitner, Daniela; Marktl, Wolfgang

    2007-10-01

    The aim of the present study was to determine the extent to which personality and treatment experience affect patients' appraisals of 4 complementary treatments for chronic pain. A total of 232 chronic pain patients (164 females, 68 males, average age 56.6 years) visiting a spa clinic in Austria returned a questionnaire on patient characteristics and personality (autonomy, depressiveness, assertiveness, self-control) as well as attitudes towards (i.e. appealing, effective, pleasant) and experience of the treatments. Results were analysed by use of linear regression analysis and confidence intervals. Although all treatments were appraised positively, the passive treatments (thermal water tub baths, classical massage) were favoured more than the active treatments (relaxation training or exercise therapy). Treatment appraisal was not predicted by any of the personality traits but to a large extent by treatment experience. Relaxing, not unpleasant treatments were the most highly esteemed treatments. How strenuous or tiring a treatment was only had a minor effect on its appraisal. Neither do dependent, passive patients prefer passive treatments, nor do conscientious patients prefer active treatments. Instead, the appraisal of treatments that induce specific somatosensory sensations is largely determined by treatment experiences, i.e. what the treatment feels like. Despite the popularity of CAM which encompasses many experientially intensive treatments, treatment experience has to date been a neglected topic of treatment research.

  5. Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Ávila, Mónica; Becerra, Virginia; Guedea, Ferran; Suárez, José Francisco; Fernandez, Pablo; Macías, Víctor; Mariño, Alfonso

    2015-01-01

    Purpose: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. Methods and Materials: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Results: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Conclusions: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical

  6. Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ávila, Mónica [Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona (Spain); CIBER en Epidemiología y Salud Pública (CIBERESP) (Spain); Universitat Pompeu Fabra, Barcelona (Spain); Becerra, Virginia [Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona (Spain); Guedea, Ferran [Servicio de Oncología Radioterápica, Institut Català d' Oncologia, L' Hospitalet de Llobregat (Spain); Suárez, José Francisco [Servicio de Urología, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat (Spain); Fernandez, Pablo [Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián (Spain); Macías, Víctor [Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca (Spain); Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès (Spain); Mariño, Alfonso [Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña (Spain); and others

    2015-02-01

    Purpose: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. Methods and Materials: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Results: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Conclusions: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical

  7. Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

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    Marie Dorow

    2018-05-01

    Full Text Available Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1 investigate treatment preferences for depression including internet-based interventions and (2 examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences.Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences.Results: Patients had a mean age of 43.9 years (SD = 13.8 and more than two thirds (68.6% were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy.Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.

  8. The influence of patients' preference/attitude towards psychotherapy and antidepressant medication on the treatment of major depressive disorder.

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    Moradveisi, Latif; Huibers, Marcus; Renner, Fritz; Arntz, Arnoud

    2014-03-01

    Preferences and attitudes patients hold towards treatment are important, as these can influence treatment outcome. In depression research, the influence of patients' preference/attitudes on outcome and dropout has mainly been studied for antidepressant medication, and less for psychological treatments. We investigated the effects of patients' preference and attitudes towards psychological treatment and antidepressant medication on treatment outcome and dropout, and tested specificity of effects. Data are based on a randomized trial testing the effectiveness of behavioural activation (BA) vs antidepressant medication (ADM) for major depression (MDD) in Iran. Patients with MDD (N = 100) were randomized to BA (N = 50) or ADM (N = 50). Patients' preference/attitudes towards psychotherapy and ADM were assessed at baseline and associated with dropout and treatment outcome using logistic regression and multilevel analysis. High scores on psychotherapy preference/attitude and low scores on ADM preference/attitude predicted dropout from ADM, while no association between dropout and preference/attitude was found in BA. Psychotherapy preference/attitude moderated the differential effect of BA and ADM on one outcome measure, but the association disappeared after one year. Because in Iran most patients have only access to ADM, offering a psychological treatment for depression could attract especially those patients that prefer this newly available treatment. Patients' preferences and attitudes towards depression treatments influence dropout from ADM, and moderate the short-term difference in effectiveness between BA and ADM. The fact that dropout from BA was not affected by preference/attitude speaks for its acceptability among patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Light transmission and preference of eye patches for occlusion treatment.

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    Hwan Heo

    Full Text Available To investigate light transmission and preference for six eye patches for occlusion therapy.Six patches were examined, including; Ortopad Fun Pack, Ortopad Flesh, Kawamoto A-1, Kawamoto A-2, 3M Opticlude, and Everade Eye Guard. The size and the presence of a light blocking pad of patches were investigated. The amount of light transmitted through the patches was evaluated, using a digital light meter and a model eye, in three different environments; indoors with fluorescent light, outdoors on a sunny day, and strong light from illuminator. After patching the normal eye, the flash visual evoked potential (VEP was measured. Thirty patients with amblyopia or horizontal strabismus, who received occlusion therapy as initial treatment, were included. After using all six patches, patients completed a 7-item questionnaire regarding the patch preference for size, color and shape, adhesive power, pain with removal, skin irritation after removing patch, parent's preference and overall opinion.All patches had a light-blocking pad, except the 3M Nexcare. Ortopad had the strongest light blocking power in the three environments, and the 3M Nexcare had the weakest power. In flash VEP, Ortopad and Kawamoto patches showed flat, but 3M Nexcare and Everade Eye Guard showed normal response. There were significant preferential differences among the patches in all the items of the questionnaire (P<0.05. In comparison between the patches respectively, 3M Nexcare received the lowest satisfaction in pain when removing a patch and skin irritation after removing a patch. Kawamoto A-2 received the lowest score in the overall satisfaction.We found differences in the light-blocking power and in the preference of the various patches for the occlusion treatment. This is a pilot study regarding only characteristics and preferences of patches. Further clinical studies regarding the relationship between characteristics or preferences of patches and outcomes of occlusion treatment

  10. Randomised clinical trials with clinician-preferred treatment.

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    Korn, E L; Baumrind, S

    1991-01-19

    The standard design for randomised clinical trials may be inappropriate when the clinician believes that one of the treatments being tested is superior for the patient, or when the clinician has a preference for one of the treatments. For such instances the suggestion is that the patient is randomly allocated to treatment only when there is clinical disagreement about treatment of choice for that patient, and then the patient is assigned to a clinician who had thought that the regimen allocated is the one most appropriate for that patient.

  11. Effects of acute corticosterone treatment on partner preferences in male and female zebra finches (Taeniopygia guttata).

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    LaPlante, Kimberly A; Huremovic, Enida; Tomaszycki, Michelle L

    2014-04-01

    Stress alters physiology and behavior across species. Most research on the effects of stress on behavior uses chronic stressors, and most are correlational. The effects of acute stressors on physiology and behavior have been mixed. Here, we use zebra finches, a highly gregarious species that forms long-term pair bonds, to test the effects of an acute corticosterone (CORT) on opposite-sex partner preferences over a same-sex individual or a group (the latter is a highly appealing option). We had two competing hypotheses. First, we predicted that acute CORT would alter preferences for the opposite sex bird in both conditions in both sexes. However, since there is a sex difference in the effects of CORT on partner preferences in voles, these effects may be more pronounced in males than in females. To test our hypotheses, we administered 2 doses of CORT (10μg and 20μg) or vehicle (control) using a repeated measures design. In the male vs. female test, there was a significant Sex by Treatment interaction, such that in males, 10μg CORT increased preferences for a female over the male compared to when these same males were treated with saline at baseline. There were no effects of treatment in females. In the opposite-sex vs. group condition, there was an overall effect of Treatment, such that the 10μg dose increased preference for the opposite-sex individual over both saline treatments, regardless of sex. These findings further our understanding of the effects of an acute stressor on sexual partner preferences. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Weight Management Preferences in a Non-Treatment Seeking Sample

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    Victoria B. Barry

    2013-12-01

    Full Text Available Background: Obesity is a serious public health issue in the United States, with the CDC reporting that most adult Americans are now either overweight or obese. Little is known about the comparative acceptability of available weight management approaches in non-treatment seeking samples. Method: This report presents preliminary survey data collected from an online sample on weight management preferences for 8 different weight management strategies including a proposed incentive-based program. Participants were 72 individuals (15 men, 55 women and 2 transgendered individuals who self-re-ported being overweight or obese, or who currently self-reported a normal weight but had attempted to lose weight in the past. Results: ANOVA and Pair-wise comparison indicated clear preferences for certain treatments over others in the full sample; most notably, the most popular option in our sample for managing weight was to diet and exercise without professional assistance. Several differences in preference between the three weight groups were also observed. Conclusions: Dieting and exercising without any professional assistance is the most highly endorsed weight management option among all groups. Overweight and obese individuals may find self-management strategies for weight loss less attractive than normal weight individuals, but still prefer it to other alternatives. This has implications for the development and dissemination of empirically based self-management strategies for weight.

  13. Treatment Preferences for CAM in Children with Chronic Pain

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    Jennie C. I. Tsao

    2007-01-01

    Full Text Available CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls (mean age = 14.5 years ± 2.4; range = 8–18 years presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80% were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy, pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

  14. Treatment Preferences for CAM in children with chronic pain.

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    Tsao, Jennie C I; Meldrum, Marcia; Kim, Su C; Jacob, Margaret C; Zeltzer, Lonnie K

    2007-09-01

    CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years +/- 2.4; range = 8-18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

  15. Early antihypertensive treatment and clinical outcomes in acute ischemic stroke: subgroup analysis by baseline blood pressure.

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    He, William J; Zhong, Chongke; Xu, Tan; Wang, Dali; Sun, Yingxian; Bu, Xiaoqing; Chen, Chung-Shiuan; Wang, Jinchao; Ju, Zhong; Li, Qunwei; Zhang, Jintao; Geng, Deqin; Zhang, Jianhui; Li, Dong; Li, Yongqiu; Yuan, Xiaodong; Zhang, Yonghong; Kelly, Tanika N

    2018-06-01

    We studied the effect of early antihypertensive treatment on death, major disability, and vascular events among patients with acute ischemic stroke according to their baseline SBP. We randomly assigned 4071 acute ischemic stroke patients with SBP between 140 and less than 220 mmHg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A composite primary outcome of death and major disability and secondary outcomes were compared between treatment and control stratified by baseline SBP levels of less than 160, 160-179, and at least 180 mmHg. At 24 h after randomization, differences in SBP reductions were 8.8, 8.6 and 7.8 mmHg between the antihypertensive treatment and control groups among patients with baseline SBP less than 160, 160-179, and at least 180 mmHg, respectively (P baseline SBP subgroups on death (P = 0.02): odds ratio (95% CI) of 2.42 (0.74-7.89) in patients with baseline SBP less than 60 mmHg and 0.34 (0.11-1.09) in those with baseline SBP at least 180 mmHg. At the 3-month follow-up, the primary and secondary clinical outcomes were not significantly different between the treatment and control groups by baseline SBP levels. Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with various baseline SBP levels. Future clinical trials are warranted to test BP-lowering effects in acute ischemic stroke patients by baseline SBP levels. ClinicalTrials.gov Identifier: NCT01840072.

  16. The effect of patients’ preference on outcome in the EVerT cryotherapy versus salicylic acid for the treatment of plantar warts (verruca trial

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    Cockayne Sarah

    2012-11-01

    Full Text Available Abstract Background Randomised controlled trials are widely accepted as the gold standard method to evaluate medical interventions, but they are still open to bias. One such bias is the effect of patient’s preference on outcome measures. The aims of this study were to examine whether patients’ treatment preference affected clearance of plantar warts and explore whether there were any associations between patients’ treatment preference and baseline variables in the EverT trial. Methods Two hundred and forty patients were recruited from University podiatry schools, NHS podiatry clinics and primary care. Patients were aged 12 years and over and had at least one plantar wart which was suitable for treatment with salicylic acid and cryotherapy. Patients were asked their treatment preference prior to randomisation. The Kruskal-Wallis test was performed to test the association between preference group and continuous baseline variables. The Fisher’s exact test was performed to test the association between preference group and categorical baseline variables. A logistic regression analysis was undertaken with verruca clearance (yes or no as the dependent variable and treatment, age, type of verruca, previous treatment, treatment preference as independent variables. Two analyses were undertaken, one using the health professional reported outcome and one using the patient’s self reported outcomes. Data on whether the patient found it necessary to stop the treatment to which they had been allocated and whether they started another treatment were summarised by treatment group. Results Pre-randomisation preferences were: 10% for salicylic acid; 42% for cryotherapy and 48% no treatment preference. There was no evidence of an association between treatment preference group and either patient (p=0.95 or healthcare professional (p=0.46 reported verruca clearance rates. There was no evidence of an association between preference group and any of the

  17. Should Studies of Diabetes Treatment Stratification Correct for Baseline HbA1c?

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    Jones, Angus G.; Lonergan, Mike; Henley, William E.; Pearson, Ewan R.; Hattersley, Andrew T.; Shields, Beverley M.

    2016-01-01

    Aims Baseline HbA1c is a major predictor of response to glucose lowering therapy and therefore a potential confounder in studies aiming to identify other predictors. However, baseline adjustment may introduce error if the association between baseline HbA1c and response is substantially due to measurement error and regression to the mean. We aimed to determine whether studies of predictors of response should adjust for baseline HbA1c. Methods We assessed the relationship between baseline HbA1c and glycaemic response in 257 participants treated with GLP-1R agonists and assessed whether it reflected measurement error and regression to the mean using duplicate ‘pre-baseline’ HbA1c measurements not included in the response variable. In this cohort and an additional 2659 participants treated with sulfonylureas we assessed the relationship between covariates associated with baseline HbA1c and treatment response with and without baseline adjustment, and with a bias correction using pre-baseline HbA1c to adjust for the effects of error in baseline HbA1c. Results Baseline HbA1c was a major predictor of response (R2 = 0.19,β = -0.44,pHbA1c were associated with response, however these associations were weak or absent after adjustment for baseline HbA1c. Bias correction did not substantially alter associations. Conclusions Adjustment for the baseline HbA1c measurement is a simple and effective way to reduce bias in studies of predictors of response to glucose lowering therapy. PMID:27050911

  18. Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

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    Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

    2015-11-01

    The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Vicarious experience affects patients' treatment preferences for depression.

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    Seth A Berkowitz

    Full Text Available Depression is common in primary care but often under-treated. Personal experiences with depression can affect adherence to therapy, but the effect of vicarious experience is unstudied. We sought to evaluate the association between a patient's vicarious experiences with depression (those of friends or family and treatment preferences for depressive symptoms.We sampled 1054 English and/or Spanish speaking adult subjects from July through December 2008, randomly selected from the 2008 California Behavioral Risk Factor Survey System, regarding depressive symptoms and treatment preferences. We then constructed a unidimensional scale using item analysis that reflects attitudes about antidepressant pharmacotherapy. This became the dependent variable in linear regression analyses to examine the association between vicarious experiences and treatment preferences for depressive symptoms.Our sample was 68% female, 91% white, and 13% Hispanic. Age ranged from 18-94 years. Mean PHQ-9 score was 4.3; 14.5% of respondents had a PHQ-9 score >9.0, consistent with active depressive symptoms. Analyses controlling for current depression symptoms and socio-demographic factors found that in patients both with (coefficient 1.08, p = 0.03 and without (coefficient 0.77, p = 0.03 a personal history of depression, having a vicarious experience (family and friend, respectively with depression is associated with a more favorable attitude towards antidepressant medications.Patients with vicarious experiences of depression express more acceptance of pharmacotherapy. Conversely, patients lacking vicarious experiences of depression have more negative attitudes towards antidepressants. When discussing treatment with patients, clinicians should inquire about vicarious experiences of depression. This information may identify patients at greater risk for non-adherence and lead to more tailored patient-specific education about treatment.

  20. Patients' preferences for involvement in treatment decision making in Japan

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    Shimbo Takuro

    2004-03-01

    Full Text Available Abstract Background A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. Methods The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. Results 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. Conclusions Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making.

  1. Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial.

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    Larsson, Birgitta; Karlström, Annika; Rubertsson, Christine; Ternström, Elin; Ekdahl, Johanna; Segebladh, Birgitta; Hildingsson, Ingegerd

    2017-12-01

    Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment. Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n=258) were recruited at one university hospital and two regional hospitals over one year. The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n=127) or standard care (face-to-face counselling) (n=131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth. Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience. Women's birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  2. Esophageal Baseline Impedance Reflects Mucosal Integrity and Predicts Symptomatic Outcome With Proton Pump Inhibitor Treatment.

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    Xie, Chenxi; Sifrim, Daniel; Li, Yuwen; Chen, Minhu; Xiao, Yinglian

    2018-01-30

    Esophageal baseline impedance, which is decreased in gastroesophageal reflux disease (GERD) patients, is related to the severity of acid reflux and the integrity of the esophageal mucosa. The study aims to compare the baseline impedance and the dilated intercellular spaces (DIS) within patients with typical reflux symptoms and to evaluate the correlation of baseline impedance with DIS, esophageal acid exposure, as well as the efficacy of proton pump inhibitor (PPI) treatment. Ninety-two patients and 10 healthy controls were included in the study. Erosive esophagitis (EE) was defined by esophageal mucosal erosion under upper endoscopy. Patients without mucosa erosion were divided into groups with pathologic acid reflux (non-erosive reflux disease [NERD]) or with hypersensitive esophagus. The biopsies of esophageal mucosa were taken 2-4 cm above the gastroesophageal junction Z-line during upper endoscopy for DIS measurement. All the patients received esomeprazole 20 mg twice-daily treatment for 8 weeks. The efficacy of esomeprazole was evaluated among all patients. The intercellular spaces were dilated in both EE and NERD patients ( P baseline impedance was decreased in both EE patients and NERD patients, and negatively correlated to the acid exposure time ( r = -0.527, P baseline impedance ( r = -0.230, P Baseline impedance > 1764 Ω" was an independent predictor for PPI failure (OR, 11.9; 95% CI, 2.4-58.9; P baseline impedance was observed in patients with mucosa erosion or pathological acid reflux. The baseline impedance reflected the mucosal integrity, it was more sensitive to esophageal acid exposure. Patients with high impedance might not benefit from the PPI treatment.

  3. Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project

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    Stefanie J. Vaccher

    2017-12-01

    Full Text Available IntroductionThe effectiveness of daily pre-exposure prophylaxis (PrEP is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM. This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project.Materials and methodsIndividuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day, event-driven (pills taken only around specific risk events, or periodic (daily dosing during periods of increased risk.ResultsOverall, 315 GBM (98% of study sample provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR = 4.58, 95% confidence intervals (95% CI: (1.68, 12.49], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76].DiscussionIndividuals’ preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to

  4. Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice

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    Stephen D. Walter

    2017-02-01

    Full Text Available Abstract Background In the two-stage randomised trial design, a randomly sampled subset of study participants are permitted to choose their own treatment, while the remaining participants are randomised to treatment in the usual way. Appropriate analysis of the data from both arms of the study allows investigators to estimate the impact on study outcomes of treatment preferences that patients may have, in addition to evaluating the usual direct effect of treatment. In earlier work, we showed how to optimise this design by making a suitable choice of the proportion of participants who should be assigned to the choice arm of the trial. However, we ignored the possibility of some participants being indifferent to the treatments under study. In this paper, we extend our earlier work to consider the analysis of two-stage randomised trials when some participants have no treatment preference, even if they are assigned to the choice arm and allowed to choose. Methods We compare alternative characterisations of the response profiles of the indifferent or undecided participants, and derive estimates of the treatment and preference effects on study outcomes. We also present corresponding test statistics for these parameters. The methods are illustrated with data from a clinical trial contrasting medical and surgical interventions. Results Expressions are obtained to estimate and test the impact of treatment choices on study outcomes, as well as the impact of the actual treatment received. Contrasts are defined between patients with stated treatment preferences and those with no preference. Alternative assumptions concerning the outcomes of undecided participants are described, and an approach leading to unbiased estimation and testing is identified. Conclusions Use of the two-stage design can provide important insights into determinants of study outcomes that are not identifiable with other designs. The design can remain attractive even in the presence of

  5. Influence of Baseline Psychological Health on Muscle Pain During Atorvastatin Treatment.

    Science.gov (United States)

    Zaleski, Amanda L; Taylor, Beth A; Pescatello, Linda S; Dornelas, Ellen A; White, Charles Michael; Thompson, Paul D

    3-hydroxy-3-methylglutaryl coenzyme A reductase reductase inhibitors (statins) are generally well tolerated, with statin-associated muscle symptoms (SAMS) the most common side effect (~10%) seen in statin users. However, studies and clinical observations indicate that many of the self-reported SAMS appear to be nonspecific (ie, potentially not attributable to statins). Mental health and well-being influence self-perception of pain, so we sought to assess the effect of baseline well-being and depression on the development of muscle pain with 6 months of atorvastatin 80 mg/d (ATORVA) or placebo in healthy, statin-naive adults. The Psychological General Well-being Index (n = 83) and Beck Depression Inventory (n = 55) questionnaires were administered at baseline in participants (aged 59.5 ± 1.2 years) from the effect of Statins on Skeletal Muscle Function and Performance (STOMP) trial (NCT00609063). Muscle pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), pain that interferes with daily life (Brief Pain Inventory [BPI]), and pain severity (BPI) were then measured before, throughout, and after treatment. At baseline, there were no differences in well-being (Psychological General Well-being Index), depression (Beck Depression Inventory), or pain measures (SF-MPQ and BPI) (P values ≥ .05) between the placebo and ATORVA groups. Baseline well-being correlated negatively with baseline BPI pain severity (r = -0.290, P = .008). Baseline depression correlated with baseline pain (SF-MPQ; r = 0.314, P = .020). Baseline well-being and depression did not predict the change in pain severity or interference after 6 months among the total sample or between groups (P values ≥ .05). Baseline well-being and depression were not significant predictors of pain after 6 months of ATORVA (P values ≥ .05). Thus, they do not appear to increase the risk of SAMS in otherwise healthy adults.

  6. US Department of Energy mixed waste characterization, treatment, and disposal focus area technical baseline development process

    International Nuclear Information System (INIS)

    Roach, J.A.; Gombert, D.

    1996-01-01

    The US Department of Energy (DOE) created the Mixed Waste Characterization, Treatment, and Disposal Focus Area (MWFA) to develop and facilitate implementation of technologies required to meet its commitments for treatment of mixed wastes under the Federal Facility Compliance Act (FFCA), and in accordance with the Land Disposal Restrictions (LDR) of the Resource Conservation and Recovery Act (RCRA). Mixed wastes include both mixed low-level waste (MLLW) and mixed transuranic (MTRU) waste. The goal of the MWFA is to develop mixed waste treatment systems to the point of implementation by the Environmental Management (EM) customer. To accomplish this goal, the MWFA is utilizing a three step process. First, the treatment system technology deficiencies were identified and categorized. Second, these identified needs were prioritized. This resulted in a list of technical deficiencies that will be used to develop a technical baseline. The third step, the Technical Baseline Development Process, is currently ongoing. When finalized, the technical baseline will integrate the requirements associated with the identified needs into the planned and ongoing environmental research and technology development activities supported by the MWFA. Completion of this three-step process will result in a comprehensive technology development program that addresses customer identified and prioritized needs. The MWFA technical baseline will be a cost-effective, technically-defensible tool for addressing and resolving DOE's mixed waste problems

  7. Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians.

    Science.gov (United States)

    Kunneman, M; Pieterse, A H; Stiggelbout, A M; Nout, R A; Kamps, M; Lutgens, L C H W; Paulissen, J; Mattheussens, O J A; Kruitwagen, R F P M; Creutzberg, C L

    2014-08-12

    Vaginal brachytherapy (VBT) in high-intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making. Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making. Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, Pdecision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making. We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.

  8. Fixed Costs and the Product Market Treatment of Preference Minorities

    OpenAIRE

    Steven Berry; Alon Eizenberg; Joel Waldfogel

    2014-01-01

    It is well documented that, in the presence of substantial fixed costs, markets offer preference majorities more variety than preference minorities. This fact alone, however, does not demonstrate the market outcome is in any way biased against preference minorities. In this paper, we clarify the sense in which the market outcome may in fact be biased against preference minorities, and we provide some conditions for such bias to occur. We then estimate the degree of bias in a particular indust...

  9. Treatment credibility, expectancy, and preference: Prediction of treatment engagement and outcome in a randomized clinical trial of hatha yoga vs. health education as adjunct treatments for depression.

    Science.gov (United States)

    Uebelacker, Lisa A; Weinstock, Lauren M; Battle, Cynthia L; Abrantes, Ana M; Miller, Ivan W

    2018-06-02

    Hatha yoga may be helpful for alleviating depression symptoms. The purpose of this analysis is to determine whether treatment program preference, credibility, or expectancy predict engagement in depression interventions (yoga or a control class) or depression symptom severity over time. This is a secondary analysis of a randomized controlled trial (RCT) of hatha yoga vs. a health education control group for treatment of depression. Depressed participants (n = 122) attended up to 20 classes over a period of 10 weeks, and then completed additional assessments after 3 and 6 months. We assessed treatment preference prior to randomization, and treatment credibility and expectancy after participants attended their first class. Treatment "concordance" indicated that treatment preference matched assigned treatment. Treatment credibility, expectancy, and concordance were not associated with treatment engagement. Treatment expectancy moderated the association between treatment group and depression. Depression severity over time differed by expectancy level for the yoga group but not for the health education group. Controlling for baseline depression, participants in the yoga group with an average or high expectancy for improvement showed lower depression symptoms across the acute intervention and follow-up period than those with a low expectancy for improvement. There was a trend for a similar pattern for credibility. Concordance was not associated with treatment outcome. This is a secondary, post-hoc analysis and should be considered hypothesis-generating. Results suggest that expectancy improves the likelihood of success only for a intervention thought to actively target depression (yoga) and not a control intervention. Copyright © 2018. Published by Elsevier B.V.

  10. Association of baseline vitamin D levels with clinical parameters and treatment outcomes in chronic hepatitis B.

    Science.gov (United States)

    Chan, Henry Lik-Yuen; Elkhashab, Magdy; Trinh, Huy; Tak, Won Young; Ma, Xiaoli; Chuang, Wan-Long; Kim, Yoon Jun; Martins, Eduardo B; Lin, Lanjia; Dinh, Phillip; Charuworn, Prista; Foster, Graham R; Marcellin, Patrick

    2015-11-01

    The relationship between vitamin D levels and chronic hepatitis B (CHB) infection and treatment outcomes are poorly elucidated. We measured pre-treatment serum vitamin D (25-hydroxyvitamin D3; 25[OH]D3) levels and determined their association with clinical parameters and treatment outcomes in active CHB patients without advanced liver disease enrolled in a global clinical trial. Patients were randomly assigned to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus peginterferon alfa-2a (PegIFN), TDF plus PegIFN for 16 weeks followed by TDF for 32 weeks, PegIFN for 48 weeks, or TDF for 120 weeks. Univariate and multivariate analyses were conducted to determine associations between vitamin D, baseline factors, and week 48 clinical outcome. Of 737 patients, 35% had insufficient (⩾20 but vitamin D levels. In univariate analysis, lower vitamin D levels were significantly associated with the following baseline parameters: younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood draw in winter or autumn, and HBV genotype D. On multivariate analysis, only HBV genotype, season of blood draw, calcium level, and age retained their association. High baseline level of vitamin D was associated with low HBV DNA, normal ALT and HBsAg at week 48 independent of treatment groups, but the association, with the exception of ALT, became statistically insignificant after adjusting for age, gender, HBeAg and HBV genotype. Abnormally low vitamin D levels are highly prevalent among untreated, active CHB patients. Baseline vitamin D levels are not associated with treatment outcomes, but were associated with normal ALT. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  11. Beyond the treatment effect: Evaluating the effects of patient preferences in randomised trials.

    Science.gov (United States)

    Walter, S D; Turner, R; Macaskill, P; McCaffery, K J; Irwig, L

    2017-02-01

    The treatments under comparison in a randomised trial should ideally have equal value and acceptability - a position of equipoise - to study participants. However, it is unlikely that true equipoise exists in practice, because at least some participants may have preferences for one treatment or the other, for a variety of reasons. These preferences may be related to study outcomes, and hence affect the estimation of the treatment effect. Furthermore, the effects of preferences can sometimes be substantial, and may even be larger than the direct effect of treatment. Preference effects are of interest in their own right, but they cannot be assessed in the standard parallel group design for a randomised trial. In this paper, we describe a model to represent the impact of preferences on trial outcomes, in addition to the usual treatment effect. In particular, we describe how outcomes might differ between participants who would choose one treatment or the other, if they were free to do so. Additionally, we investigate the difference in outcomes depending on whether or not a participant receives his or her preferred treatment, which we characterise through a so-called preference effect. We then discuss several study designs that have been proposed to measure and exploit data on preferences, and which constitute alternatives to the conventional parallel group design. Based on the model framework, we determine which of the various preference effects can or cannot be estimated with each design. We also illustrate these ideas with some examples of preference designs from the literature.

  12. Low-dose budesonide treatment improves lung function in patients with infrequent asthma symptoms at baseline

    DEFF Research Database (Denmark)

    Reddel, H. K.; Busse, W. W.; Pedersen, Søren

    2015-01-01

    symptom frequency groups (Figure). CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment plus usual asthma medication improves lung function in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0......RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for improving asthma outcomes, including lung function. In the past, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, evidence is lacking for the benefit of ICS...... in patients with less frequent symptoms at presentation. This was investigated in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years (median 21 years) with a history of recent-onset mild asthma (11 years...

  13. Caregiver acceptability and preferences for early childhood caries preventive treatments for Hispanic children.

    Science.gov (United States)

    Adams, Sally H; Hyde, Susan; Gansky, Stuart A

    2009-01-01

    The objective of this study was to determine caregiver treatment acceptability and preferences for five preventive dental treatments for early childhood caries in young Hispanic children. We interviewed 211 parents/caregivers of Hispanic children attending Head Start programs regarding their acceptability of, and preferences for, five standard preventive dental treatments for young children. Treatments assessed were toothbrushing with fluoride toothpaste, fluoride varnish, and xylitol in food for children, and xylitol gum and chlorhexidine rinse for mothers. The interview assessment included presentation of illustrated cards with verbal description of treatment, photograph/video clip, and treatment samples. Parents rated the acceptability of each treatment (1-5 scale) and treatment preferences within each of 10 possible pairs. Individual treatment preferences were summed to create overall preference scores (range 0-4). All treatments were rated as highly acceptable, however, there were differences (range 4.6-4.9; Friedman chi-square = 23.4, P treatment preferences revealed greater variability (means ranged 1.4-2.6; Friedman chi-square = 128.2, P treatments were highly acceptable, however, when choosing among treatments overall, fluoride varnish and toothbrushing were favored over other treatments.

  14. Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer

    NARCIS (Netherlands)

    Knuttel, Floor; van den Bosch, Maurice A A J; Young-Afat, Danny A.; Emaus, Marleen J.; van den Bongard, Desirée H J G; Witkamp, Arjen J.; Verkooijen, Helena M.

    Background: Noninvasive or minimally invasive treatments are being developed as alternatives to surgery for patients with early-stage breast cancer. Patients' preferences with regard to these new treatments have not been investigated. Objectives: To assess preferences of patients with breast cancer

  15. Determining patient preferences for improved chemotoxicity during treatment for advanced bladder cancer

    DEFF Research Database (Denmark)

    Aristides, M.; Maase, Hans von der; Roberts, T.

    2005-01-01

    Determining patient preferences for improved chemotoxicity during treatment for advanced bladder cancer Conventional treatment for advanced bladder cancer is methotrexate, vinblastine, doxorubicin plus cisplatin (MVAC), with a median survival of 1 year but significant toxicity. The newer combinat...

  16. Patients' preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

    OpenAIRE

    Jansen, S J T; Kievit, J; Nooij, M A; Haes, J C J M de; Overpelt, I M E; Slooten, H van; Maartense, E; Stiggelbout, A M

    2001-01-01

    When making decisions about adjuvant chemotherapy for early-stage breast cancer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of the present study were: (1) to determine the minimum benefits that patients need to find chemotherapy acceptable, and (2) to explore potential preference determinants, namely: positive experience of the treatment, reconciliation with the treatment decision, and demographic...

  17. Is insulin the preferred treatment for HbA1c >9%?

    Science.gov (United States)

    Bloomgarden, Zachary

    2017-09-01

    approaches are more effective than monotherapy, with a combination regimen the HbA1c reduction will not be directly additive, because the expected reduction decreases at lower baseline HbA1c levels. As an example of this, administration of canagliflozin 300 mg daily to patients with baseline HbA1c >9% reduced levels from 9.6% by 1.8%, whereas at a baseline HbA1c of 10% either canagliflozin 300 mg or metformin 2 g/day reduced HbA1c by 2%; the addition of both agents led to an HbA1c reduction by somewhat less than 3%, which appears concordant with a reduction by the second agent from approximately 8% (10% to 2%). Similar less-than-additive effects of the addition of exenatide QW to dapagliflozin have been reported, with HbA1c reduction from a baseline of 10.0%-10.1% of 1.9% and 1.6% with the individual agents, respectively, and a reduction of 2.2% with their combination. However, one may consider these approaches inferior to the expected HbA1c reduction with insulin, suggesting that insulin should, indeed, be the preferred treatment for people with T2D and HbA1c >9%. Rather, studies comparing basal insulin directly with glucagon-like peptide-1 (GLP-1) receptor agonists (RA) suggest that the latter agents may offer superior benefit. The Diabetes Therapy Utilization: Researching Changes in HBA1C, Weight, and Other Factors Through Intervention with Exenatide Once Weekly (DURATION)-3 and Liraglutide Effect and Action in Diabetes (LEAD)-5 studies compared exenatide QW and liraglutide, respectively, with insulin glargine. Those study participants in the highest quartile of baseline HbA1c had levels ≥9.0% and ≥8.9%, with the GLP-1RA leading to 0.3% and 0.2% greater reductions in HbA1c, respectively, than insulin glargine. Another study comparing T2D patients receiving oral agents given liraglutide with those given insulin glargine showed that those in the highest baseline HbA1c quartile (mean 10.6%) had an HbA1c reduction of 3.1% with either agent. In the exenatide QW study

  18. Patients' and urologists' preferences for prostate cancer treatment: a discrete choice experiment

    Science.gov (United States)

    de Bekker-Grob, E W; Bliemer, M C J; Donkers, B; Essink-Bot, M-L; Korfage, I J; Roobol, M J; Bangma, C H; Steyerberg, E W

    2013-01-01

    Background: Patients' preferences are important for shared decision making. Therefore, we investigated patients' and urologists' preferences for treatment alternatives for early prostate cancer (PC). Methods: A discrete choice experiment was conducted among 150 patients who were waiting for their biopsy results, and 150 urologists. Regression analysis was used to determine patients' and urologists' stated preferences using scenarios based on PC treatment modality (radiotherapy, surgery, and active surveillance (AS)), and risks of urinary incontinence and erectile dysfunction. Results: The response rate was 110 out of 150 (73%) for patients and 50 out of 150 (33%) for urologists. Risk of urinary incontinence was an important determinant of both patients' and urologists' stated preferences for PC treatment (Prisk of erectile dysfunction due to radiotherapy was mainly important to urologists (Pof patients with anxious/depressed feelings who preferred radical treatment to AS. Conclusion: Although patients and urologists generally may prefer similar treatments for PC, they showed different trade-offs between various specific treatment aspects. This implies that urologists need to be aware of potential differences compared with the patient's perspective on treatment decisions in shared decision making on PC treatment. PMID:23860533

  19. Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.

    Science.gov (United States)

    Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M

    2015-06-01

    To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options. Published by Elsevier Ltd.

  20. Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations.

    Science.gov (United States)

    Landau, Sabine; Emsley, Richard; Dunn, Graham

    2018-06-01

    Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise. Investigators increasingly carry out explanatory analyses to decompose total treatment effects into components that are mediated by an intermediate continuous outcome and a non-mediated part. Traditional mediation analysis might be performed based on (A) post-treatment values of the intermediate and clinical outcomes alone, (B) respective change scores or (C) conditioning on baseline measures of both intermediate and clinical outcomes. Using causal diagrams and Monte Carlo simulation, we investigated the performance of the three competing mediation approaches. We considered a data generating model that included three possible confounding processes involving baseline variables: The first two processes modelled baseline measures of the clinical variable or the intermediate variable as common causes of post-treatment measures of these two variables. The third process allowed the two baseline variables themselves to be correlated due to past common causes. We compared the analysis models implied by the competing mediation approaches with this data generating model to hypothesise likely biases in estimators, and tested these in a simulation study. We applied the methods to a randomised trial of pragmatic rehabilitation in patients with chronic fatigue syndrome, which examined the role of limiting activities as a mediator. Estimates of causal mediation effects derived by approach (A) will be biased if one of

  1. End-Users' Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa.

    Science.gov (United States)

    Weinrib, Rachel; Minnis, Alexandra; Agot, Kawango; Ahmed, Khatija; Owino, Fred; Manenzhe, Kgahlisho; Cheng, Helen; van der Straten, Ariane

    2018-01-01

    A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women's health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users. The Trio Study was a mixed-methods study in women ages 18-30 that examined acceptability of three MPT delivery forms: oral tablets, injections, and vaginal ring. Approval ratings and stated choice among the products was collected at baseline. Factors influencing stated product choice were explored using multivariable multinomial logistic regression. The majority (62%) of women in Trio stated they would choose injections, 27% would choose tablets and 11% would choose the ring. Significant predictors of choice included past experience with similar contraceptive delivery forms, age, and citing frequency of use as important. Ring choice was higher for older (25-30) women than for younger (18-24) women (aRR = 3.1; p < 0.05). These results highlight the importance of familiarity in MPT product choice of potential for variations in MPT preference by age.

  2. Information Needs and Preferences of Parents Considering Treatment of Child Anxiety.

    Science.gov (United States)

    Mak, Leanne; Walker, John R; Hiebert-Murphy, Diane; Altman, Gary

    2017-04-01

    To assess the information needs and preferences of parents who were making decisions concerning treatment for their child's anxiety. Ninety-three parents were recruited from hospital-based clinics, a parent group, and a public information meeting. They completed a survey about preference for decision-making involvement, information needs, and preferences concerning source and amount of information. Most (69%) parents indicated that they prefer a collaborative decision-making role. They rated very highly the need for general information related to treatment and information related to psychosocial interventions and medication treatment. Fewer parents rated information about logistics of treatment (e.g., scheduling, cost) as highly important although this information was considered important by many parents. Direct discussions with a provider, written information, and information accessed through the internet were the most preferred sources of information. Many parents indicated a preference for substantial amounts of information about psychosocial and medication treatments. Much of the information that parents want concerning treatment is not widely available. It would be helpful to develop evidence-based brochures and web information resources that focus on answering parents' questions concerning treatment of children's anxiety.

  3. Preference and usage of intracanal medications during endodontic treatment

    Directory of Open Access Journals (Sweden)

    Ahmad A. Madarati

    2017-07-01

    Full Text Available Objectives: To investigate the preferences of general dental practitioners (GDPs and endodontists in using endodontic intra-canal medications (ICMs. Methods: This observational and descriptive study was conducted in 2014 in the western province of Saudi Arabia. Following ethical clearance and 2 pilot studies, a web-based questionnaire was electronically sent to 375 randomly and systematically selected GDPs and all endodontists in the western province (n=49. An accompanying e-mail explained the study’s aims and confirmed that the data yielded would remain confidential. The responses were collected, and the data was analyzed using the Chi-square test at p=0.05. Results: Significantly, the highest proportion of respondents (53.7% reported disinfection of the root canals as the main function of ICMs. Calcium hydroxide (CH was the preferred material of the majority of those who used the same ICM in all cases (85.7%. While the vast majority of all endodontists (87.5% used CH after pulp extirpation, 48.5% of GDPs used formocresol (p less than 0.001. Almost 30% of those who used ICMs after pulp extirpation did not do so after cleaning and shaping of vital cases. Most endodontists used CH (62.5% and antibiotics (37.5% in necrotic pulp cases without apical lesions, which were significantly greater than those of GDPs who did the same (43.8% and 17.2%. Conclusions: Participants were aware that the main function of ICMs is disinfection of the root canal system. However, it is clear that GDPs should reduce their reliance on phenol- and formaldehyde-based medications. There was a distinct trend toward the use of ICMs, especially CH, in necrotic pulp cases.

  4. Colour preference between adults and children during a dental treatment session.

    Science.gov (United States)

    Oner Ozdas, Didem; Kazak, Magrur

    2017-02-01

    It is evidently shown that colour has physical, psychological and sociological effects on human beings. There are many studies showing the effects of colours on brain activity. Colour preferences may change from childhood to adulthood and are significantly different in various age groups. The aim of this study was to evaluate the adults and children in their preference for mouthrinses in various colours under stress condition during a dental treatment session. 240 adults and 263 children were included in the study. Three transparent cups were filled with water, two of which were coloured green/pink rinsing by dissolving a tablet in the water. Cups were placed near the dental unit. During dental treatment sessions, patients were told to rinse their mouth with whichever cup they preferred. Preferred colour of cup, gender and age of patient, number of sessions were recorded. Data were statistically analysed by SPSS 15.0 programme and chi-square tests. Half of all cases preferred water. In adults, while females statistically significantly preferred water, males chose cups with coloured contents (pcoloured contents in multi-dental treatment sessions, children regularly preferred water (pcolours of cups affected choices made by adults and children. Female adults and children were not interested in trying colourful mouthrinses, while male adults were curious about trying colourful mouthrinses during dental treatment sessions under stress condition. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Treatment Preference among Suicidal and Self-Injuring Women with Borderline Personality Disorder and PTSD

    Science.gov (United States)

    Harned, Melanie S.; Tkachuck, Mathew A.; Youngberg, Kelly A.

    2014-01-01

    Objectives This study examined treatment preferences among suicidal and self-injuring women with borderline personality disorder (BPD) and PTSD. Method Women (N = 42, Mage =34) with BPD, PTSD and recent intentional self-injury were evaluated upon entry into a psychotherapy outcome study. Results The majority preferred a combined dialectical behavior therapy (DBT) and prolonged exposure (PE) treatment (73.8%), followed by DBT alone (26.2%), and PE alone (0%). Women who preferred the combined treatment were more likely to report a desire to obtain relief from PTSD and to receive specific DBT and PE treatment components as reasons underlying this preference. Few women (21.4%) reported concerns about PE, but those who did were more likely to prefer DBT alone. More severe PTSD re-experiencing symptoms, a childhood index trauma, and less reduction in positive affect after a trauma interview predicted a preference for the combined treatment. Conclusions These results may help to inform treatment for these complex patients. PMID:23444147

  6. Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

    Science.gov (United States)

    Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

    2016-01-01

    Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

  7. Going direct to the consumer: Examining treatment preferences for veterans with insomnia, PTSD, and depression.

    Science.gov (United States)

    Gutner, Cassidy A; Pedersen, Eric R; Drummond, Sean P A

    2018-05-01

    Inclusion of consumer preferences to disseminate evidence-based psychosocial treatment (EBPT) is crucial to effectively bridge the science-to-practice quality chasm. We examined this treatment gap for insomnia, posttraumatic stress disorder (PTSD), depression, and comorbid symptoms in a sample of 622 young adult veterans through preference in symptom focus, treatment modality, and related gender differences among those screening positive for each problem. Data were collected from veteran drinkers recruited through targeted Facebook advertisements as part of a brief online alcohol intervention. Analyses demonstrated that veterans reported greater willingness to seek insomnia-focused treatment over PTSD- or depression-focused care. Notably, even when participants screened negative for insomnia, they preferred sleep-focused care to PTSD- or depression-focused care. Although one in five veterans with a positive screen would not consider care, veterans screening for both insomnia and PTSD who would consider care had a preference for in-person counseling, and those screening for both insomnia and depression had similar preferences for in-person and mobile app-based/computer self-help treatment. Marginal gender differences were found. Incorporating direct-to-consumer methods into research can help educate stakeholders about methods to expand EBPT access. Though traditional in-person counseling was often preferred, openness to app-based/computer interventions offers alternative methods to provide veterans with EBPTs. Published by Elsevier B.V.

  8. Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment.

    Science.gov (United States)

    Schubart, Jane R; Green, Michael J; Van Scoy, Lauren J; Lehman, Erik; Farace, Elana; Gusani, Niraj J; Levi, Benjamin H

    2015-12-01

    People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment. We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT). This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes). We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT. Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.

  9. Preference for Blocking or Response Redirection during Stereotypy Treatment

    Science.gov (United States)

    Giles, Aimee F.; St. Peter, Claire C.; Pence, Sacha T.; Gibson, Alexandra B.

    2012-01-01

    Response redirection and response blocking reduce stereotypy maintained by automatic reinforcement. The current study evaluated the effects of redirection and response blocking on the stereotypic responding of three elementary-age children diagnosed with autism. During the treatment evaluation, redirection and response blocking were evaluated…

  10. [Treatment of femoral neck fracture--preference to internal fixation].

    Science.gov (United States)

    Minato, Izumi

    2011-03-01

    In the guidelines for the treatment of femoral neck fracture, prosthetic replacement is recommended in displaced one and internal fixation is in undisplaced one. However, in the long view, survived femoral head after internal fixation can be superior to prosthesis which will deteriorate as time goes by. Surgical method should be considered not only by type of fracture but general status of the patient.

  11. Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps.

    Science.gov (United States)

    Vernazza, C R; Steele, J G; Whitworth, J M; Wildman, J R; Donaldson, C

    2015-12-01

    To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  12. Non-communicable disease risk factors and treatment preference of obese patients in Cape Town

    OpenAIRE

    Manning, Kathryn; Senekal, Marjanne; Harbron, Janetta

    2016-01-01

    Background: Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim: To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs) or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG]) versus usual care (individual consultations) treatment. Setting: A primary healthcare facility in Cape Town, South Africa. ...

  13. Preferences for trauma treatment: A systematic review of the empirical literature.

    Science.gov (United States)

    Simiola, Vanessa; Neilson, Elizabeth C; Thompson, Richard; Cook, Joan M

    2015-11-01

    The prevalence of trauma histories and related psychological problems is high in general clinical settings, but little is known about trauma patient preferences for mental health treatment. The purpose of this article is to systematically review and synthesize the literature on treatment preferences in survivors of traumatic events. Studies were identified using comprehensive searches of PsycINFO, Medline, PubMed, Published International Literature on Traumatic Stress, and Cumulative Index to Nursing and Allied Health Literature databases. Included in the review were articles published between January 1980 and September 2014, in English that reported patient preference of treatment for trauma related disorders in either clinical or nonclinical (e.g., analog) samples. The total number of individual participants was 6,091. Of the identified studies, 35 were quantitative and 6 were qualitative. Methodological concerns included the use of analog samples, small sample sizes, and the assessment of a limited number of treatment options (e.g., asking about only 1 type of psychotherapy or medication). Overall, participants expressed a preference for psychotherapy over medication and for talking about their trauma. Understanding and addressing trauma patient preferences may assist in improving treatment initiation as well as facilitate engagement, retention and outcome. (c) 2015 APA, all rights reserved).

  14. Epidemiological and Clinical Baseline Characteristics as Predictive Biomarkers of Response to Anti-VEGF Treatment in Patients with Neovascular AMD

    Directory of Open Access Journals (Sweden)

    Miltiadis K. Tsilimbaris

    2016-01-01

    Full Text Available Purpose. To review the current literature investigating patient response to antivascular endothelial growth factor-A (VEGF therapy in the treatment of neovascular age-related macular degeneration (nAMD and to identify baseline characteristics that might predict response. Method. A literature search of the PubMed database was performed, using the keywords: AMD, anti-VEGF, biomarker, optical coherence tomography, treatment outcome, and predictor. The search was limited to articles published from 2006 to date. Exclusion criteria included phase 1 trials, case reports, studies focusing on indications other than nAMD, and oncology. Results. A total of 1467 articles were identified, of which 845 were excluded. Of the 622 remaining references, 47 met all the search criteria and were included in this review. Conclusion. Several baseline characteristics correlated with anti-VEGF treatment response, including best-corrected visual acuity, age, lesion size, and retinal thickness. The majority of factors were associated with disease duration, suggesting that longer disease duration before treatment results in worse treatment outcomes. This highlights the need for early treatment for patients with nAMD to gain optimal treatment outcomes. Many of the identified baseline characteristics are interconnected and cannot be evaluated in isolation; therefore multivariate analyses will be required to determine any specific relationship with treatment response.

  15. Evidence-Responsiveness and the Ongoing Autonomy of Treatment Preferences.

    Science.gov (United States)

    Weimer, Steven

    2017-06-14

    To be an autonomous agent is to determine one's own path in life. However, this cannot plausibly be seen as a one-off affair. An autonomous agent does not merely set herself on a particular course and then lock the steering wheel in place, so to speak, but must maintain some form of ongoing control over her direction in life-must keep her eyes on the road and her hands on the wheel. Circumstances often change in important and unexpected ways, after all, and it is reasonable to think that a crucial part of autonomy consists of the ability and disposition to recognize and properly respond to such changes. This implies, I contend, that a patient whose initial decision to undergo a given treatment satisfied plausible requirements of autonomy, but who is now unable to recognize that available evidence indicates the need to reconsider her medical situation and options has come to lack autonomy with respect to her desire to continue that treatment. However, and despite its importance with respect to both theoretical understandings of autonomy and applications of the concept to clinical ethics, this ongoing aspect of autonomy has received little attention. This paper aims to go some way toward remedying that. I first critically review two of the few theories of autonomy that do address "evidence-responsiveness" so as to identify and elaborate what I take to be the most promising way in which to account for this aspect of autonomy. After considering and responding to a possible objection to the evidence-responsiveness condition I propose, I conclude by discussing its clinical implications. That condition, I argue, is not merely theoretically sound, but can and should be applied to clinical practice.

  16. Exploring longitudinal course and treatment-baseline severity interactions in secondary outcomes of smoking cessation treatment in individuals with attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Luo, Sean X; Wall, Melanie; Covey, Lirio; Hu, Mei-Chen; Scodes, Jennifer M; Levin, Frances R; Nunes, Edward V; Winhusen, Theresa

    2018-01-25

    A double blind, placebo-controlled randomized trial (NCT00253747) evaluating osmotic-release oral system methylphenidate (OROS-MPH) for smoking-cessation revealed a significant interaction effect in which participants with higher baseline ADHD severity had better abstinence outcomes with OROS-MPH while participants with lower baseline ADHD severity had worse outcomes. This current report examines secondary outcomes that might bear on the mechanism for this differential treatment effect. Longitudinal analyses were conducted to evaluate the effect of OROS-MPH on three secondary outcomes (ADHD symptom severity, nicotine craving, and withdrawal) in the total sample (N = 255, 56% Male), and in the high (N = 134) and low (N = 121) baseline ADHD severity groups. OROS-MPH significantly improved ADHD symptoms and nicotine withdrawal symptoms in the total sample, and exploratory analyses showed that in both higher and lower baseline severity groups, OROS-MPH statistically significantly improved these two outcomes. No effect on craving overall was detected, though exploratory analyses showed statistically significantly decreased craving in the high ADHD severity participants on OROS-MPH. No treatment by ADHD baseline severity interaction was detected for the outcomes. Methylphenidate improved secondary outcomes during smoking cessation independent of baseline ADHD severity, with no evident treatment-baseline severity interaction. Our results suggest divergent responses to smoking cessation treatment in the higher and lower severity groups cannot be explained by concordant divergence in craving, withdrawal and ADHD symptom severity, and alternative hypotheses may need to be identified.

  17. The development of PubMed search strategies for patient preferences for treatment outcomes

    Directory of Open Access Journals (Sweden)

    Ralph van Hoorn

    2016-07-01

    Full Text Available Abstract Background The importance of respecting patients’ preferences when making treatment decisions is increasingly recognized. Efficiently retrieving papers from the scientific literature reporting on the presence and nature of such preferences can help to achieve this goal. The objective of this study was to create a search filter for PubMed to help retrieve evidence on patient preferences for treatment outcomes. Methods A total of 27 journals were hand-searched for articles on patient preferences for treatment outcomes published in 2011. Selected articles served as a reference set. To develop optimal search strategies to retrieve this set, all articles in the reference set were randomly split into a development and a validation set. MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance (e.g. sensitivity (Se and specificity (Sp. Results Of 8238 articles, 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes. The best search filters reached Se of 100 % [95 % CI 100-100] with Sp of 95 % [94–95 %] and Sp of 97 % [97–98 %] with 75 % Se [74–76 %]. In the validation set these queries reached values of Se of 90 % [89–91 %] with Sp 94 % [93–95 %] and Se of 80 % [79–81 %] with Sp of 97 % [96–96 %], respectively. Conclusions Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes. Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment.

  18. The development of PubMed search strategies for patient preferences for treatment outcomes.

    Science.gov (United States)

    van Hoorn, Ralph; Kievit, Wietske; Booth, Andrew; Mozygemba, Kati; Lysdahl, Kristin Bakke; Refolo, Pietro; Sacchini, Dario; Gerhardus, Ansgar; van der Wilt, Gert Jan; Tummers, Marcia

    2016-07-29

    The importance of respecting patients' preferences when making treatment decisions is increasingly recognized. Efficiently retrieving papers from the scientific literature reporting on the presence and nature of such preferences can help to achieve this goal. The objective of this study was to create a search filter for PubMed to help retrieve evidence on patient preferences for treatment outcomes. A total of 27 journals were hand-searched for articles on patient preferences for treatment outcomes published in 2011. Selected articles served as a reference set. To develop optimal search strategies to retrieve this set, all articles in the reference set were randomly split into a development and a validation set. MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance (e.g. sensitivity (Se) and specificity (Sp)). Of 8238 articles, 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes. The best search filters reached Se of 100 % [95 % CI 100-100] with Sp of 95 % [94-95 %] and Sp of 97 % [97-98 %] with 75 % Se [74-76 %]. In the validation set these queries reached values of Se of 90 % [89-91 %] with Sp 94 % [93-95 %] and Se of 80 % [79-81 %] with Sp of 97 % [96-96 %], respectively. Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes. Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment.

  19. Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline

    DEFF Research Database (Denmark)

    Reddel, H. K.; Busse, W. W.; Pedersen, Søren

    2015-01-01

    symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4......-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30...... even in patients with the lowest baseline asthma symptom frequency (0-1 days/week). (Figure Presented)....

  20. The influence of baseline marijuana use on treatment of cocaine dependence: application of an informative-priors Bayesian approach.

    Directory of Open Access Journals (Sweden)

    Charles eGreen

    2012-10-01

    Full Text Available Background: Marijuana use is prevalent among patients with cocaine dependence and often non-exclusionary in clinical trials of potential cocaine medications. The dual-focus of this study was to (1 examine the moderating effect of baseline marijuana use on response to treatment with levodopa/carbidopa for cocaine dependence; and (2 apply an informative-priors, Bayesian approach for estimating the probability of a subgroup-by-treatment interaction effect.Method: A secondary data analysis of two previously published, double-blind, randomized controlled trials provided samples for the historical dataset (Study 1: N = 64 complete observations and current dataset (Study 2: N = 113 complete observations. Negative binomial regression evaluated Treatment Effectiveness Scores (TES as a function of medication condition (levodopa/carbidopa, placebo, baseline marijuana use (days in past 30, and their interaction. Results: Bayesian analysis indicated that there was a 96% chance that baseline marijuana use predicts differential response to treatment with levodopa/carbidopa. Simple effects indicated that among participants receiving levodopa/carbidopa the probability that baseline marijuana confers harm in terms of reducing TES was 0.981; whereas the probability that marijuana confers harm within the placebo condition was 0.163. For every additional day of marijuana use reported at baseline, participants in the levodopa/carbidopa condition demonstrated a 5.4% decrease in TES; while participants in the placebo condition demonstrated a 4.9% increase in TES.Conclusion: The potential moderating effect of marijuana on cocaine treatment response should be considered in future trial designs. Applying Bayesian subgroup analysis proved informative in characterizing this patient-treatment interaction effect.

  1. Measurement of consumer preference for treatments used to induce labour: a willingness-to-pay approach.

    Science.gov (United States)

    Taylor, Susan J.; Armour, Carol L.

    2000-09-01

    AIM: The purpose of the study was to assess the acceptability to consumers of two methods of induction of labour using a willingness-to-pay (WTP) approach. The methods compared were amniotomy plus oxytocin and prostaglandin E2 vaginal gel, followed by oxytocin if necessary. METHODS: A description of each method was presented, in questionnaire format, to pregnant women attending a public hospital ante-natal clinic. Women were asked to choose one of the two treatments, then give a valuation in dollar terms for both their preferred treatment and the alternative. RESULTS: It was found that 73.7% of patients preferred gel. The mean maximum WTP for amniotomy plus oxytocin was Aus$133 while that for gel was Aus$178 (P=0.0001). Those who chose amniotomy plus oxytocin were WTP 90% more for their preferred treatment compared with the alternative (Aus$180 vs. Aus$95). Similarly, those who preferred gel were WTP 90% more for their preferred treatment compared with the alternative (Aus$222 vs. Aus$119). CONCLUSION: Consumers were able to assess drug information provided on the two therapies, make an informed choice and to value that choice. Information obtained in this way, combined with information on costs, could be used in policy decision-making.

  2. Measurement of consumer preference for treatments used to induce labour: a willingness‐to‐pay approach

    Science.gov (United States)

    Taylor, Susan J.; Armour, Carol L.

    2001-01-01

    Aim The purpose of the study was to assess the acceptability to consumers of two methods of induction of labour using a willingness‐to‐pay (WTP) approach. The methods compared were amniotomy plus oxytocin and prostaglandin E2 vaginal gel, followed by oxytocin if necessary. Methods A description of each method was presented, in questionnaire format, to pregnant women attending a public hospital ante‐natal clinic. Women were asked to choose one of the two treatments, then give a valuation in dollar terms for both their preferred treatment and the alternative. Results It was found that 73.7% of patients preferred gel. The mean maximum WTP for amniotomy plus oxytocin was Aus$133 while that for gel was Aus$178 (P=0.0001). Those who chose amniotomy plus oxytocin were WTP 90% more for their preferred treatment compared with the alternative (Aus$180 vs. Aus$95). Similarly, those who preferred gel were WTP 90% more for their preferred treatment compared with the alternative (Aus$222 vs. Aus$119). Conclusion Consumers were able to assess drug information provided on the two therapies, make an informed choice and to value that choice. Information obtained in this way, combined with information on costs, could be used in policy decision‐making. PMID:11281930

  3. The customer is always right? Subjective target symptoms and treatment preferences in patients with psychosis.

    Science.gov (United States)

    Moritz, Steffen; Berna, Fabrice; Jaeger, Susanne; Westermann, Stefan; Nagel, Matthias

    2017-06-01

    Clinicians and patients differ concerning the goals of treatment. Eighty individuals with schizophrenia were assessed online about which symptoms they consider the most important for treatment, as well as their experience with different interventions. Treatment of affective and neuropsychological problems was judged as more important than treatment of positive symptoms (p experience with Occupational and Sports Therapy, only a minority had received Cognitive-Behavioral Therapy, Family Therapy, and Psychoeducation with family members before. Patients appraised Talk, Psychoanalytic, and Art Therapy as well as Metacognitive Training as the most helpful treatments. Clinicians should carefully take into consideration patients' preferences, as neglect of consumers' views may compromise outcome and adherence to treatment.

  4. Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

    Directory of Open Access Journals (Sweden)

    Hernández Susana

    2011-01-01

    Full Text Available Abstract Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression.. The dependent variable being the type of treatment chosen (oral or topical and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.

  5. Clinical preference for factors in treatment of geriatric depression

    Directory of Open Access Journals (Sweden)

    Riepe MW

    2014-12-01

    Full Text Available Matthias W Riepe Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69% returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. Keywords: depressive disorder, symptoms, analytic hierarchy process, toxicity, adverse events, symptoms

  6. Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy.

    Science.gov (United States)

    Norrholm, Seth Davin; Jovanovic, Tanja; Gerardi, Maryrose; Breazeale, Kathryn G; Price, Matthew; Davis, Michael; Duncan, Erica; Ressler, Kerry J; Bradley, Bekh; Rizzo, Albert; Tuerk, Peter W; Rothbaum, Barbara O

    2016-07-01

    Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS). Published by Elsevier Ltd.

  7. The impact of quality of life on treatment preferences in multiple sclerosis patients

    Directory of Open Access Journals (Sweden)

    Lee Mortensen G

    2017-10-01

    Full Text Available Gitte Lee Mortensen,1 Peter V Rasmussen2 1Medical Anthropology Department, AnthroConsult, 2Department of Neurology, University Hospital of Aarhus, Aarhus C, Denmark Introduction: Multiple sclerosis (MS is a demyelinating disorder with an unpredictable and often disabling course. MS symptoms are very heterogeneous and may lead to reduced physical, cognitive, and psychosocial functioning decreasing patients’ quality of life (QoL. Today, various disease-modifying treatments (DMTs may prevent disease progression. However, it is increasingly complex to select the right therapy for a given patient and patient preferences should be considered when making treatment decisions. This study aimed to explore the main factors affecting patients’ preferences regarding MS treatment and health care.Methods: Five qualitative focus group interviews were carried out with a total of 40 participants from across Denmark. A semistructured question guide included questions that were identified in a systematic literature study about QoL and treatment preferences in patients with MS. The participants were asked to describe their disease experiences, their health-related QoL, and reasons behind their preferences with regard to treatment and care. The data were analyzed using content analysis and a constructivist approach.Results: The participants’ physical, cognitive, and psychosocial QoL and functioning were reduced by disease symptoms, treatment side effects, and mode of administration. Their ability to uphold meaningful role functioning was crucial to their treatment priorities. The preeminence of anticipated efficacy, ie, the patients’ hope that DMT might prevent disease deterioration in the future, was modified by their present QoL and functioning when ultimately framing their treatment preferences. There was an unmet information and support need from neurology clinics, particularly at the time of diagnosis.Conclusion: The participants’ treatment preferences

  8. Hypertension Treatment and Concern About Falling: Baseline Data from the Systolic Blood Pressure Intervention Trial.

    Science.gov (United States)

    Berlowitz, Dan R; Breaux-Shropshire, Tonya; Foy, Capri G; Gren, Lisa H; Kazis, Lewis; Lerner, Alan J; Newman, Jill C; Powell, James R; Riley, William T; Rosman, Robert; Wadley, Virginia G; Williams, Julie A

    2016-11-01

    To determine the extent of concern about falling in older adults with hypertension, whether lower blood pressure (BP) and greater use of antihypertensive medications are associated with greater concern about falling, and whether lower BP has a greater effect on concern about falling in older and more functionally impaired individuals. Secondary analysis involving cross-sectional study of baseline characteristics of participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Approximately 100 outpatient sites. SPRINT enrollees aged 50 and older (mean age 69) diagnosed with hypertension (N = 2,299). Concern about falling was determined using the shortened version of the Falls Efficacy Scale International as measured at the baseline examination. Mild concern about falling was present in 29.3% of participants and moderate to severe concern in 17.9%. Neither low BP (systolic BPconcern about falling (P > .10). Participants with moderate to severe concern about falling were taking significantly more antihypertensive medications than those with mild or no concern. After adjusting for baseline characteristics, no associations were evident between BP, medications, and concern about falling. Results were similar in older and younger participants; interactions between BP and age and functional status were not significantly associated with concern about falling. Although concern about falling is common in older adults with hypertension, it was not found to be associated with low BP or use of more antihypertensive medications in baseline data from SPRINT. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  9. Substance use disorders and PTSD: an exploratory study of treatment preferences among military veterans.

    Science.gov (United States)

    Back, Sudie E; Killeen, Therese K; Teer, Andrew P; Hartwell, Emily E; Federline, Amanda; Beylotte, Frank; Cox, Elizabeth

    2014-02-01

    Substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD) frequently co-occur among Veterans and are associated with poor treatment outcomes. Historically, treatments for SUDs and PTSD have been delivered sequentially and independently. More recently, however, integrated treatments have shown promise. This study investigated Veterans' perceptions of the interrelationship between SUDs and PTSD, as well as treatment preferences. Participants were 35 Veterans of recent military conflicts in Iraq and Afghanistan, and prior operations, who completed the Treatment Preferences Questionnaire as well as an in-depth interview. The majority (94.3%) perceived a relationship between their SUD and PTSD symptoms. Veterans reported that PTSD symptom exacerbation was typically (85.3%) associated with an increase in substance use, and PTSD symptom improvement was typically (61.8%) followed by a decrease in substance use (pdevelopment and provision of care for Veterans with SUDs and PTSD. Published by Elsevier Ltd.

  10. Advance statements for borderline personality disorder: a qualitative study of future crisis treatment preferences.

    Science.gov (United States)

    Borschmann, Rohan; Trevillion, Kylee; Henderson, R Claire; Rose, Diana; Szmukler, George; Moran, Paul

    2014-06-01

    Little is known about the crisis treatment preferences of people with borderline personality disorder. Clinicians may also question service users' ability to make considered decisions about their treatment when in crisis. Therefore, this qualitative study aimed to investigate crisis treatment preferences of a sample of community-dwelling adults with borderline personality disorder. Participants were 41 adults with borderline personality disorder who had created joint crisis plans during a randomized controlled trial. Data from all 41 joint crisis plans were analyzed iteratively via a thematic analysis framework. Participants gave clear statements in their crisis plans relating to the desire to recover from the crisis and to improve their social functioning. Key themes included the desire to be treated with dignity and respect and to receive emotional and practical support from clinicians. Many participants spoke of the importance of connecting with others during periods of crisis, but several reported a clear desire to be left alone during a future crisis. Other themes concerned preferences for specific treatment refusals during crises, including particular types of psychotropic medication and involuntary treatment. The variation of participants' preferences underscores the importance of developing individually tailored crisis plans for people with borderline personality disorder. The need to be treated with dignity and respect and to be given autonomy in decision making--also identified in global surveys of people with severe mental illness--is important to people with borderline personality disorder. Key messages for clinicians, service users, and policy makers, in addition to staff training issues, are discussed.

  11. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

    Directory of Open Access Journals (Sweden)

    Jemimah Ride

    Full Text Available Perinatal depression and anxiety (PNDA are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  12. Women's Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment.

    Science.gov (United States)

    Ride, Jemimah; Lancsar, Emily

    2016-01-01

    Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women's preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women's sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families.

  13. Women’s Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment

    Science.gov (United States)

    Ride, Jemimah; Lancsar, Emily

    2016-01-01

    Perinatal depression and anxiety (PNDA) are an international healthcare priority, associated with significant short- and long-term problems for women, their children and families. Effective treatment is available but uptake is suboptimal: some women go untreated whilst others choose treatments without strong evidence of efficacy. Better understanding of women’s preferences for treatment is needed to facilitate uptake of effective treatment. To address this issue, a discrete choice experiment (DCE) was administered to 217 pregnant or postnatal women in Australia, who were recruited through an online research company and had similar sociodemographic characteristics to Australian data for perinatal women. The DCE investigated preferences regarding cost, treatment type, availability of childcare, modality and efficacy. Data were analysed using logit-based models accounting for preference and scale heterogeneity. Predicted probability analysis was used to explore relative attribute importance and policy change scenarios, including how these differed by women’s sociodemographic characteristics. Cost and treatment type had the greatest impact on choice, such that a policy of subsidising effective treatments was predicted to double their uptake compared with the base case. There were differences in predicted uptake associated with certain sociodemographic characteristics: for example, women with higher educational attainment were more likely to choose effective treatment. The findings suggest policy directions for decision makers whose goal is to reduce the burden of PNDA on women, their children and families. PMID:27258096

  14. Rorschach Inkblot Method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Andersen, Palle Bent; Knudsen, Per Bjerregaard

    2012-01-01

    Background: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. Aims: To describe relevant...... Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other...... outcome measures [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Strauss-Carpenter and socio-demographic variables]. Methods: In a prospective study, 34 patients consecutively admitted to treatment for a first episode of schizophrenia were tested using Exner...

  15. Patient-Centered Outcomes and Treatment Preferences Regarding Sexual Problems: A Qualitative Study Among Midlife Women.

    Science.gov (United States)

    Thomas, Holly N; Hamm, Megan; Hess, Rachel; Borrero, Sonya; Thurston, Rebecca C

    2017-08-01

    Sexual dysfunction is common in midlife women and can have a significant negative impact on quality of life. Although treatments exist, there is little research on which sexual function outcomes and treatments midlife women prefer. To better understand the sexual function outcomes that were most important to sexually active women 45 to 60 years old and the types of treatments they would prefer from individual interviews and focus groups. Twenty individual interviews and three focus groups (N = 39) were led by a trained facilitator, audio recorded, and transcribed. Two investigators developed a codebook, and the primary investigator coded all data. A second investigator coded five randomly selected interviews to ensure intercoder reliability. Codes relating to outcomes and treatment preferences were examined to identify central themes. The mean age was 52.8 years (range = 45-59). When asked what they would want a sexual dysfunction treatment to do, women sought solutions to specific sexual problems: low desire, vaginal pain and dryness, and decreased arousal or ability to achieve orgasm. However, when asked about the most important aspect of their sex life, most women indicated emotional outcomes, such as enhanced intimacy with their partner, were most important to them. Most women preferred behavioral over pharmaceutical treatments, citing concerns about side effects. These women felt that behavioral treatments might be better equipped to address physical and psychological aspects of sexual problems. This study highlights the importance of considering not only physical but also emotional outcomes when evaluating and treating sexual dysfunction in midlife women. It also emphasizes the importance of developing behavioral treatments in addition to pharmaceutical treatments. By using a qualitative approach, this study allowed women the time and space to speak their own words about their experiences with sexuality at midlife. In addition, different racial and ethnic

  16. Patient Preferences for Device-Aided Treatments Indicated for Advanced Parkinson Disease.

    Science.gov (United States)

    Marshall, Thomas; Pugh, Amy; Fairchild, Angelyn; Hass, Steven

    2017-12-01

    Effective treatment for advanced Parkinson disease (PD) uncontrolled with oral medication includes device-aided therapies such as deep brain stimulation (DBS) and continuous levodopa-carbidopa infusion to the duodenum via a portable pump. Our objective was to quantify patient preferences for attributes of these device-aided treatments. We administered a Web-enabled survey to 401 patients in the United States. A discrete-choice experiment (DCE) was used to evaluate patients' willingness to accept tradeoffs among efficacy, tolerability, and convenience of alternative treatments. DCE data were analyzed using random-parameters logit. Best-worst scaling (BWS) was used to elicit the relative importance of device-specific attributes. Conditional logit was used to analyze the BWS data. We tested for differences in preferences among subgroups of patients. Improving ability to think clearly was twice as important as a 6-hour-per-day improvement in control of movement symptoms. After controlling for efficacy, treatment delivered via portable infusion pump was preferred over DBS, and both devices were preferred to oral therapy with poor symptom control. Patients were most concerned about device attributes relating to risk of stroke, difficulty thinking, and neurosurgery. Avoiding surgery to insert a wire in the brain was more important than avoiding surgery to insert a tube into the small intestine. Some differences in preferences among subgroups were statistically, but not qualitatively, significant. This study clarifies the patient perspective in therapeutic choices for advanced PD. These findings may help improve communication between patients and providers and also provide evidence on patient preferences to inform regulatory and access decisions. Copyright © 2017. Published by Elsevier Inc.

  17. Patients prefer pictures to numbers to express cardiovascular benefit from treatment.

    Science.gov (United States)

    Goodyear-Smith, Felicity; Arroll, Bruce; Chan, Lydia; Jackson, Rod; Wells, Sue; Kenealy, Timothy

    2008-01-01

    This study aimed to determine which methods of expressing a preventive medication's benefit encourage patients with known cardiovascular disease to decide to take the medication and which methods patients prefer. We identified patients in Auckland, New Zealand, family practices located in areas of differing socioeconomic status who had preexisting heart disease (myocardial infarction, angina, or both) and were taking statins. The patients were interviewed about their preference for methods of expressing the benefit of a hypothetical medication. Benefits were expressed numerically (relative risk, absolute risk, number needed to treat, odds ratio, natural frequency) and graphically. Statistical testing was adjusted for practice. We interviewed 100 eligible patients, representing a 53% response rate. No matter how the risk was expressed, the majority of patients indicated they would be encouraged to take the medication. Two-thirds (68) of the patients preferred 1 method of expressing benefit over others. Of this group, 57% preferred the information presented graphically. This value was significantly greater (P framing preferred positive framing (description of the benefit of treatment) over negative framing (description of the harm of not being treated). Although number needed to treat is a useful tool for communicating risk and benefit to clinicians, this format was the least likely to encourage patients to take medication. As graphical representation of benefit was the method patients preferred most, consideration should be given to developing visual aids to support shared clinical decision making.

  18. Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

    NARCIS (Netherlands)

    Thys, S. D.; Roovers, J. P.; Geomini, P. M.; Bongers, M. Y.

    2012-01-01

    Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our

  19. Patients' preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

    NARCIS (Netherlands)

    Jansen, S. J.; Kievit, J.; Nooij, M. A.; de Haes, J. C.; Overpelt, I. M.; van Slooten, H.; Maartense, E.; Stiggelbout, A. M.

    2001-01-01

    When making decisions about adjuvant chemotherapy for early-stage breast cancer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of the present study were: (1) to determine the minimum benefits that patients

  20. Attitudes and preferences in patients with acromegaly on long-term treatment with somatostatin analogues

    Directory of Open Access Journals (Sweden)

    Cecilia Follin

    2016-08-01

    Full Text Available Introduction: Patients with acromegaly can be treated with surgery, medical therapy and/or radiation therapy. For the patients not being cured with surgery, treatment with somatostatin analogues (SSAs is the primary therapy. SSA can be taken by self- or partner-administered injections in addition to being given by a nurse at a clinic. The aim was to assess if patients with acromegaly prefer self-injections and to investigate their attitudes towards long-term medical therapy. Method: All patients in the southern medical region of Sweden with a diagnosis of acromegaly and treated with SSA were eligible for the study (n = 24. The study is based on a questionnaire asking about the patients’ attitudes and preferences for injections with SSA, including their attitudes towards self-injection with SSA. Results: The patients’ (23 included median age was 68.5 years and the patients had been treated with SSA for 13 (1–38 years. One patient was currently self-injecting. All of the other patients were receiving injections from a nurse at a clinic. Three patients preferred self-injections, one preferred partner injections and 19 patients did not prefer self- or partner injections. The most frequent arguments to not preferring self-injections were ‘feeling more secure with an educated nurse’ and ‘preferring regular contact with a specialised nurse’. Conclusion: Patients with acromegaly prefer regular contact with the endocrine team to the independence offered by self-injections. These findings might mirror the patients’ desires for continuity and safety. We need to address patients’ concerns regarding injections with SSA and support them in their choices.

  1. Elevated baseline serum glutamate as a pharmacometabolomic biomarker for acamprosate treatment outcome in alcohol-dependent subjects

    Science.gov (United States)

    Nam, H W; Karpyak, V M; Hinton, D J; Geske, J R; Ho, A M C; Prieto, M L; Biernacka, J M; Frye, M A; Weinshilboum, R M; Choi, D-S

    2015-01-01

    Acamprosate has been widely used since the Food and Drug Administration approved the medication for treatment of alcohol use disorders (AUDs) in 2004. Although the detailed molecular mechanism of acamprosate remains unclear, it has been largely known that acamprosate inhibits glutamate action in the brain. However, AUD is a complex and heterogeneous disorder. Thus, biomarkers are required to prescribe this medication to patients who will have the highest likelihood of responding positively. To identify pharmacometabolomic biomarkers of acamprosate response, we utilized serum samples from 120 alcohol-dependent subjects, including 71 responders (maintained continuous abstinence) and 49 non-responders (any alcohol use) during 12 weeks of acamprosate treatment. Notably, baseline serum glutamate levels were significantly higher in responders compared with non-responders. Importantly, serum glutamate levels of responders are normalized after acamprosate treatment, whereas there was no significant glutamate change in non-responders. Subsequent functional studies in animal models revealed that, in the absence of alcohol, acamprosate activates glutamine synthetase, which synthesizes glutamine from glutamate and ammonia. These results suggest that acamprosate reduces serum glutamate levels for those who have elevated baseline serum glutamate levels among responders. Taken together, our findings demonstrate that elevated baseline serum glutamate levels are a potential biomarker associated with positive acamprosate response, which is an important step towards development of a personalized approach to treatment for AUD. PMID:26285131

  2. TOWARDS PATIENT-CENTERED CARE FOR DEPRESSION: CONJOINT METHODS TO TAILOR TREATMENT BASED ON PREFERENCES

    OpenAIRE

    Wittink, Marsha N.; Cary, Mark; TenHave, Thomas; Baron, Jonathan; Gallo, Joseph J.

    2010-01-01

    Background: Although antidepressants and counseling have been shown to be effective in treating patients with depression, non-treatment or under-treatment for depression is common, especially among the elderly and minorities. Previous work on patient preferences has focused on medication versus counseling, but less is known about the value that patients place on attributes of medication and counseling. Objective: To examine, using conjoint analysis, the relative importance of various attribut...

  3. Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections.

    Science.gov (United States)

    Reed, Jennifer L; Huppert, Jill S; Gillespie, Gordon L; Taylor, Regina G; Holland, Carolyn K; Alessandrini, Evaline A; Kahn, Jessica A

    2015-01-01

    Important barriers to addressing the sexually transmitted infection (STI) epidemic among adolescents are the inadequate partner notification of positive STI results and insufficient rates of partner testing and treatment. However, adolescent attitudes regarding partner notification and treatment are not well understood. The aim was to qualitatively explore the barriers to and preferences for partner notification and treatment among adolescent males and females tested for STIs in an emergency department (ED) setting and to explore the acceptability of ED personnel notifying their sexual partners. This was a descriptive, qualitative study in which a convenience sample of 40 adolescents (18 females, 22 males) 14 to 21 years of age who presented to either adult or pediatric EDs with STI-related complaints participated. Individualized, semistructured, confidential interviews were administered to each participant. Interviews were audiotaped and transcribed verbatim by an independent transcriptionist. Data were analyzed using framework analysis. Barriers to partner notification included fear of retaliation or loss of the relationship, lack of understanding of or concern for the consequences associated with an STI, and social stigma and embarrassment. Participants reported two primary barriers to their partners obtaining STI testing and treatment: lack of transportation to the health care site and the partner's fear of STI positive test results. Most participants preferred to notify their main sexual partners of an STI exposure via a face-to-face interaction or a phone call. Most participants were agreeable with a health care provider (HCP) notifying their main sexual partners of STI exposure and preferred that the HCP notify the partner by phone call. There are several adolescent preferences and barriers for partner notification and treatment. To be most effective, future interventions to prevent adolescent STIs should incorporate these preferences and address the

  4. Baseline Body Mass Index and the Efficacy of Hypoglycemic Treatment in Type 2 Diabetes: A Meta-Analysis

    Science.gov (United States)

    Cai, Xiaoling; Yang, Wenjia; Gao, Xueying; Zhou, Lingli; Han, Xueyao; Ji, Linong

    2016-01-01

    Aim The aim of this study is to compare the effects of hypoglycemic treatments in groups of patients categorized according to the mean baseline body mass indexes (BMIs). Methods Studies were identified by a literature search and all the studies were double blind, placebo-controlled randomized trials in type 2 diabetes patients; study length of ≥12 weeks with the efficacy evaluated by changes in HbA1c from baseline in groups. The electronic search was first conducted in January 2015 and repeated in June 2015. Results 227 studies were included. Treatment with sulfonylureas was compared with placebo in overweight patients and resulted in a significantly greater change in the HbA1c levels (weighted mean difference (WMD), −1.39%) compared to obese patients (WMD, −0.77%)(p0.05). Treatment with alpha glucosidase inhibitors in normal weight patients was associated with a HbA1c change (WMD, −0.94%) that was comparable that in overweight (WMD, −0.72%) and obese patients (WMD, −0.56%)(p>0.05). Treatment with thiazolidinediones in normal weight patients was associated with a HbA1c change (WMD, −1.04%) that was comparable with that in overweight (WMD, −1.02%) and obese patients (WMD, −0.88%)(p>0.05). Treatment with DPP-4 inhibitors in normal weight patients was associated with a HbA1c change (WMD, −0.93%) that was comparable with that in overweight (WMD, −0.66%) and obese patients (WMD, −0.61%)(p>0.05). In total, of the seven hypoglycemic agents, regression analysis indicated that the mean baseline BMI was not associated with the mean HbA1c changes from baseline. Conclusion In each kind of hypoglycemic therapy in type 2 diabetes, the baseline BMI was not associated with the efficacy of HbA1c changes from baseline. PMID:27935975

  5. What determines providers' stated preference for the treatment of uncomplicated malaria?

    Science.gov (United States)

    Mangham-Jefferies, Lindsay; Hanson, Kara; Mbacham, Wilfred; Onwujekwe, Obinna; Wiseman, Virginia

    2014-03-01

    As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay. 518 providers working at non-profit health facilities and for-profit pharmacies and drug stores in Yaoundé and Bamenda in Cameroon and in Enugu State in Nigeria were surveyed between July and December 2009 to elicit the antimalarial they prefer to supply for uncomplicated malaria. Multilevel modelling was used to determine the effect of financial and non-financial incentives on their preference, while controlling for information and institutional constraints, and accounting for the clustering of providers within facilities and geographic areas. 69% of providers stated a preference for artemisinin-combination therapy (ACT), which is the recommended treatment for uncomplicated malaria in Cameroon and Nigeria. A preference for ACT was significantly associated with working at a for-profit facility, reporting that patients prefer ACT, and working at facilities that obtain antimalarials from drug company representatives. Preferences were similar among colleagues within a facility, and among providers working in the same locality. Knowing the government recommends ACT was a significant predictor, though having access to clinical guidelines was not sufficient. Providers are agents serving multiple principals and their preferences over alternative antimalarials were influenced by patients, drug company representatives, and other providers working at the

  6. Quantifying women's stated benefit-risk trade-off preferences for IBS treatment outcomes.

    Science.gov (United States)

    Johnson, F Reed; Hauber, A Brett; Ozdemir, Semra; Lynd, Larry

    2010-01-01

    The Food and Drug Administration, currently, is exploring quantitative benefit-risk methods to support regulatory decision-making. A scientifically valid method for assessing patients' benefit-risk trade-off preferences is needed to compare risks and benefits in a common metric. The study aims to quantify the maximum acceptable risk (MAR) of treatment-related adverse events (AEs) that women with diarrhea-predominant irritable bowel syndrome (IBS) are willing to accept in exchange for symptom relief. A stated-choice survey was used to elicit trade-off preferences among constructed treatment profiles, each defined by symptom severity and treatment-related AEs. Symptom attributes included frequency of abdominal pain and discomfort, frequency of diarrhea, and frequency of urgency. AE attributes included frequency of mild-to-moderate constipation and the risk of four possible serious AEs. A Web-enabled survey was administered to 589 female US residents at least 18 years of age with a self-reported diagnosis of diarrhea-predominant IBS. Preference weights and MAR were estimated using mixed-logit methods. SUBJECTS were willing to accept higher risks of serious AEs in return for treatments offering better symptom control. For an improvement from the lowest to the highest of four benefit levels, subjects were willing to tolerate a 2.65% increase in impacted-bowel risk, but only a 1.34% increase in perforated-bowel risk. Variation in MARs across AE types is consistent with the relative seriousness of the AEs. Stated-preference methods offer a scientifically valid approach to quantifying benefit-risk trade-off preferences that can be used to inform regulatory decision-making.

  7. Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries.

    Science.gov (United States)

    Teo, Alan R; Fetters, Michael D; Stufflebam, Kyle; Tateno, Masaru; Balhara, Yatan; Choi, Tae Young; Kanba, Shigenobu; Mathews, Carol A; Kato, Takahiro A

    2015-02-01

    Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking. To identify individuals with hikikomori in multiple countries and describe features of the condition. Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index. A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features. Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment. © The Author(s) 2014.

  8. The effect of support on Internet-delivered treatment for insomnia: Does baseline depression severity matter?

    NARCIS (Netherlands)

    Lancee, J.; Sorbi, M.J.; Eisma, M.C.; van Straten, A.; van den Bout, J.

    2014-01-01

    Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we

  9. Changing Patients' Treatment Preferences and Values with a Decision Aid for Type 2 Diabetes Mellitus: Results from the Treatment Arm of a Randomized Controlled Trial.

    Science.gov (United States)

    Bailey, Robert A; Shillington, Alicia C; Harshaw, Qing; Funnell, Martha M; VanWingen, Jeffrey; Col, Nananda

    2018-04-01

    Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options. Participants' preferences for treatment, decision-making, and the relative importance they placed on various values related to treatment options (e.g., dosing, weight gain, side effects) were assessed before and after interacting with the PDA. Changes from baseline were calculated (post-PDA minus pre-PDA difference) and assessed in univariate generalized linear models exploring associations with patients' personal values. Analyses included 114 diverse patients from 27 clinics across the US. The importance of avoiding injections, concern about hypoglycemia, and taking medications only once a day significantly decreased after interacting with the PDA [- 1.1 (p = 0.002), - 1.3 (p values-focused PDA for T2DM medication intensification prepared patients to make a shared decision with their clinician and changed patients' values regarding what was important in making that decision. Helping patients understand their options and underlying values can promote shared decision-making and may reduce clinical inertia delaying treatment intensification. Janssen Scientific Affairs, LLC.

  10. Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification.

    Science.gov (United States)

    Kenney, Shannon R; Bailey, Genie L; Anderson, Bradley J; Stein, Michael D

    2017-10-01

    An individual's self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one's perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Participants (N=397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user's desire for MAT. An effective continuum of care model may benefit from greater attention to patient's perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery. Copyright © 2017. Published by Elsevier Ltd.

  11. PTSD in Latino patients: illness beliefs, treatment preferences, and implications for care.

    Science.gov (United States)

    Eisenman, David P; Meredith, Lisa S; Rhodes, Hilary; Green, Bonnie L; Kaltman, Stacey; Cassells, Andrea; Tobin, Jonathan N

    2008-09-01

    Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. Semi-structured, face-to-face interviews. Sixty foreign-born, Latino adults recruited from five primary care centers in New York and New Jersey and screened for PTSD. Content analytic methods identified common themes, their range, and most frequent or typical responses. Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was "sad" (triste). Other words frequently volunteered were "angry" (enojada), "nervous" (nerviosa), and "scared" (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the "stress" from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was "in the past." Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.

  12. Patient and parent preferences for characteristics of prophylactic treatment in hemophilia

    Directory of Open Access Journals (Sweden)

    Furlan R

    2015-11-01

    Full Text Available Roberto Furlan,1 Sangeeta Krishnan,2 Jeffrey Vietri3 1Advanced Methods, Kantar Health, Epsom, Surrey, UK; 2Global Health Economics and Outcomes Research, Biogen, MA, USA; 3Health Outcomes, Kantar Health, Milan, Italy Introduction: New longer-acting factor products will potentially allow for less frequent infusion in prophylactic treatment of hemophilia. However, the role of administration frequency relative to other treatment attributes in determining preferences for prophylactic hemophilia treatment regimens is not well understood. Aim: To identify the relative importance of frequency of administration, efficacy, and other treatment characteristics among candidates for prophylactic treatment for hemophilia A and B. Method: An Internet survey was conducted among hemophilia patients and the parents of pediatric hemophilia patients in Australia, Canada, and the US. A monadic conjoint task was included in the survey, which varied frequency of administration (three, two, or one time per week for hemophilia A; twice weekly, weekly, or biweekly for hemophilia B, efficacy (no bleeding or breakthrough bleeding once every 4 months, 6 months, or 12 months, diluent volume (3 mL vs 2.5 mL for hemophilia A; 5 mL vs 3 mL for hemophilia B, vials per infusion (2 vs 1, reconstitution device (assembly required vs not, and manufacturer (established in hemophilia vs not. Respondents were asked their likelihood to switch from their current regimen to the presented treatment. Respondents were told to assume that other aspects of treatment, such as risk of inhibitor development, cost, and method of distribution, would remain the same. Results: A total of 89 patients and/or parents of children with hemophilia A participated; another 32 were included in the exercise for hemophilia B. Relative importance was 47%, 24%, and 18% for frequency of administration, efficacy, and manufacturer, respectively, in hemophilia A; analogous values were 48%, 26%, and 21% in

  13. Antipsychotic drug treatment for patients with schizophrenia: theoretical background, clinical considerations and patients preferences

    DEFF Research Database (Denmark)

    Nielsen, René Ernst; Nielsen, Jimmi

    2009-01-01

      The cornerstone in treatment of psychosis is antipsychotic drugs. Treatment options have increased over the years; newer antipsychotic drugs with a proposed efficacy regarding negative and cognitive symptoms, but also a shift in side-effects from neurological side-effects to metabolic side......-effects have arisen as the new challenge. The basis of successful pharmacological treatment is a fundamental understanding of the mechanisms of action, the desired effects and side-effects of antipsychotic drugs, a good relationship with the patient and a thorough monitoring of the patient before and during...... treatment. The clinically relevant aspects of antipsychotic drug treatment are reviewed; mechanism of antipsychotic drug action, clinical considerations in treatment, switching antipsychotic drugs, polypharmacy, safety and patient preference.  ...

  14. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists

    NARCIS (Netherlands)

    Hifinger, M.; Hiligsmann, M.; Ramiro, S.; Watson, V.; Severens, J. L.; Fautrel, B.; Uhlig, T.; van Vollenhoven, R.; Jacques, P.; Detert, J.; Canas da Silva, J.; Scirè, C. A.; Berghea, F.; Carmona, L.; Péntek, M.; Keat, A.; Boonen, A.

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with

  15. Patient preferences for important attributes of bipolar depression treatments: a discrete choice experiment

    Directory of Open Access Journals (Sweden)

    Ng-Mak D

    2017-12-01

    Full Text Available Daisy Ng-Mak,1 Jiat-Ling Poon,2 Laurie Roberts,2 Leah Kleinman,2 Dennis A Revicki,2 Krithika Rajagopalan1 1Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, 2Patient-Centered Research, Evidera, Bethesda, MD, USA Purpose: The purpose of this study was to assess patient preferences regarding pharmacological treatment attributes for bipolar depression using a discrete choice experiment (DCE.Methods: Adult members of an Internet survey panel with a self-reported diagnosis of bipolar depression were invited via e-mail to participate in a web-based DCE survey. Participants were asked to choose between hypothetical medication alternatives defined by attributes and levels that were varied systematically. The six treatment attributes included in the DCE were time to improvement, risk of becoming manic, weight gain, risk of sedation, increased blood sugar, and increased cholesterol. Attributes were supported by literature review, expert input, and results of focus groups with patients. Sawtooth CBC System for Choice-Based Conjoint Analysis was used to estimate the part-worth utilities for the DCE analyses.Results: The analytical sample included 185 participants (50.8% females from a total of 200 participants. The DCE analyses found weight gain to be the most important treatment attribute (relative importance =49.6%, followed by risk of sedation (20.2%, risk of mania (13.0%, increased blood sugar (8.3%, increased cholesterol (5.2%, and time to improvement (3.7%.Conclusion: Results from this DCE suggest that adults with bipolar depression considered risks of weight gain and sedation associated with pharmacotherapy as the most important attributes for the treatment of bipolar depression. Incorporating patient preferences in the treatment decision-making process may potentially have an impact on treatment adherence and satisfaction and, ultimately, patient outcomes. Keywords: bipolar depression, treatment

  16. Patients' Preferences Related to Benefits, Risks, and Formulations of Schizophrenia Treatment.

    Science.gov (United States)

    Levitan, Bennett; Markowitz, Michael; Mohamed, Ateesha F; Johnson, F Reed; Alphs, Larry; Citrome, Leslie; Bridges, John F P

    2015-07-01

    The objective of this study was to quantify patients' preferences related to benefits and risks of antipsychotic treatments for schizophrenia and to assess the relative importance of treatment attributes and adherence. Treatment-related preferences among U.S. residents with a self-reported physician diagnosis of schizophrenia were assessed via a discrete-choice experiment. Patients chose between competing hypothetical scenarios characterized by improvements in positive symptoms, negative symptoms, and social functioning; incidence of weight gain, extrapyramidal symptoms (EPS), hyperprolactinemia, and hyperglycemia; and medication formulation. Preferences were estimated by using a random-parameters logit model, and the impact of adherence was estimated with conditional logit models. The final sample consisted of 271 patients. Complete improvement in positive symptoms was the most preferred outcome (relative importance score of 10.0), followed by elimination of hyperglycemia (3.6, 95% confidence interval [CI]=2.6-4.6), improvement in negative symptoms (3.0, CI=1.6-4.3), reduced weight gain (2.6, CI=1.2-4.0), avoidance of hyperprolactinemia (1.7, CI=.9-2.6), improved social functioning (1.5, CI=.4-2.5), and avoidance of EPS (1.0, CI=.3-1.8). Patients judged a daily pill superior to monthly injections (p<.01) and monthly injections superior to injections every three months (p<.01) for adherent patients and monthly injections superior to a daily pill for nonadherent patients (p=.01). Persons who self-identified as having schizophrenia judged improvement in positive symptoms as the most important treatment benefit. Hyperglycemia was identified as the most important adverse event. Patients judged oral formulations to be better than monthly injections for adherent patients and monthly injections to be a better choice for nonadherent patients.

  17. Baseline predictors of persistence to first disease-modifying treatment in multiple sclerosis.

    Science.gov (United States)

    Zettl, U K; Schreiber, H; Bauer-Steinhusen, U; Glaser, T; Hechenbichler, K; Hecker, M

    2017-08-01

    Patients with multiple sclerosis (MS) require lifelong therapy. However, success of disease-modifying therapies is dependent on patients' persistence and adherence to treatment schedules. In the setting of a large multicenter observational study, we aimed at assessing multiple parameters for their predictive power with respect to discontinuation of therapy. We analyzed 13 parameters to predict discontinuation of interferon beta-1b treatment during a 2-year follow-up period based on data from 395 patients with MS who were treatment-naïve at study onset. Besides clinical characteristics, patient-related psychosocial outcomes were assessed as well. Among patients without clinically relevant fatigue, males showed a higher persistence rate than females (80.3% vs 64.7%). Clinically relevant fatigue scores decreased the persistence rate in men and especially in women (71.4% and 51.2%). Besides gender and fatigue, univariable and multivariable analyses revealed further factors associated with interferon beta-1b therapy discontinuation, namely lower quality of life, depressiveness, and higher relapse rate before therapy initiation, while higher education, living without a partner, and higher age improved persistence. Patients with higher grades of fatigue and depressiveness are at higher risk to prematurely discontinue MS treatment; especially, women suffering from fatigue have an increased discontinuation rate. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Efficacy, safety, and patient preference of monoamine oxidase B inhibitors in the treatment of Parkinson's disease.

    Science.gov (United States)

    Robottom, Bradley J

    2011-01-20

    Parkinson's disease (PD) is the second most common neurodegenerative disease and the most treatable. Treatment of PD is symptomatic and generally focuses on the replacement or augmentation of levodopa. A number of options are available for treatment, both in monotherapy of early PD and to treat complications of advanced PD. This review focuses on rasagiline and selegiline, two medications that belong to a class of antiparkinsonian drugs called monoamine oxidase B (MAO-B) inhibitors. Topics covered in the review include mechanism of action, efficacy in early and advanced PD, effects on disability, the controversy regarding disease modification, safety, and patient preference for MAO-B inhibitors.

  19. Impact of medical treatment on lung diffusion capacity in elderly patients with heart failure. Baseline characteristics and 1-year follow up after medical treatment

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Kjaer, Andreas

    2005-01-01

    treatment (baseline) and after 1 year of treatment with diuretics and ACE-inhibitors/angiotensin-II receptor antagonists. Age- and gender-matched healthy volunteers were included as control group. RESULTS: (mean+/-S.E.M.): K(CO) at baseline was 0.95+/-0.06 and 1.25+/-0.04 mmol/min x kPa/l in HF patients......AIM: The aim of this investigation was (1) to study the effect of untreated chronic heart failure (CHF) on alveolar membrane diffusion capacity (transfer coefficient, K(CO)) in elderly patients and (2) to study the impact of the standard regime of medical treatment with diuretics and ACE......-inhibitor/angiotensin-II receptor antagonists on K(CO) in these patients. METHODS: Non-medicated patients (except for diuretics) with symptoms of heart failure (NYHA II-III) and echocardiographically estimated left ventricular ejection fraction (LVEF)

  20. Host feeding patterns and preference of Anopheles minimus (Diptera: Culicidae) in a malaria endemic area of western Thailand: baseline site description.

    Science.gov (United States)

    Tisgratog, Rungarun; Tananchai, Chatchai; Juntarajumnong, Waraporn; Tuntakom, Siripun; Bangs, Michael J; Corbel, Vincent; Chareonviriyaphap, Theeraphap

    2012-06-07

    Host feeding patterns of Anopheles minimus in relation to ambient environmental conditions were observed during a 2-year period at Tum Sua Village, located in Mae Sot District, Tak Province, in western Thailand, where An. minimus is found in abundance and regarded as the most predominant malaria vector species. Detailed information on mosquito behavior is important for understanding the epidemiology of disease transmission and developing more effective and efficient vector control methods. Adult mosquitoes were collected every 2 months for two consecutive nights from 1800 to 0600 hrs. Three collection methods were used; indoor human-landing collections (HLC), outdoor HLC, and outdoor cattle-bait collections (CBC). A total of 7,663 female Anopheles mosquitoes were collected of which 5,392 were identified as members of 3 different species complexes, the most prevalent being Anopheles minimus complex (50.36%), followed by Anopheles maculatus complex (19.68%) and Anopheles dirus complex (0.33%). An. minimus s.s. comprised virtually all (> 99.8 percent) of Minimus Complex species captured. Blood feeding behavior of An. minimus was more pronounced during the second half of the evening, showing a slight preference to blood feed outdoors (~60%) versus inside structures. Significantly (P feeding behavior. Although a significant difference in total number of mosquitoes from the HLC was recorded between the first and second year, the mean biting frequency over the course of the evening hours remained similar. The Human landing activity of An. minimus in Tum Sua Village showed a stronger preference/attraction for humans compared to a cow-baited collection method. This study supports the incrimination of An. minimus as the primary malaria vector in the area. A better understanding of mosquito behavior related to host preference, and the temporal and spatial blood feeding activity will help facilitate the design of vector control strategies and effectiveness of vector

  1. Baseline study of methane emission from anaerobic ponds of palm oil mill effluent treatment.

    Science.gov (United States)

    Yacob, Shahrakbah; Ali Hassan, Mohd; Shirai, Yoshihito; Wakisaka, Minato; Subash, Sunderaj

    2006-07-31

    The world currently obtains its energy from the fossil fuels such as oil, natural gas and coal. However, the international crisis in the Middle East, rapid depletion of fossil fuel reserves as well as climate change have driven the world towards renewable energy sources which are abundant, untapped and environmentally friendly. Malaysia has abundant biomass resources generated from the agricultural industry particularly the large commodity, palm oil. This paper will focus on palm oil mill effluent (POME) as the source of renewable energy from the generation of methane and establish the current methane emission from the anaerobic treatment facility. The emission was measured from two anaerobic ponds in Felda Serting Palm Oil Mill for 52 weeks. The results showed that the methane content was between 35.0% and 70.0% and biogas flow rate ranged between 0.5 and 2.4 L/min/m(2). Total methane emission per anaerobic pond was 1043.1 kg/day. The total methane emission calculated from the two equations derived from relationships between methane emission and total carbon removal and POME discharged were comparable with field measurement. This study also revealed that anaerobic pond system is more efficient than open digesting tank system for POME treatment. Two main factors affecting the methane emission were mill activities and oil palm seasonal cropping.

  2. Consumer preferences for household water treatment products in Andhra Pradesh, India.

    Science.gov (United States)

    Poulos, Christine; Yang, Jui-Chen; Patil, Sumeet R; Pattanayak, Subhrendu; Wood, Siri; Goodyear, Lorelei; Gonzalez, Juan Marcos

    2012-08-01

    Over 5 billion people worldwide are exposed to unsafe water. Given the obstacles to ensuring sustainable improvements in water supply infrastructure and the unhygienic handling of water after collection, household water treatment and storage (HWTS) products have been viewed as important mechanisms for increasing access to safe water. Although studies have shown that HWTS technologies can reduce the likelihood of diarrheal illness by about 30%, levels of adoption and continued use remain low. An understanding of household preferences for HWTS products can be used to create demand through effective product positioning and social marketing, and ultimately improve and ensure commercial sustainability and scalability of these products. However, there has been little systematic research on consumer preferences for HWTS products. This paper reports the results of the first state-of-the-art conjoint analysis study of HWTS products. In 2008, we conducted a conjoint analysis survey of a representative sample of households in Andhra Pradesh (AP), India to elicit and quantify household preferences for commercial HWTS products. Controlling for attribute non-attendance in an error components mixed logit model, the study results indicate that the most important features to respondents, in terms of the effect on utility, were the type of product, followed by the extent to which the product removes pathogens, the retail outlet and, the time required to treat 10 L. Holding all other product attributes constant, filters were preferred to combination products and chemical additives. Department stores and weekly markets were the most favorable sales outlets, followed by mobile salespeople. In general, households do not prefer to purchase HWTS products at local shops. Our results can inform the types of products and sales outlets that are likely to be successful in commercial HWTS markets in AP, as well as the influence of different pricing and financing strategies on product demand

  3. Patient preferences for outcomes of depression treatment in Germany: a choice-based conjoint analysis study.

    Science.gov (United States)

    Zimmermann, Thomas M; Clouth, Johannes; Elosge, Michael; Heurich, Matthias; Schneider, Edith; Wilhelm, Stefan; Wolfrath, Anette

    2013-06-01

    In general, treatment efficacy in depressed patients is evaluated mainly based on the core symptoms of depression. However, patients might consider different outcomes. This study used choice-based conjoint analysis (CBC) to evaluate patient preferences for depression treatment outcomes. Adult subjects from Germany, currently or previously on antidepressant treatment, were presented with 18 pairs of hypothetical treatment outcome scenarios, differing in eight attributes (2-3 factor levels each): depressed mood, loss of interest and enjoyment, loss of energy/fatigue, sleep disturbance, feelings of guilt, depression-related pain, treatment duration, side effects after 2 weeks. Attributes and factor levels were defined by literature review, expert consultations, and in-depth subject interviews. Data were analyzed using multinomial logit modeling; individual part-worth utilities were estimated using hierarchical Bayes routines. Two hundred twenty-seven subjects (89.4% currently treated with antidepressants, 30.0% with depression-related pain) completed the survey. They valued the relative importance of outcomes as follows: loss of energy/fatigue 18.5%, side effects after 2 weeks 14.2%, loss of interest and enjoyment 13.5%, depression-related pain 12.0%, sleep disturbance 12.0%, feelings of guilt 11.5%, treatment duration 9.9%, depressed mood 8.5%. Participants were not required to meet ICD-10 or DSM-IV criteria for depression and had heterogeneous disease severity. CBC analysis was able to reveal patient preferences for outcomes of depression treatment. Subjects valued the ability to cope with activities of everyday living highest. They considered being free of depression-related pain and side effects more important than being free of depressed mood. These findings should be considered when making treatment decisions. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Host feeding patterns and preference of Anopheles minimus (Diptera: Culicidae in a malaria endemic area of western Thailand: baseline site description

    Directory of Open Access Journals (Sweden)

    Tisgratog Rungarun

    2012-06-01

    Full Text Available Abstract Background Host feeding patterns of Anopheles minimus in relation to ambient environmental conditions were observed during a 2-year period at Tum Sua Village, located in Mae Sot District, Tak Province, in western Thailand, where An. minimus is found in abundance and regarded as the most predominant malaria vector species. Detailed information on mosquito behavior is important for understanding the epidemiology of disease transmission and developing more effective and efficient vector control methods. Methods Adult mosquitoes were collected every 2 months for two consecutive nights from 1800 to 0600 hrs. Three collection methods were used; indoor human-landing collections (HLC, outdoor HLC, and outdoor cattle-bait collections (CBC. Results A total of 7,663 female Anopheles mosquitoes were collected of which 5,392 were identified as members of 3 different species complexes, the most prevalent being Anopheles minimus complex (50.36%, followed by Anopheles maculatus complex (19.68% and Anopheles dirus complex (0.33%. An. minimus s.s. comprised virtually all (> 99.8 percent of Minimus Complex species captured. Blood feeding behavior of An. minimus was more pronounced during the second half of the evening, showing a slight preference to blood feed outdoors (~60% versus inside structures. Significantly (P An. minimus were collected from human-baited methods compared with a tethered cow, indicating a more anthropophilic feeding behavior. Although a significant difference in total number of mosquitoes from the HLC was recorded between the first and second year, the mean biting frequency over the course of the evening hours remained similar. Conclusions The Human landing activity of An. minimus in Tum Sua Village showed a stronger preference/attraction for humans compared to a cow-baited collection method. This study supports the incrimination of An. minimus as the primary malaria vector in the area. A better understanding of mosquito

  5. Can persons with a history of multiple addiction treatment episodes benefit from technology delivered behavior therapy? A moderating role of treatment history at baseline.

    Science.gov (United States)

    Kim, Sunny Jung; Marsch, Lisa A; Acosta, Michelle C; Guarino, Honoria; Aponte-Melendez, Yesenia

    2016-03-01

    A growing line of research has shown positive treatment outcomes from technology-based therapy for substance use disorders (SUDs). However, little is known about the effectiveness of technology-based SUD interventions for persons who already had numerous prior SUD treatments. We conducted a secondary analysis on a 12-month trial with patients (N=160) entering methadone maintenance treatment (MMT). Patients were randomly assigned to either standard MMT treatment or a model in which half of standard counseling sessions were replaced with a computer-based intervention, called Therapeutic Education System (standard+TES). Four treatment history factors at baseline, the number of lifetime SUD treatment episodes, detoxification episodes, and inpatient/outpatient treatment episodes were categorized into three levels based on their tertile points, and analyzed as moderators. Dependent variables were urine toxicology results for opioid and cocaine abstinence for 52-weeks. The standard+TES condition produced significantly better opioid abstinence than standard treatment for participants with 1) a moderate or high frequency of lifetime SUD treatment episodes, and 2) those with all three levels (low, moderate and high) of detoxification and inpatient/outpatient treatment episodes, pshistory, pstechnology-based behavioral therapy as part of treatment can be more effective than MMT alone, even among patients with a history of multiple addiction treatment episodes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients.

    Science.gov (United States)

    Brom, Linda; Pasman, H Roeline W; Widdershoven, Guy A M; van der Vorst, Maurice J D L; Reijneveld, Jaap C; Postma, Tjeerd J; Onwuteaka-Philipsen, Bregje D

    2014-01-01

    Patients are often encouraged to participate in treatment decision-making. Most studies on this subject focus on choosing between different curative treatment types. In the last phase of life treatment decisions differ as they often put more emphasis on weighing quantity against quality of life, such as whether or not to start treatment aimed at life prolongation but with the possibility of side effects. This study aimed to obtain insight into cancer patients' preferences and the reasons for patients' preferred role in treatment decision-making at the end of life. 28 advanced cancer patients were included at the start of their first line treatment. In-depth interviews were held prior to upcoming treatment decisions whether or not to start a life prolonging treatment. The Control Preference Scale was used to start discussing the extent and type of influence patients wanted to have concerning upcoming treatment decision-making. Interviews were audio taped and transcribed. All patients wanted their physician to participate in the treatment decision-making process. The extent to which patients themselves preferred to participate seemed to depend on how patients saw their own role or assessed their own capabilities for participating in treatment decision-making. Patients foresaw a shift in the preferred level of participation to a more active role depending in the later phase of illness when life prolongation would become more limited and quality of life would become more important. Patients vary in how much involvement they would like to have in upcoming treatment decision-making. Individual patients' preferences may change in the course of the illness, with a shift to more active participation in the later phases. Communication about patients' expectations, wishes and preferences for participation in upcoming treatment decisions is of great importance. An approach in which these topics are openly discussed would be beneficial.

  7. Treatment preferences and outcome in male hypogonadotropic hypogonadism: an Indian perspective.

    Science.gov (United States)

    Sanyal, D; Chatterjee, S

    2016-06-01

    This retrospective study assessed treatment preferences and outcome with testosterone or HCG / HCG-FSH combination in Indian male idiopathic hypogonadotropic hypogonadism (IHH) subjects (n = 31) above 18 years of age. 38.7% of IHH study subjects had no fertility plans and chose 3 monthly intramuscular testosterone undecanoate. 73.7% of subjects with fertility plans chose human chorionic gonadotropin (HCG) alone due to cost considerations. Spermatogenesis occurred in 21.4% on HCG alone and 60% of subjects on HCG with follicle-stimulating hormone (FSH) combination. Treatment failure is higher than published Western rates. FSH and HCG combination regimen is costly but superior to HCG alone. However, treatment failure still persists, suggesting unknown testicular defect in IHH. © 2015 Blackwell Verlag GmbH.

  8. Patient preference and willingness to pay for knee osteoarthritis treatments

    Directory of Open Access Journals (Sweden)

    Posnett J

    2015-06-01

    Full Text Available John Posnett,1 Sanjeev Dixit,2 Brooks Oppenheimer,2 Sven Kili,3 Nazanin Mehin4 1HERONTM Commercialization, PAREXEL® International, London, UK; 2Reason Research, Philadelphia, PA, USA; 3Sanofi Biosurgery, Oxford, UK; 4Sanofi, Paris, France Purpose: To review treatments for osteoarthritis of the knee (OAK received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments.Patients and methods: A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products.Results: Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%, physical therapy (68.2%, and nonprescription oral pain medication (73.9%. Treatments perceived as most effective were: viscosupplement injections (74.1%, narcotics (67.8%, and steroid injection (67.6%. Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee (each P<0.05.Conclusion: OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are

  9. Baseline Flowsheet Generation for the Treatment and Disposal of Idaho National Engineering and Environmental Laboratory Sodium Bearing Waste

    International Nuclear Information System (INIS)

    Barnes, C.M.; Lauerhass, L.; Olson, A.L.; Taylor, D.D.; Valentine, J.H.; Lockie, K.A.

    2002-01-01

    The High-Level Waste (HLW) Program at the Idaho National Engineering and Environmental Laboratory (INEEL) must implement technologies and processes to treat and qualify radioactive wastes located at the Idaho Nuclear Technology and Engineering Center (INTEC) for permanent disposal. This paper describes the approach and accomplishments to date for completing development of a baseline vitrification treatment flowsheet for sodium-bearing waste (SBW), including development of a relational database used to manage the associated process assumptions. A process baseline has been developed that includes process requirements, basis and assumptions, process flow diagrams, a process description, and a mass balance. In the absence of actual process or experimental results, mass and energy balance data for certain process steps are based on assumptions. Identification, documentation, validation, and overall management of the flowsheet assumptions are critical to ensuring an integrated, focused program. The INEEL HLW Program initially used a roadmapping methodology, developed through the INEEL Environmental Management Integration Program, to identify, document, and assess the uncertainty and risk associated with the SBW flowsheet process assumptions. However, the mass balance assumptions, process configuration and requirements should be accessible to all program participants. This need resulted in the creation of a relational database that provides formal documentation and tracking of the programmatic uncertainties related to the SBW flowsheet

  10. Using the internet to understand smokers' treatment preferences: informing strategies to increase demand.

    Science.gov (United States)

    Westmaas, J Lee; Abroms, Lorien; Bontemps-Jones, Jeuneviette; Bauer, Joseph E; Bade, Jeanine

    2011-08-26

    Most smokers attempt to quit on their own even though cessation aids can substantially increase their chances of success. Millions of smokers seek cessation advice on the Internet, so using it to promote cessation products and services is one strategy for increasing demand for treatments. Little is known, however, about what cessation aids these smokers would find most appealing or what predicts their preferences (eg, age, level of dependence, or timing of quit date). The objective of our study was to gain insight into how Internet seekers of cessation information make judgments about their preferences for treatments, and to identify sociodemographic and other predictors of preferences. An online survey assessing interest in 9 evidence-based cessation products and services was voluntarily completed by 1196 smokers who visited the American Cancer Society's Great American Smokeout (GASO) webpage. Cluster analysis was conducted on ratings of interest. In total, 48% (572/1196) of respondents were "quite a bit" or "very much" interested in nicotine replacement therapy (NRT), 45% (534/1196) in a website that provides customized quitting advice, and 37% (447/1196) in prescription medications. Only 11.5% (138/1196) indicated similar interest in quitlines, and 17% (208/1196) in receiving customized text messages. Hierarchical agglomerative cluster analysis revealed that interest in treatments formed 3 clusters: interpersonal-supportive methods (eg, telephone counseling, Web-based peer support, and in-person group programs), nonsocial-informational methods (eg, Internet programs, tailored emails, and informational booklets), and pharmacotherapy (NRT, bupropion, and varenicline). Only 5% (60/1196) of smokers were "quite a bit" or "very much" interested in interpersonal-supportive methods compared with 25% (298/1196) for nonsocial-informational methods and 33% (399/1196) for pharmacotherapy. Multivariate analyses and follow-up comparisons indicated that level of interest in

  11. Assessment of the ecological potential of mine-water treatment wetlands using a baseline survey of macroinvertebrate communities

    International Nuclear Information System (INIS)

    Batty, L.C.; Atkin, L.; Manning, D.A.C.

    2005-01-01

    A baseline survey of macroinvertebrate populations in two mine-water treatment wetlands, one treating a net acidic spoil heap discharge and one a net alkaline ferruginous pumped mine water, was undertaken to assess the potential of these systems to provide habitats for faunal communities. Both wetlands were found to be impoverished in comparison to natural wetlands but did sustain a macroinvertebrate community that could support higher organisms. Wetland size and water quality in terms of pH, conductivity and metal concentrations were found to be important factors in determining the quality of the populations supported. Direct toxicity to organisms was unlikely to be the main cause of lower diversity, but the smothering of organisms via the precipitation of iron hydroxides particularly in the early parts of the treatment systems affected macroinvertebrate communities. The presence of areas of open water within the planted systems was found to be important for providing habitats for macroinvertebrates and this should be both a future design and maintenance consideration for environmental managers. - Mine-water treatment wetlands can be engineered to provide habitats for ecological communities

  12. Efficacy, safety, and patient preference of monoamine oxidase B inhibitors in the treatment of Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Bradley J Robottom

    2011-01-01

    Full Text Available Bradley J RobottomDepartment of Neurology, University of Maryland School of Medicine, Baltimore, MD, USAAbstract: Parkinson's disease (PD is the second most common neurodegenerative disease and the most treatable. Treatment of PD is symptomatic and generally focuses on the replacement or augmentation of levodopa. A number of options are available for treatment, both in monotherapy of early PD and to treat complications of advanced PD. This review focuses on rasagiline and selegiline, two medications that belong to a class of antiparkinsonian drugs called monoamine oxidase B (MAO-B inhibitors. Topics covered in the review include mechanism of action, efficacy in early and advanced PD, effects on disability, the controversy regarding disease modification, safety, and patient preference for MAO-B inhibitors.Keywords: monoamine oxidase inhibitors, rasagiline, selegiline, Parkinson's disease, efficacy, safety

  13. Parent Expectancies and Preferences for Mental Health Treatment: The Roles of Emotion Mind-Sets and Views of Failure.

    Science.gov (United States)

    Schleider, Jessica L; Weisz, John R

    2018-01-24

    Because parents are primary gatekeepers to mental health care for their children, parental expectations that mental health treatment is ineffective may undermine treatment seeking, retention, and response. Thus, a need exists to understand parents' expectations about treatment and to develop scalable interventions that can instill more favorable views. We examined parents' treatment expectancies and preferences for their offspring and themselves in relation to two global beliefs: mind-sets (malleability beliefs) of emotions and anxiety, and views of failure as enhancing versus debilitating. Study 1 (N = 200; 49.5% fathers; 70.4% Caucasian) examined associations among parents' emotion mind-sets, anxiety mind-sets, failure beliefs, and treatment expectancies and preferences. Study 2 (N = 430; 44.70% fathers; 75.80% Caucasian) tested whether online inductions teaching "growth emotion mind-sets" (viewing emotions as malleable), adaptive failure beliefs, or both improved parents' treatment expectancies and hypothetical preferences for treatment (vs. no-treatment). Participants received one of three 8- to 15-min inductions or a psychoeducation control, rating treatment expectancies. and preferences pre- and postinduction. In Study 1, fixed emotion mind-sets and failure-is-debilitating beliefs were associated with lower parent psychotherapy expectancies for offspring and themselves and stronger "no-treatment" preferences for offspring. In Study 2, inductions teaching (a) growth emotion mind-sets only and (b) growth emotion mind-sets and failure-is-enhancing beliefs improved parents' psychotherapy expectancies for themselves (ds = .38, .51) and offspring (ds = .30, .43). No induction increased parents' hypothetical preferences for treatment (vs. no-treatment). Findings suggest scalable strategies for strengthening parents' psychotherapy effectiveness beliefs for themselves and their children.

  14. Non-communicable disease risk factors and treatment preference of obese patients in Cape Town

    Directory of Open Access Journals (Sweden)

    Kathryn Manning

    2016-06-01

    Full Text Available Background: Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim: To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG] versus usual care (individual consultations treatment. Setting: A primary healthcare facility in Cape Town, South Africa. Methods: One hundred and ninety-three patients were recruited in this cross-sectional study. Ninety six chose FBTG while 97 chose usual care. A questionnaire, the hospital database and patients’ folders were used to collect data. Weight, height and waist circumference were measured. STATA 11.0 was used for descriptive statistics and to compare the two groups. Results: The subjects’ mean age was 50.4 years, 78% were women and of low education levels and income, and 41.5% had type 2 diabetes, 83.4% hypertension and 69.5% high cholesterol. Mean (s.d. HbA1c was 9.1 (2.0%, systolic BP 145.6 (21.0 mmHg, diastolic BP 84.5 (12.0 mmHg, cholesterol 5.4 (1.2 mmol/L, body mass indicator (BMI 39.3 (7.3 kg/m2 and waist circumference 117 (12.6 cm. These figures were undesirable although pharmacological treatment for diabetes and hypertension was in place. Only 14% were physically active, while TV viewing was > 2h/day. Mean daily intake of fruit and vegetables (2.2 portions/day was low while added sugar (5 teaspoons and sugar-sweetened beverages (1.3 glasses were high. Usual care patients had a higher smoking prevalence, HbA1c, number of NCD risk factors and refined carbohydrate intake, and a lower fruit and vegetable intake. Conclusion: Treatment seekers were typically middle-aged, low income women with various modifiable and intermediate risk factors for NCDs. Patients choosing usual care could have more NCD risks. Keywords: Non-communicable diseases; primary health care; family

  15. Comparative efficacy and patient preference of topical anaesthetics in dermatological laser treatments and skin microneedling

    Directory of Open Access Journals (Sweden)

    Yi Zhen Chiang

    2015-01-01

    Full Text Available Background: Topical anaesthetics are effective for patients undergoing superficial dermatological and laser procedures. Our objective was to compare the efficacy and patient preference of three commonly used topical anaesthetics: (2.5% lidocaine/2.5% prilocaine cream (EMLA ® , 4% tetracaine gel (Ametop TM and 4% liposomal lidocaine gel (LMX4 ® in patients undergoing laser procedures and skin microneedling. Settings and Design: This was a prospective, double-blind study of patients undergoing laser and skin microneedling procedures at a laser unit in a tertiary referral dermatology centre. Materials and Methods: All 29 patients had three topical anaesthetics applied under occlusion for 1 hour prior to the procedure, at different treatment sites within the same anatomical zone. A self-assessment numerical pain rating scale was given to each patient to rate the pain during the procedure and each patient was asked to specify their preferred choice of topical anaesthetic at the end of the procedure. Statistical Analysis: Parametric data (mean pain scores and frequency of topical anaesthetic agent of choice were compared using the paired samples t-test. A P-value of ≤0.05 was considered as statistically significant. Results and Conclusions: Patients reported a mean (±SD; 95% confidence interval pain score of 5 (±2.58; 3.66-6.46 with Ametop TM , 4.38 (±2.53; 2.64-4.89 with EMLA ® and 3.91 (±1.95; 2.65-4.76 with LMX4 ® . There was no statistically significant difference in pain scores between the different topical anaesthetics. The majority of patients preferred LMX4 ® as their choice of topical anaesthetic for dermatological laser and skin microneedling procedures.

  16. Genital warts: Canadians' perception, health-related behaviors, and treatment preferences.

    Science.gov (United States)

    Steben, Marc; LaBelle, Deborah

    2012-10-01

    The study aimed to gauge the perceptions of Canadians toward genital warts, related health behaviors, and treatment preferences. An online survey supported by an unrestricted grant from Graceway Canada was conducted in February 2011 by Leger Marketing. It included 9 demographic questions and 17 questions relating to genital wart perception (2 multiple-choice, 15 four-point rating from strongly agree to strongly disagree). The survey was completed by 1520 Canadian adults aged 18 to older than 75 years, of whom 52% (786/1520) were female. Fifty-two percent of respondents stated that they would monitor an unrecognized spot on their genitals, and only seek medical assistance if it did not go away. Only 43% (652/1520) said that they would stop having sex until the spots were gone. Although only 10% (158/1520) of respondents stated that they would not inform their partner, this was much higher among men (14%, 103/734) than women (7%, 55/786), with p ≤ .01. Concerns of being judged by friends/family were high (44%, 669/1520), especially among younger (18-34 y) Canadians (60%), with p ≤ .05. Regarding prevention, 32% (493/1520) of respondents believed that monogamy would protect against genital warts and 25% (373/1520) believed they are not at risk if they use a condom. Treatment preference was in favor of a cream rather than an "invasive" treatment (58%, 886/1520), particularly among younger (67%, 283/425, p ≤ .05) and male respondents (63%, 464/734, p ≤ .01). Sixty percent (921/1520) would worry that genital warts could not be resolved; and 44% (668/1520), that they would recur. Among Canadians, genital warts were associated with a fair degree of social stigma and potential negative impact on their psyche, especially for younger Canadians.

  17. Patient preferences for first-line oral treatment for mild-to-moderate ulcerative colitis: a discrete-choice experiment.

    Science.gov (United States)

    Hodgkins, Paul; Swinburn, Paul; Solomon, Dory; Yen, Linnette; Dewilde, Sarah; Lloyd, Andrew

    2012-01-01

    Patients with ulcerative colitis (UC) frequently require long-term therapy to prevent relapse. Treatments such as 5-aminosalicylic acid (5-ASA [mesalazine]) are efficacious and well tolerated, but adherence to treatment is often poor. This discrete-choice experiment (DCE) was conducted to estimate differences in patient preferences for 5-ASA treatment in mild-to-moderate UC based on levels of self-reported adherence. Inclusion of patients residing in the US, UK, Germany, and Canada allowed for assessment of possible cultural differences in patient preferences. DCE attributes were determined through literature review, clinician consultation, and patient interviews. Six treatment attributes were identified: ease of swallowing, time of day, quantity, extent of flare resolution, likelihood of flare occurrence, and cost. A total of 400 patients in four countries completed the DCE and adherence (Modified Morisky Scale) surveys. Data were analyzed using generalized estimating equations to estimate patient preference and willingness to pay (WTP) by levels of self-reported adherence and country of residence. All attributes had expected polarity and were significant predictors of patient preference. Self-reported 'good' versus 'poor' adherers significantly preferred symptom control (p = 0.0108) and mucosal healing (p = 0.0190) attributes. All patients stated preference for symptom control/mucosal healing and flare risk attributes; the latter attribute was significantly preferred across all countries. Country differences in patient preference for convenience versus clinical attributes were found. Overall, patients were willing to pay £29.24 ($US46.27) per month for symptom control and mucosal healing, and an additional £78.81 ($US124.70) per month for reduction in flare risk to 10% per year (WTP costs were equalized between each country using the published 2008 purchasing power parity). Those with flares in the past year significantly preferred avoiding future

  18. Patients' and physicians' needs, experiences and preferences in the treatment of right ventricular outflow tract dysfunction

    Directory of Open Access Journals (Sweden)

    Luciana Scalone

    2012-06-01

    Full Text Available

    Background: patients with congenital heart defects, developing right ventricular outflow tract (rVoT dysfunction, can face repeated open chest interventions over their lifetime. repeating surgery increases difficulties and procedural risks, and exposes patients to burdensome and long recovery times that may induce them to postpone the treatment, with possible severe and irreversible consequences for their health. The percutaneous procedure was introduced to delay the need for open chest surgery. uncertainties still exist regarding the lifelong consequences that may result from adopting different treatment strategies. current decisions on treatment depend on patients’ clinical needs, but also on physicians’ experience and opinion, patients’ preferences, and procedural costs. The objective is to identify which treatment characteristics influence decisions on how to treat patients with rVoT dysfunction.

    Methods: a literature review was conducted, followed by a discussion with a panel of experts. Ten treatment characteristics, potentially relevant for treatment, were identified and rated in a survey, according to the importance assigned to each characteristic by specialist physicians, patients and/or their caregivers.

    Results: while some characteristics appear to be more important (risk of severe complications associated with intervention delays or less important (scar to both physicians and patients/caregivers, other characteristics are rated differently in importance depending on subjects consulted, e.g., risk of complications during the months post intervention was among the most important characteristics for patients/caregivers, but the fifth most important characteristic for physicians.

    Conclusions: to optimize benefits and efficiency of the treatment strategies, perceptions and opinions from the different subjects involved, together with patients

  19. Preferences for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD: a discrete choice experiment

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    Lincke Hans-Joachim

    2009-08-01

    Full Text Available Abstract Background While there is an increasing emphasis on patient empowerment and shared decision-making, subjective values for attributes associated with their treatment still need to be measured and considered. This contribution seeks to define properties of an ideal drug treatment of individuals concerned with Attention-Deficit/Hyperactivity Disorder (ADHD. Because of the lack of information on patient needs in the decision-makers assessment of health services, the individuals' preferences often play a subordinate role at present. Discrete Choice Experiments offer strategies for eliciting subjective values and making them accessible for physicians and other health care professionals. Methods The evidence comes from a Discrete Choice Experiments (DCE performed in 2007. After reviewing the literature about preferences of ADHS we conducted a qualitative study with four focus groups consisting of five to eleven ADHS-patients each. In order to achieve content validity, we aimed at collecting all relevant factors for an ideal ADHS treatment. In a subsequent quantitative study phase (n = 219, data was collected in an online or paper-pencil self-completed questionnaire. It included sociodemographic data, health status and patients' preferences of therapy characteristics using direct measurement (23 items on a five-point Likert-scale as well as a Discrete-Choice-Experiment (DCE, six factors in a fold-over design. Results Those concerned were capable of clearly defining success criteria and expectations. In the direct assessment and the DCE, respondents attached special significance to the improvement of their social situation and emotional state (relative importance 40%. Another essential factor was the desire for drugs with a long-lasting effect over the day (relative importance 18%. Other criteria, such as flexibility and discretion, were less important to the respondents (6% and 9%, respectively. Conclusion Results point out that ADHD patients

  20. Pre-treatment preferences and characteristics among patients seeking in vitro fertilisation.

    LENUS (Irish Health Repository)

    Walsh, Anthony Ph

    2009-01-01

    BACKGROUND: This study sought to describe patient features before beginning fertility treatment, and to ascertain their perceptions relative to risk of twin pregnancy outcomes associated with such therapy. METHODS: Data on readiness for twin pregnancy outcome from in vitro fertilisation (IVF) was gathered from men and women before initiating fertility treatment by anonymous questionnaire. RESULTS: A total of 206 women and 204 men were sampled. Mean (+\\/- SD) age for women and men being 35.5 +\\/- 5 and 37.3 +\\/- 7 yrs, respectively. At least one IVF cycle had been attempted by 27.2% of patients and 33.9% of this subgroup had initiated >\\/=3 cycles, reflecting an increase in previous failed cycles over five years. Good agreement was noted between husbands and wives with respect to readiness for twins from IVF (77% agreement; Cohen\\'s K = 0.61; 95% CI 0.53 to 0.70). CONCLUSION: Most patients contemplating IVF already have ideas about particular outcomes even before treatment begins, and suggests that husbands & wives are in general agreement on their readiness for twin pregnancy from IVF. However, fertility patients now may represent a more refractory population and therefore carry a more guarded prognosis. Patient preferences identified before IVF remain important, but further studies comparing pre- and post-treatment perceptions are needed.

  1. Treatment preferences of originator versus biosimilar drugs in Crohn's disease; discrete choice experiment among gastroenterologists.

    Science.gov (United States)

    Baji, Petra; Gulácsi, László; Lovász, Barbara D; Golovics, Petra A; Brodszky, Valentin; Péntek, Márta; Rencz, Fanni; Lakatos, Péter L

    2016-01-01

    To explore preferences of gastroenterologists for biosimilar drugs in Crohn's disease. Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator), 2) severity of disease, 3) availability of continuous medicine supply, 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator, 2) willing to consider biosimilar for biological-naïve patients only, 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. Men, senior consultants, working in inflammatory bowel disease center and treating more patients were more likely willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in case of biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% versus 11% for new patients, and 44% versus 56% for patients already treated with biological. For gastroenterologist, the continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.

  2. Determinants of National Fire Plan Fuels Treatment Expenditures: A Revealed Preference Analysis for Northern New Mexico

    Science.gov (United States)

    Shepherd, Curt; Grimsrud, Kristine; Berrens, Robert P.

    2009-10-01

    The accumulation of fire fuels in forests throughout the world contributes significantly to the severity of wildfires. To combat the threat of wildfire, especially in the wildland-urban interface (WUI), US federal land management agencies have implemented a number of forest restoration and wildfire risk reduction programs. In the spirit of revealed preference analyses, the objective of this study is to investigate the pattern and determinants of National Fire Plan (NFP) expenditures for fuel reduction treatments in northern New Mexico (USA). Estimation results from a set of Generalized Estimating Equations models are mixed with respect to risk reduction hypotheses, and also raise issues regarding how risk reduction should be defined for a region characterized by both pockets of urban sprawl into the WUI and large areas of chronic rural poverty. Program preferences for project funding under the federal Collaborative Forest Restoration Program in New Mexico are shown to be distinctly different (e.g., exhibiting greater concern for social equity) than for other NFP-funded projects.

  3. Implementation, recruitment and baseline characteristics: A randomized trial of combined treatments for smoking cessation and weight control

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    Terry Bush

    2017-09-01

    Full Text Available Background: Two-thirds of treatment-seeking smokers are obese or overweight. Most smokers are concerned about gaining weight after quitting. The average smoker experiences modest post-quit weight gain which discourages many smokers from quitting. Although evidence suggests that combined interventions to help smokers quit smoking and prevent weight gain can be helpful, studies have not been replicated in real world settings. Methods: This paper describes recruitment and participant characteristics of the Best Quit Study, a 3-arm randomized controlled trial testing tobacco cessation treatment alone or combined with simultaneous or sequential weight management. Study participants were recruited via tobacco quitlines from August 5, 2013 to December 15, 2014. Results: Statistical analysis on baseline data was conducted in 2015/2016. Among 5082 potentially eligible callers to a tobacco quitline, 2540 were randomized (50% of eligible. Compared with individuals eligible but not randomized, those randomized were significantly more likely to be female (65.7% vs 54.5%, p < 0.01, overweight or obese (76.3% vs 62.5%, p < 0.01, more confident in quitting (p < 0.01, more addicted (first cigarette within 5 min: 50.0% vs 44.4%, p < 0.01, and have a chronic disease (28.6% vs. 24.4%, p < 0.01. Randomized groups were not statistically significantly different on demographics, tobacco or weight variables. Two-thirds of participants were female and white with a mean age of 43. Conclusions: Adding weight management interventions to tobacco cessation quitlines was feasible and acceptable to smokers. If successful for cessation and weight outcomes, a combined intervention may provide a treatment approach for addressing weight gain with smoking cessation through tobacco quitlines. Trial registration: Clinicaltrials.gov NCT01867983. Keywords: Smoking, Weight gain, Quitlines, Simultaneous, Sequential

  4. Variation in pre-treatment count lead time and its effect on baseline estimates of cage-level sea lice abundance.

    Science.gov (United States)

    Gautam, R; Boerlage, A S; Vanderstichel, R; Revie, C W; Hammell, K L

    2016-11-01

    Treatment efficacy studies typically use pre-treatment sea lice abundance as the baseline. However, the pre-treatment counting window often varies from the day of treatment to several days before treatment. We assessed the effect of lead time on baseline estimates, using historical data (2010-14) from a sea lice data management programme (Fish-iTrends). Data were aggregated at the cage level for three life stages: (i) chalimus, (ii) pre-adult and adult male and (iii) adult female. Sea lice counts were log-transformed, and mean counts by lead time relative to treatment day were computed and compared separately for each life stage, using linear mixed models. There were 1,658 observations (treatment events) from 56 sites in 5 Bay Management Areas. Our study showed that lead time had a significant effect on the estimated sea lice abundance, which was moderated by season. During the late summer and autumn periods, counting on the day of treatment gave significantly higher values than other days and would be a more appropriate baseline estimate, while during spring and early summer abundance estimates were comparable among counts within 5 days of treatment. A season-based lead time window may be most appropriate when estimating baseline sea lice levels. © 2016 John Wiley & Sons Ltd.

  5. Diabetes treatment patterns and goal achievement in primary diabetes care (DiaRegis - study protocol and patient characteristics at baseline

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    Deeg Evelin

    2010-09-01

    Full Text Available Abstract Background Patients with type 2 diabetes are at an increased risk for disease and treatment related complications after the initial approach of oral mono/dual antidiabetic therapy has failed. Data from clinical practice with respect to this patient group are however scarce. Therefore we set up a registry in primary care documenting the course and outcomes of this patient group. Methods Diabetes Treatment Patterns and Goal Achievement in Primary Diabetes Care (DiaRegis is a prospective, observational, German, multicenter registry including patients with type-2 diabetes in which oral mono/dual antidiabetic therapy has failed. Data were recorded at baseline and will be prospectively documented during visits at 6 ± 1, 12 ± 2 and 24 ± 2 months. The primary objective is to estimate the proportion of patients with at least 1 episode of severe hypoglycemia within one year. Results 313 primary care offices included 4,048 patients between June 2009 and March 2010 of which 3,810 patients fulfilled the in- and exclusion criteria. 46.7% of patients were female; patients had a median diabetes duration of 5.5 years and most were obese with respect to BMI or waist circumference. HbA1c at baseline was 7.4%, fasting plasma glucose 142 mg/dl and postprandial glucose 185 mg/dl. Co-morbidity in this patient population was substantial with 17.9% having coronary artery disease, 14.4% peripheral neuropathy, 9.9% heart failure and 6.0% peripheral arterial disease. 68.6% of patients received oral monotherapy, 31.4% dual oral combination therapy. The most frequent antidiabetic agent used as monotherapy was metformin (79.0% followed by sulfonylureas (14.8%. Conclusions DiaRegis is a large, prospective registry in primary diabetes care to document the course and outcomes of patients with type-2 diabetes in which the initial approach of oral mono/dual antidiabetic therapy has failed. The two year follow-up will allow for a prospective evaluation of these patients

  6. Patient and Oncology Nurse Preferences for the Treatment Options in Advanced Melanoma: A Discrete Choice Experiment.

    Science.gov (United States)

    Liu, Frank Xiaoqing; Witt, Edward A; Ebbinghaus, Scot; DiBonaventura Beyer, Grace; Basurto, Enrique; Joseph, Richard W

    2017-10-25

    Understanding the perceptions of patients and oncology nurses about the relative importance of benefits and risks associated with newer treatments of advanced melanoma can help to inform clinical decision-making. The aims of this study were to quantify and compare the views of patients and oncology nurses regarding the importance of attributes of treatments of advanced melanoma. A discrete choice experiment (DCE) was conducted in US-based oncology nurses and patients diagnosed with advanced melanoma. Patients and nurses were enlisted through online panels. In a series of scenarios, respondents had to choose between 2 hypothetical treatments, each with 7 attributes: mode of administration (MoA), dosing schedule (DS), median duration of therapy (DoT), objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and grade 3 or 4 adverse events (AEs). Hierarchical Bayesian logistic regression models were used to estimate preference weights. A total of 200 patients with advanced melanoma and 150 oncology nurses participated. The relative importance estimates of attributes by patients and nurses, respectively, were as follows: OS, 33% and 28%; AEs, 29% and 26%; ORR, 25% and 27%; PFS, 12% and 15%; DS, 2% and 3%; DoT, 0% and 0%; and MoA, 0% and 0%. Both patients and oncology nurses valued OS, ORR, and AEs as the most important treatment attributes for advanced melanoma, followed by PFS, whereas DS, DoT, and MoA were given less value in their treatment decisions. Oncology nurses and patients have similar views on important treatment considerations for advanced melanoma, which can help build trust in shared decision-making.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  7. Women’s experiences and preferences regarding breast imaging after completing breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Brandzel S

    2017-02-01

    Full Text Available Susan Brandzel,1 Dori E Rosenberg,1 Dianne Johnson,1 Mary Bush,1 Karla Kerlikowske,2–5 Tracy Onega,6,7 Louise Henderson,8 Larissa Nekhlyudov,9,10 Wendy DeMartini,11 Karen J Wernli1 1Group Health Research Institute, Group Health Cooperative, Seattle, WA, 2Department of Medicine, 3Department of Epidemiology, 4Department of Biostatistics, 5Department of Veterans Affairs, University of California, San Francisco, San Francisco, CA, 6Department of Biomedical Data Science, 7Department of Epidemiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 8Department of Radiology, University of North Carolina, Chapel Hill, NC, 9Department of Population Medicine, Harvard Medical School, 10Department of Medicine, Brigham and Women’s Hospital, Boston, MA, 11Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA Background: After treatment for breast cancer, most women receive an annual surveillance mammography to look for subsequent breast cancers. Supplemental breast MRI is sometimes used in addition to mammography despite the lack of clinical evidence for it. Breast imaging after cancer treatment is an emotionally charged experience, an important part of survivorship care, and a topic about which limited patient information exists. We assessed women’s experiences and preferences about breast cancer surveillance imaging with the goal of determining where gaps in care and knowledge could be filled. Participants and methods: We conducted six focus groups with a convenience sample of 41 women in California, North Carolina, and New Hampshire (USA. Participants were aged 38–75 years, had experienced stage 0–III breast cancer within the previous 5 years, and had completed initial treatment. We used inductive thematic analysis to identify key themes from verbatim transcripts. Results: Women reported various types and frequencies of surveillance imaging and a range of surveillance imaging

  8. A STUDY TO EXPLORE PREFERRED METHOD OF TREATMENT AMONG PHYSIOTHERAPISTS FOR MECHANICAL LOW BACK PAIN

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    Iram Iqbal Shamsi

    2016-02-01

    Full Text Available Background: Conservative treatment remains the standard of care for treating nonspecific mechanical low back pain which is very common problem all around the world. In Pakistan, physiotherapists encounter this problem frequently in clinical practice. Despite a wide variety of treatments, 100 percent results have been unachievable. The purpose of this study was to establish a Standard and Uniform Physiotherapy Protocol for mechanical low back pain. Methods: To achieve the objective of this study, a questionnaire with structured and open ended questions were designed and distributed to hospitals and private clinics. 139 questionnaires were distributed from 1st March 2009 to 30th May 2009. By the end of July 5, 2009, 101 were filled and returned. The data was analyzed using descriptive statistics. Results: Results have shown that McKenzie (25%, combination of McKenzie and Maitland (9% were among the preferred techniques. However, 14% did not use a specific technique. The preferred physical agents were hot packs (22%, combination of hot packs, ultrasound, TENS (22%. However, 4% did not prefer any physical agent. Out of 101 subjects per week, 20 subjects were treated for 7 days, 11 were treated for 5 days, 53 were treated for 3 days, 6 were treated for 2 days and 11 were treated for 1 day. The recurrence rate was 32.14% for those who were treated for six days, 34.75% for those treated for 5 days, 33.55% for those who were treated for 3 days, 31.25% for those who were treated for 2 days, and 37.55% for those who were treated for one day. 39% did not consider ergonomical issues while 27% did not advice regarding the patient nutritional facts. Average depression among patients was 24.7%. Conclusion: This study shows that the results for mechanical low back pain were not as effective with combination of techniques and modalities. If the physiotherapists had taken the psychological factors, ergonomical approach and nutrition into consideration, the

  9. Preference elicitation approach for measuring the willingness to pay for liver cancer treatment in Korea

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    Donghun Cho

    2015-09-01

    Full Text Available Background/AimsThe Korean government has expanded the coverage of the national insurance scheme for four major diseases: cancers, cardiovascular diseases, cerebrovascular diseases, and rare diseases. This policy may have a detrimental effect on the budget of the national health insurance agency. Like taxes, national insurance premiums are levied on the basis of the income or wealth of the insured.MethodsUsing a preference elicitation method, we attempted to estimate how much people are willing to pay for insurance premiums that would expand their coverage for liver cancer treatment.ResultsWe calculated the marginal willingness to pay (MWTP through the marginal rate of substitution between the two attributes of the insurance premium and the total annual treatment cost by adopting conditional logit and mixed logit models.ConclusionsThe effects of various other terms that could interact with socioeconomic status were also estimated, such as gender, income level, educational attainment, age, employment status, and marital status. The estimated MWTP values of the monthly insurance premium for liver cancer treatment range from 4,130 KRW to 9,090 KRW.

  10. The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities.

    Directory of Open Access Journals (Sweden)

    Daniel Poremski

    Full Text Available To determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions.Qualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments.Participants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals.A rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.

  11. The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities.

    Science.gov (United States)

    Poremski, Daniel; Sagayadevan, Vathsala D/O; Wang, Peizhi; Lum, Alvin; Subramaniam, Mythily; Ann, Chong Siow

    2016-01-01

    To determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions. Qualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments. Participants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals. A rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.

  12. [Clinical efficacy of preferred use of high-frequency oscillatory ventilation in treatment of neonatal pulmonary hemorrhage].

    Science.gov (United States)

    Wang, Hua; Du, Li-Zhong; Tang, Jun; Wu, Jin-Lin; Mu, De-Zhi

    2015-03-01

    To investigate the clinical efficacy and safety of preferred use of high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal pulmonary hemorrhage. The clinical efficacy of preferred use of HFOV (preferred use group) and rescue use of HFOV after conventional mechanical ventilation proved ineffective (rescue use group) in the treatment of 26 cases of neonatal pulmonary hemorrhage was retrospectively analyzed. The oxygenation index (OI), pulmonary hemorrhage time, hospitalization time, ventilation time, oxygen therapy time, complications, and outcome of the two groups were compared. Compared with the rescue use group, the preferred use group had significantly lower IO values at 1, 6, 12, 24, 48, and 72 hours after treatment (Phemorrhage, and digestive tract hemorrhage between the two groups (P>0.05). Compared with those in the rescue use group, children who survived in the preferred use group had significantly shorter pulmonary hemorrhage time, hospitalization time, ventilation time, and oxygen therapy time (P<0.05). Compared with the rescue use of HFOV, preferred use of HFOV can better improve oxygenation function, reduce the incidence of VAP, shorten the course of disease, and increase cure rate while not increasing the incidence of adverse effects.

  13. [Learn new version of Preferred Practice Pattern to further standardize the diagnosis and treatment of amblyopia].

    Science.gov (United States)

    Zhao, Kanxing; Shi, Xuefeng

    2014-07-01

    The introduction of Preferred Practice Patterns (PPP) into China has given ophthalmologists in China more opportunities to acquaint themselves with international clinical guidelines for eye care, including its developing principles, methods and the application value. It had brought significant effects on the fast improvement of clinical eye care and standardization of diagnosis and treatment of eye diseases in China, and promoted the international academic exchanges. The 2nd Chinese version of PPPs translated by Prof. Jialiang Zhao was officially published in November, 2013. The new version of PPP for amblyopia adopted the newest standard for grading of evidence strength and recommendation assessment, and emphasizes the practicability based on evidence. New explanations of the definition of amblyopia are added according to the recent research progresses in amblyopia. The diagnostic criteria of best visual acuity for bilateral amblyopia at different ages is given with new specifications. Comprehensive and practical suggestions on the examination methods for amblyopia are provided from the qualitative assessment of visual acuity, the choice of eye chart, to the use of cycloplegic agents. In the aspect of the treatment of amblyopia, based on the findings of recent multi-central random controlled clinical trials, not only strong recommendations are provided, but also the insufficiency of evidence supporting for some choices of therapy is pointed out. The necessity of the follow-up evaluation after the cessation of the treatment of amblyopia is emphasized too. In the aspect of the prevention of amblyopia, the new amblyopia PPP points out the importance of the early-period screening of amblyopia, and that the healthcare insurance plans should cover timely screening, treatment, and monitoring for recurrence of amblyopia. This article deciphers the essential contents of the new version of Chinese PPP for amblyopia, and aims to promote the standardization of the diagnosis

  14. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists.

    Science.gov (United States)

    Hifinger, M; Hiligsmann, M; Ramiro, S; Watson, V; Severens, J L; Fautrel, B; Uhlig, T; van Vollenhoven, R; Jacques, P; Detert, J; Canas da Silva, J; Scirè, C A; Berghea, F; Carmona, L; Péntek, M; Keat, A; Boonen, A

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  15. A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding.

    Science.gov (United States)

    Cooper, Natalie A M; Middleton, Lee; Smith, Paul; Denny, Elaine; Stobert, Lynda; Daniels, Jane; Clark, T Justin

    2016-01-01

    Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women's preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand.

  16. Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer

    DEFF Research Database (Denmark)

    Rønde, Heidi S; Wee, Leonard; Pløen, John

    2017-01-01

    PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multipl...... that preference-informed dose planning is feasible for clinical studies utilizing shared decision making....... dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy. MATERIAL AND METHODS: Retrospective plans.......7%-points; (0.3; 30.6); p decision space available in anal cancer radiotherapy to incorporate preferences, although tradeoffs are highly patient-dependent. This study demonstrates...

  17. Societal preferences in the treatment of pediatric medulloblastoma: Balancing risk of death and quality of life.

    Science.gov (United States)

    Khakban, Amir; Mohammadi, Tima; Lynd, Larry D; Mabbott, Don; Bouffet, Eric; Gastonguay, Louise; Zafari, Zafar; Malkin, David; Taylor, Michael; Marra, Carlo A

    2017-06-01

    Medulloblastoma is the most prevalent childhood brain cancer. Children with medulloblastoma typically receive a combination of surgery, radiation, and chemotherapy. The survival rate is high but survivors often have sequelae from radiotherapy of the entire developing brain and spinal cord. Ongoing genetic studies have suggested that decreasing the dose of radiation might be possible among children with favorable molecular variants; however, this may result in an increased disease recurrence. As such, there is a need to investigate the nature of trade-offs that individuals are willing to make regarding the treatment of medulloblastoma. We used best-worst scaling to estimate the importance of attributes affecting the general public's decision making around the treatment of medulloblastoma. After conducting focus groups, we selected three relevant attributes: (1) the accuracy of the genetic test; (2) the probability of serious adverse effects of the treatment(s); and (3) the survival rate. Using the paired method, we applied a conditional logit model to estimate preferences. In total, 3,006 respondents (51.3% female) with an average age of 43 years answered the questionnaires. All coefficients were statistically significantly different from zero and the attribute levels of adverse effects and the survival rate had the most impact on individuals' stated decision making. Overall, respondents showed high sensitivity to children experiencing disability particularly in the setting of a good prognosis. However, among children with poor prognostic molecular variants, participants showed tolerance about having a child with mild and partial disability compared to a low rate of survival. © 2016 Wiley Periodicals, Inc.

  18. Decisional strategy determines whether frame influences treatment preferences for medical decisions.

    Science.gov (United States)

    Woodhead, Erin L; Lynch, Elizabeth B; Edelstein, Barry A

    2011-06-01

    Decision makers are influenced by the frame of information such that preferences vary depending on whether survival or mortality data are presented. Research is inconsistent as to whether and how age impacts framing effects. This paper presents two studies that used qualitative analyses of think-aloud protocols to understand how the type of information used in the decision making process varies by frame and age. In Study 1, 40 older adults, age 65 to 89, and 40 younger adults, age 18 to 24, responded to a hypothetical lung cancer scenario in a within-subject design. Participants received both a survival and mortality frame. Qualitative analyses revealed that two main decisional strategies were used by all participants: one strategy reflected a data-driven decisional process, whereas the other reflected an experience-driven process. Age predicted decisional strategy, with older adults less likely to use a data-driven strategy. Frame interacted with strategy to predict treatment choice; only those using a data-driven strategy demonstrated framing effects. In Study 2, 61 older adults, age 65 to 98, and 63 younger adults, age 18 to 30, responded to the same scenarios as in Study 1 in a between-subject design. The results of Study 1 were replicated, with age significantly predicting decisional strategy and frame interacting with strategy to predict treatment choice. Findings suggest that framing effects may be more related to decisional strategy than to age. (c) 2011 APA, all rights reserved.

  19. Most Trial Eligibility Criteria and Patient Baseline Characteristics Do Not Modify Treatment Effect in Trials Using Targeted Therapies for Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Christensen, Anton Wulf; Tarp, Simon; Furst, Daniel E

    2015-01-01

    OBJECTIVE: To determine if variations in trial eligibility criteria and patient baseline characteristics could be considered effect modifiers of the treatment response when testing targeted therapies (biological agents and targeted synthetic disease modifying antirheumatic drugs (DMARDs....... Odds ratios (ORs) were calculated from the response rates and compared among the trial eligibility criteria/patient baseline characteristics of interest. Comparisons are presented as the Ratio of Odds Ratios (ROR). RESULTS: Sixty-two trials (19,923 RA patients) were included in the primary analyses...... using ACR20 response. Overall, targeted therapies constituted an effective treatment (OR 3.96 95% confidence interval (CI) 3.41 to 4.60). The majority of the trial eligibility criteria and patient baseline characteristics did not modify treatment effect. The added benefit of targeted therapies was lower...

  20. Analysis of Initial Baseline Clinical Parameters and Treatment Strategy Associated with Medication Failure in the Treatment of Benign Prostatic Hyperplasia in Korea

    Directory of Open Access Journals (Sweden)

    Hoon Choi

    2010-12-01

    Full Text Available Purpose To analyze the baseline clinical factors and medication treatment strategy used in cases with medication treatment failure of benign prostatic hyperplasia (BPH. Methods From January 2006 to December 2009, 677 BPH patients with at least 3 months of treatment with medication were enrolled. We analyzed clinical factors by medication failure (n=161 versus maintenance (n=516, by prostate size (less than 30 g, n=231; 30 to 50 g, n=244; greater than 50 g, n=202, and by prostate-specific antigen (PSA levels (less than 1.4 ng/mL, n=324; more than 1.4 ng/mL, n=353. Results Age, combination medication rate, PSA, and prostate volume were statistically different between the medication treatment failure and maintenance groups. By prostate size, the PSA and medication failure rates were relatively higher and the medication period was shorter in patients with a prostate size of more than 30 g. The combination medication rate was higher in patients with a prostate size of more than 50 g. The medication failure rate and prostate volume were higher in patients with a PSA level of more than 1.4 ng/mL. However, the combination treatment rate was not significantly different in patients with a PSA level lower than 1.4 ng/mL. Suggestive cutoffs for combination medication are a prostate volume of 34 g and PSA level of 1.9 ng/mL. Conclusions The clinical factors associated with medication failure were age, treatment type, and prostate volume. Combination therapy should be considered more in Korea in patients with a PSA level higher than 1.4 ng/mL and a prostate volume of between 30 and 50 g to prevent medication failure.

  1. Can baseline ultrasound results help to predict failure to achieve DAS28 remission after 1 year of tight control treatment in early RA patients?

    Science.gov (United States)

    Ten Cate, D F; Jacobs, J W G; Swen, W A A; Hazes, J M W; de Jager, M H; Basoski, N M; Haagsma, C J; Luime, J J; Gerards, A H

    2018-01-30

    At present, there are no prognostic parameters unequivocally predicting treatment failure in early rheumatoid arthritis (RA) patients. We investigated whether baseline ultrasonography (US) findings of joints, when added to baseline clinical, laboratory, and radiographical data, could improve prediction of failure to achieve Disease Activity Score assessing 28 joints (DAS28) remission (baseline. Clinical, laboratory, and radiographical parameters were recorded. Primary analysis was the prediction by logistic regression of the absence of DAS28 remission 12 months after diagnosis and start of therapy. Of 194 patients included, 174 were used for the analysis, with complete data available for 159. In a multivariate model with baseline DAS28 (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2-2.2), the presence of rheumatoid factor (OR 2.3, 95% CI 1.1-5.1), and type of monitoring strategy (OR 0.2, 95% CI 0.05-0.85), the addition of baseline US results for joints (OR 0.96, 95% CI 0.89-1.04) did not significantly improve the prediction of failure to achieve DAS28 remission (likelihood ratio test, 1.04; p = 0.31). In an early RA population, adding baseline ultrasonography of the hands, wrists, and feet to commonly available baseline characteristics did not improve prediction of failure to achieve DAS28 remission at 12 months. Clinicaltrials.gov, NCT01752309 . Registered on 19 December 2012.

  2. Baseline rationing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    The standard problem of adjudicating conflicting claims describes a situation in which a given amount of a divisible good has to be allocated among agents who hold claims against it exceeding the available amount. This paper considers more general rationing problems in which, in addition to claims...... to international protocols for the reduction of greenhouse emissions, or water distribution in drought periods. We define a family of allocation methods for such general rationing problems - called baseline rationing rules - and provide an axiomatic characterization for it. Any baseline rationing rule within...... the family is associated with a standard rule and we show that if the latter obeys some properties reflecting principles of impartiality, priority and solidarity, the former obeys them too....

  3. Baseline blood immunological profiling differentiates between Her2-breast cancer molecular subtypes: implications for immunomediated mechanisms of treatment response.

    Science.gov (United States)

    Tudoran, Oana; Virtic, Oana; Balacescu, Loredana; Lisencu, Carmen; Fetica, Bogdan; Gherman, Claudia; Balacescu, Ovidiu; Berindan-Neagoe, Ioana

    2015-01-01

    Breast cancer patients' response to treatment is highly dependent on the primary tumor molecular features, with triple-negative breast tumors having the worst prognosis of all subtypes. According to the molecular features, tumors stimulate the microenvironment to induce distinct immune responses, baseline immune activation being associated with higher likelihood of pathologic response. In this study, we investigated the deconvolution of the immunological status of triple-negative tumors in comparison with luminal tumors and the association with patients' clinicopathological characteristics. Gene expression of 84 inflammatory molecules and their receptors were analyzed in 40 peripheral blood samples from patients with Her2- primary breast cancer tumors. We studied the association of triple-negative phenotype with age, clinical stage, tumor size, lymph nodes, and menopausal status. We observed that more patients with estrogen (ER)/progesterone (PR)-negative tumors had grade III, while more patients with ER/PR-positive tumors had grade II tumors. Gene expression analysis revealed a panel of 14 genes to have differential expression between the two groups: several interleukins: IL13, IL16, IL17C and IL17F, IL1A, IL3; interleukin receptors: IL10RB, IL5RA; chemokines: CXCL13 and CCL26; and cytokines: CSF2, IFNA2, OSM, TNSF13. The expression levels of these genes have been previously shown to be associated with reduced immunological status; indeed, the triple-negative breast cancer patients presented with lower counts of lymphocytes and eosinophils than the ER/PR-positive ones. These results contribute to a better understanding of the possible role of antitumor immune responses in mediating the clinical outcome.

  4. Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations With End-of-Life Treatment Preferences and Quality of Life

    Science.gov (United States)

    Balboni, Tracy A.; Vanderwerker, Lauren C.; Block, Susan D.; Paulk, M. Elizabeth; Lathan, Christopher S.; Peteet, John R.; Prigerson, Holly G.

    2008-01-01

    Purpose Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. Methods The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. Results Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). Conclusion Many advanced cancer patients' spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life. PMID:17290065

  5. Glycemic excursions are positively associated with HbA1c reduction from baseline after treatment with acarbose in patients with type 2 diabetes on metformin monotherapy.

    Science.gov (United States)

    Wang, Jun-Sing; Lee, I-Te; Lee, Wen-Jane; Lin, Shi-Dou; Su, Shih-Li; Tu, Shih-Te; Tseng, Yao-Hsien; Lin, Shih-Yi; Sheu, Wayne Huey-Herng

    2017-03-01

    The aim of the present study was to examine the association between glycemic excursions before treatment and HbA1c reduction after treatment intensification with acarbose or glibenclamide in patients with type 2 diabetes (T2D). Patients receiving single or dual oral antidiabetic drug treatment with an HbA1c of 7.0-11.0 % (53-97 mmol/mol) were switched to metformin monotherapy (500 mg, t.i.d.) for 8 weeks, followed by randomization to either acarbose (100 mg, t.i.d.) or glibenclamide (5 mg, t.i.d.) as add-on treatment for 16 weeks. Glycemic excursions were assessed as mean amplitude of glycemic excursions (MAGE) with 72-h ambulatory continuous glucose monitoring. Treatment efficacy was evaluated as relative HbA1c reduction (%), calculated as (baseline HbA1c - post-treatment HbA1c)/baseline HbA1c × 100. Fifty patients (mean [±SD] age 53.5 ± 8.2 years, 48 % men, mean baseline HbA1c 8.4 ± 1.2 %) were analyzed. Baseline MAGE was positively correlated with relative HbA1c reduction from baseline in patients treated with acarbose (r = 0.421, P = 0.029) but not glibenclamide (r = 0.052, P = 0.813). Linear regression analysis revealed that the association between baseline MAGE and relative HbA1c reduction from baseline (β = 0.125, P = 0.029) in patients treated with acarbose remained significant after adjustment for several confounders (P HbA1c reduction from baseline after treatment with acarbose, but not glibenclamide. These findings highlight the importance of glycemic excursions in individualized treatment for patients with T2D. © 2016 Ruijin Hospital, Shanghai JiaoTong University School of Medicine (SJTU), Chinese Society of Endocrinology and Chinese Endocrinologist Association and John Wiley & Sons Australia, Ltd.

  6. Depression CBT treatment gains among HIV-infected persons with a history of injection drug use varies as a function of baseline substance use.

    Science.gov (United States)

    Labbe, Allison K; O'Cleirigh, Conall M; Stein, Michael; Safren, Steven A

    2015-01-01

    Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment outcomes and accelerated HIV disease progression. Though previous research has demonstrated short-term and follow-up success for cognitive behavioral therapy for adherence and depression (CBT-AD) on depression outcomes among patients with HIV in care and among patients with HIV in active substance abuse treatment for injection drug use (IDU), there is little information regarding possible moderating effects of active use versus abstinence on depression treatment gains. The present study aimed to examine recent substance use at treatment initiation as a moderator of the acute and maintenance effects of CBT-AD on depression. We used data from a two-arm, randomized controlled trial (N = 89) comparing CBT-AD to enhanced treatment as usual in individuals in treatment for IDU. To test whether depression at time of presentation affected outcomes, repeated-measures ANOVAs were conducted for two time frames: (1) acute phase (baseline to post-treatment) (acute) and (2) maintenance phase (baseline to 12-month follow-up). To further examine maintenance of gains, we additionally looked at post-treatment to 12-month follow-up. Depression scores derived from the clinical global impression for severity and the Montgomery-Asberg depression rating scale (MADRS) served as the primary outcome variables. Acute (baseline post treatment) moderation effects were found for those patients endorsing active drug use at baseline in the CBT-AD condition, who demonstrated the greatest reductions in MADRS scores at post-treatment (F[1,76] = 6.78, p = .01) and follow-up (F[1,61] = 5.46, p = .023). Baseline substance use did not moderate differences from post-treatment to 12-month follow-up as depression treatment gains that occurred acutely from baseline to post-treatment were maintained across both patients engaged in substance use and abstainers. We conclude that CBT

  7. Functional Analysis and Treatment of Aggression Maintained by Preferred Conversational Topics

    Science.gov (United States)

    Roscoe, Eileen M.; Kindle, Arianne E.; Pence, Sacha T.

    2010-01-01

    After an initial functional analysis of a participant's aggression showed unclear outcomes, we conducted preference and reinforcer assessments to identify preferred forms of attention that may maintain problem behavior. Next, we conducted an extended functional analysis that included a modified attention condition. Results showed that the…

  8. Treatment comfort, time perception, and preference for conventional and digital impression techniques : A comparative study in young patients

    NARCIS (Netherlands)

    Burhardt, Lukasz; Livas, Christos; Kerdijk, Wouter; van der Meer, Wicher Joerd; Ren, Yijin

    INTRODUCTION: The aim of this crossover study was to assess perceptions and preferences for impression techniques in young orthodontic patients receiving alginate and 2 different digital impressions. METHODS: Thirty-eight subjects aged 10 to 17 years requiring impressions for orthodontic treatment

  9. Factors influencing women's preferences for subsequent management in the event of incomplete evacuation of the uterus after misoprostol treatment for miscarriage

    NARCIS (Netherlands)

    Hentzen, Judith E. K. R.; Verschoor, Marianne A.; Lemmers, Marike; Ankum, Willem M.; Mol, Ben Willem J.; van Wely, Madelon

    2017-01-01

    STUDY QUESTION: What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? SUMMARY ANSWER: Women's treatment preferences in the management of an incomplete evacuation of the uterus after

  10. Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

    Directory of Open Access Journals (Sweden)

    Karen Harrison Dening

    Full Text Available When a person with dementia (PWD has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ to explore whether family carers' choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this.A cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer each completing a modified LSPQ. We assessed how closely carers' choices resembled the PWD's preferences for treatment in three proposed health states: the here and now; severe stroke with coma; terminal cancer. Agreement between the PWD and their family carer responses was assessed using Kappa and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK statistics. We examined whether carer burden and distress, and relationship quality, influenced agreement.In interviews PWD were able to indicate their treatment preferences across all three scenarios. In the here-and-now most wanted antibiotics (98%, fewer cardio-pulmonary resuscitation (CPR (50% and tube feeding (47%. In severe stroke and coma antibiotics remained the more preferred treatment (88%, followed by CPR (57% and tube feeding (30%. In advanced cancer PWD expressed lower preferences for all treatments (antibiotics 68%; CPR 50%; tube feeding 37%. Carers' choices were similar to the PWDs' preferences in the here-and-now (71% (k = 0.03; PABAK = 0.4 with less agreement for future hypothetical health states. In severe stroke and coma carers tended wrongly to suggest that the PWD preferred more intervention (antibiotic, 67%; k = -0.022; PABAK = -0.60; CPR, 73%; k = 0.20; PABAK = -0.20, tube feeding, 66%; k = 0.25; PABAK = -0.12. In advanced cancer the agreement between PWD and carers was low (antibiotics; k = -0.03; PABAK = -0.52; CPR, k = -0.07; PABAK = -0

  11. Rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study : a cluster randomised controlled trial

    NARCIS (Netherlands)

    Valk, Mark J.; Hoes, Arno W.; Mosterd, Arend; Landman, Marcel A.; Broekhuizen, Berna D L; Rutten, Frans H.

    2015-01-01

    BACKGROUND: Heart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal. We present the rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study. In this study we assess the

  12. Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Belinchón I

    2016-11-01

    Full Text Available I Belinchón,1 R Rivera,2 C Blanch,3 M Comellas,4 L Lizán4,5 1Department of Dermatology, Hospital General Universitario de Alicante, Alicante, 2Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, 3Novartis Farmacéutica S.A., Barcelona, 4Outcomes’10, Castellón, Spain; 5Medical Department, University Jaime I, Castellón, Spain Background and objective: Adherence to treatment in patients with psoriasis is often poor. An investigation of patient preferences and satisfaction with treatment may be important, based on the expected correlation with therapy compliance. This paper aims to examine and describe the current literature on patient preferences, satisfaction and adherence to treatment for psoriasis in the European Union (EU.Methods: Electronic searches were conducted using PubMed, ISI Web of Knowledge, Scopus, Spanish databases and Google Scholar. European studies published in English or Spanish between January 1, 2009 and December 31, 2014 regarding patient-reported outcomes in psoriatic patients were included. Studies conducted in non-EU countries, letters to the editor, editorials, experts’ opinions, case studies, congress proceedings, publications that did not differentiate between patients with psoriasis and psoriatic arthritis or studies related to specific treatment were excluded.Results: A total of 1,769 titles were identified, of which 1,636 were excluded as they were duplicates or did not provide any relevant information. After a full-text reading and application of the inclusion/exclusion criteria, 46 publications were included. This paper will describe publications on adherence (n=4, preferences (n=5 and satisfaction with treatment (n=7. Results related to health-related quality of life articles (n=30 have been published elsewhere. Adherence rates are generally low in psoriasis patients regardless of the type of treatment, severity of disease or methods used to measure adherence. Biologic therapy is

  13. Hot flush frequency and severity at baseline as predictors of time to transient and stable treatment success: pooled analysis of two CE/BZA studies.

    Science.gov (United States)

    Pinkerton, JoAnn V; Bushmakin, Andrew G; Bobula, Joel; Lavenberg, Joanne; Komm, Barry S; Abraham, Lucy

    2017-12-01

    To evaluate the impact of baseline hot flush frequency and severity on time to symptom improvement during treatment with conjugated estrogens/bazedoxifene (CE/BZA). Data were pooled through week 12 from two randomized placebo-controlled trials (SMART-1 and SMART-2) of nonhysterectomized postmenopausal women with hot flushes treated with CE 0.45 mg/BZA 20 mg or CE 0.625 mg/BZA 20 mg. Time to transient and stable improvement (≥ 50% reduction in hot flush frequency/severity) was estimated using nonparametric models. Transient improvement in hot flush frequency occurred earlier in women treated with CE 0.45 mg/BZA 20 mg with less frequent versus more frequent baseline hot flushes per day: median time to transient improvement was 2, 7, and 11 days for women with hot flushes per day at baseline, respectively (P = 0.0009). Transient improvement in severity occurred earlier for women with less severe versus more severe baseline hot flushes: median time to transient improvement was 2, 6, and 16 days for women with mild, moderate, and severe hot flushes at baseline, respectively (P hot flushes take longer to achieve transient improvements with CE/BZA and should be encouraged to continue treatment, as it may take longer than a few weeks to achieve significant improvement.

  14. Gastrointestinal symptoms and association with medication use patterns, adherence, treatment satisfaction, quality of life, and resource use in osteoporosis: baseline results of the MUSIC-OS study.

    Science.gov (United States)

    Modi, A; Sen, S; Adachi, J D; Adami, S; Cortet, B; Cooper, A L; Geusens, P; Mellström, D; Weaver, J; van den Bergh, J P; Nguyen, A M; Sajjan, S

    2016-03-01

    The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study (MUSIC-OS) is a prospective, observational study of women with osteoporosis in Europe and Canada. At baseline, patients with gastrointestinal symptoms reported lower adherence to osteoporosis treatment, treatment satisfaction, and health-related quality of life, than those without gastrointestinal symptoms. The aim of the study was to examine gastrointestinal (GI) symptoms and the association between GI symptoms and treatment adherence, treatment satisfaction, and health-related quality of life (HRQoL) among osteoporotic women in Europe and Canada. Baseline results are reported here for a prospective study which enrolled postmenopausal, osteoporotic women who were initiating (new users) or continuing (experienced users) osteoporosis treatment at study entry (baseline). A patient survey was administered at baseline and included the occurrence of GI symptoms during 6-month pre-enrolment, treatment adherence (adherence evaluation of osteoporosis (ADEOS), score 0-22), treatment satisfaction (Osteoporosis Treatment Satisfaction Questionnaire for Medications (OPSAT-Q), score 0-100) and HRQoL (EuroQol-5 dimension (EQ-5D) utility, score 0-1; OPAQ-SV, score 0-100). The association between GI symptoms and ADEOS (experienced users), OPSAT-Q (experienced users), and HRQoL (new and experienced users) was assessed by general linear models adjusted for patient characteristics. A total of 2959 patients (2275 experienced and 684 new users) were included. Overall, 68.1% of patients experienced GI symptoms in the past 6 months. Compared with patients without GI symptoms, patients with GI symptoms had lower mean baseline scores on most measures. The mean adjusted differences were ADEOS, -0.43; OPSAT-Q, -5.68; EQ-5D, -0.04 (new users) and -0.06 (experienced users), all P < 0.01. GI symptoms were also associated with lower OPAQ-SV domain scores: physical function, -4.17 (experienced

  15. Real-world evaluation of compliance and preference in Alzheimer’s disease treatment: an observational study in Taiwan 

    Directory of Open Access Journals (Sweden)

    Lai TH

    2016-03-01

    Full Text Available Tzu-Hsien Lai,1,2,* Wen-Fu Wang,3,* Bak-Sau Yip,4 Yu-Wan Yang,5 Giia-Sheun Peng,6 Shih-Jei Tsai,7,8 Yi-Chu Liao,9 Ming-Chyi Pai10,111Section of Neurology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, 2Department of Neurology, National Yang-Ming University School of Medicine, Taipei, 3Department of Neurology, Changhua Christian Hospital, Changhua, 4Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 5Department of Neurology, China Medical University Hospital, Taichung, 6Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 7Department of Neurology, Chung Shan Medical University Hospital, Taichung, 8School of Medicine, Chung Shan Medical University, Taichung, 9Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 10Division of Behavioral Neurology, Department of Neurology, 11Alzheimer’s Disease Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan *These authors contributed equally to this workPurpose: Among the medications approved for Alzheimer’s disease (AD, rivastigmine is the only one available as transdermal patch. The aim of this study was to evaluate compliance and caregivers’ preference with oral and transdermal (rivastigmine monotherapy in patients with mild-to-moderate AD from Taiwan.Methods: Real-world Evaluation of Compliance And Preference in Alzheimer’s disease treatment (RECAP in Taiwan was a prospective, noninterventional, observational study with a 24-week (±8 weeks observational period for each participant. Eligible patients were grouped into one of the two treatment cohorts based on the baseline AD therapy: oral (donepezil, galantamine, rivastigmine, or memantine or transdermal (rivastigmine patch. The primary end points were caregiver preference and caregiver assessment of patients’ compliance to

  16. Inpatients' Preferences, Beliefs, and Stated Willingness to Pay for Complementary and Alternative Medicine Treatments.

    Science.gov (United States)

    Montross-Thomas, Lori P; Meier, Emily A; Reynolds-Norolahi, Kimberly; Raskin, Erin E; Slater, Daniel; Mills, Paul J; MacElhern, Lauray; Kallenberg, Gene

    2017-04-01

    Research demonstrates the benefits of complementary and alternative medicine (CAM) in myriad environments. Yet, the majority of CAM services are offered in outpatient settings. Incorporating CAM into hospital settings may lead to increased patient comfort, well-being, and overall satisfaction with hospital admissions. Few studies have examined CAM services among inpatients. Therefore, this study assessed inpatients' preferences and beliefs regarding CAM, as well as their stated willingness to pay for these services. Adult patients (n = 100), ranging in age from 19-95 years (M = 53 years; SD = 19.2 years), were recruited during their hospitalization in the University of California, San Diego, Healthcare System. The inpatients completed a brief individual interview to gather their perspectives on common CAM services, including acupuncture, aromatherapy, art therapy, guided imagery, healthy food, humor therapy, massage therapy, music therapy, pet therapy, Reiki, and stress management. Inpatients were asked which CAM therapies they perceived as being potentially the most helpful, their willingness to pay for those therapies, and their perceived beliefs regarding the use of those therapies. Inpatients most commonly perceived healthy food (85%), massage therapy (82%), and humor therapy (70%) to be the most helpful, and were most willing to pay for healthy food (71%), massage therapy (70%), and stress management (48%). Inpatients most commonly believed CAM treatments would provide relaxation (88%), increase well-being (86%), and increase their overall satisfaction with the hospitalization (85%). This study suggests that CAM services may be a beneficial addition to hospitals, as demonstrated by inpatients' interest and stated willingness to pay for these services. These findings may help organizational leaders when making choices regarding the development of CAM services within hospitals, particularly since a significant percentage of inpatients reported that

  17. Walking at speeds close to the preferred transition speed as an approach to obesity treatment

    Directory of Open Access Journals (Sweden)

    Ilić Duško

    2012-01-01

    Full Text Available Introduction. Increasing energy expenditure through certain exercise is an important component of effective interventions to enhance initial weight loss and prevent weight regain. Objective. The purpose of this study was to determine the effect of a 16-week weight loss exercise programme on morpho-functional changes in female adults and to examine the programme effects on two subpopulations with different levels of obesity. Methods. Fifty-six middle-aged women were divided into 2 groups according to their body mass index (BMI: 25-29.9 kg/m2 - overweight (OW and ≥30 kg/m2 - obese (OB. The exercise protocol included a walking technique based on hip rotation at horizontal plane at speeds close to the preferred transition speed (PTS. At the initiation of the study and after 16 weeks of the programme, anthropometric, morphological and cardiovascular parameters of all subjects were assessed. The main effects of Group (OW and OB and Time and the interaction effect of Group by Time were tested by time repeated measures General Linear Model (mixed between-within subjects ANOVA. Results. Mean weight loss during the programme was 10.3 kg and 20.1 kg in OW and OB, respectively. The average fat mass (FM loss was 9.4 kg in OW and 16.9 kg in OB. The Mixed ANOVA revealed a significant Group by Time interaction effects for waist circumference, body weight, body water, fat free mass, FM, %FM and BMI (p<0.05. Conclusion. The applied exercise protocol has proved as beneficial in the treatment of obesity, since it resulted in a significant weight loss and body composition changes. The reduction in body weight was achieved mainly on account of the loss of fat mass.

  18. Comparison of two multi-criteria decision techniques for eliciting treatment preferences in people with neurological disorders.

    Science.gov (United States)

    Ijzerman, Maarten J; van Til, Janine A; Snoek, Govert J

    2008-12-01

    To present and compare two multi-criteria decision techniques (analytic hierarchy process [AHP] and conjoint analysis [CA]) for eliciting preferences in patients with cervical spinal cord injury (SCI) who are eligible for surgical augmentation of hand function, either with or without implantation of a neuroprosthesis. The methods were compared in respect to attribute weights, overall preference, and practical experiences. Two previously designed and administered multi-criteria decision surveys in patients with SCI were compared and further analysed. Attributes and their weights in the AHP experiment were determined by an expert panel, followed by determination of the weights in the patient group. Attributes for the CA were selected and validated using an expert panel, piloted in six patients with SCI and subsequently administered to the same group of patients as participated in the AHP experiment. Both experiments showed the importance of non-outcome-related factors such as inpatient stay and number of surgical procedures. In particular, patients were less concerned with clinical outcomes in actual decision making. Overall preference in both the AHP and CA was in favor of tendon reconstruction (0.6 vs 0.4 for neuroprosthetic implantation). Both methods were easy to apply, but AHP was less easily explained and understood. Both the AHP and CA methods produced similar outcomes, which may have been caused by the obvious preferences of patients. CA may be preferred because of the holistic approach of considering all treatment attributes simultaneously and, hence, its power in simulating real market decisions. On the other hand, the AHP method is preferred as a hands-on, easy-to-implement task with immediate feedback to the respondent. This flexibility allows AHP to be used in shared decision making. However, the way the technique is composed results in many inconsistencies. Patients preferred CA but complained about the number of choice tasks.

  19. Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

    Science.gov (United States)

    Shams, Tanzila; Auchus, Alexander P; Oparil, Suzanne; Wright, Clinton B; Wright, Jackson; Furlan, Anthony J; Sila, Cathy A; Davis, Barry R; Pressel, Sara; Yamal, Jose-Miguel; Einhorn, Paula T; Lerner, Alan J

    2017-11-01

    The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542. © 2017 American Heart Association, Inc.

  20. Attitudes and preferences towards exercise training in individuals with alcohol use disorders in a residential treatment setting.

    Science.gov (United States)

    Stoutenberg, Mark; Warne, James; Vidot, Denise; Jimenez, Erika; Read, Jennifer P

    2015-02-01

    Alcohol use disorders (AUD) are a major public health concern due to their association with several acute and chronic health conditions. Exercise training offers a myriad of physical and mental health benefits, and may be a promising adjunct intervention for those in AUD treatment. The purpose of this study was to explore the possible role of exercise training as a treatment strategy by examining the attitudes, beliefs, and preferences of individuals entering residential AUD treatment. Surveys were administered to eligible individuals with AUD within 2days of intake to one of two residential treatment centers. The survey asked respondents about their attitudes, beliefs, and preferences towards exercise training as a part of their residential treatment. Respondents were in favor of receiving exercise counseling as part of their treatment (70.6%), in a face-to-face format (90.0%), and from an exercise counselor at the treatment center (55.5%). The top reported benefits included: improved health, feeling good about oneself, and feeling more confident. The most commonly reported barriers to exercise training included transportation issues, lack of motivation, knowledge, and proper equipment, and cost. Our study supports previous work in individuals with substance abuse disorders and suggests that exercise training would be widely accepted as a part of residential treatment for AUD. This study also identified several strategies that can be used to individualize exercise training programs to better meet the needs of AUD patients and maximize their participation in future interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Acceptability of psychological treatment to Chinese- and Caucasian-Australians: Internet treatment reduces barriers but face-to-face care is preferred.

    Science.gov (United States)

    Choi, Isabella; Sharpe, Louise; Li, Stephen; Hunt, Caroline

    2015-01-01

    Internet treatments have the potential to improve access, especially for cultural groups who face considerable treatment barriers. This study explored the perceived barriers and likelihood of using Internet and face-to-face treatments for depression among Chinese and Caucasian Australian participants. Three-hundred ninety-five (289 Chinese, 106 Caucasian) primary care patients completed a questionnaire about depression history, previous help-seeking, perceived barriers to Internet and face-to-face treatment, and likelihood of using either treatment for depressive symptoms. Internet treatment reduced perceived barriers (including stigma, lack of motivation, concerns of bringing up upsetting feelings, time constraints, transport difficulties, and cost) for both groups to a similar degree, except for time constraints. There were heightened concerns about the helpfulness, suitability, and confidentiality of Internet treatments. Chinese participants and individuals with a probable depression history reported increased perceived barriers across treatments. Both Chinese and Caucasian groups preferred face-to-face treatment across depression severity. However, when age was controlled, there were no significant concerns about Internet treatment, and face-to-face treatment was only preferred for severe depression. Only 12 % of the entire sample refused to try Internet treatment for depression. Endorsement of perceived Internet treatment barriers (including concerns of bringing up upsetting feelings, that treatment would be unhelpful or unsuitable, lack of motivation, cost, cultural sensitivity, and confidentiality) reduced the likelihood to try Internet treatments. Internet treatment reduced perceived treatment barriers across groups, with encouraging support for Internet treatment as an acceptable form of receiving help. Negative concerns about Internet treatment need to be addressed to encourage use.

  2. Baseline prostate-specific antigen levels following treatment with abiraterone acetate as a prognostic factor in castration-resistant prostate cancer.

    Science.gov (United States)

    Hiroshige, Tasuku; Eguchi, Yoshiro; Yoshizumi, Osamu; Chikui, Katsuaki; Kumagai, Hisaji; Kawaguchi, Yoshihiro; Onishi, Rei; Hayashi, Tokumasa; Watanabe, Kouta; Mitani, Tomotaro; Saito, Koujiro; Igawa, Tsukasa

    2018-05-01

    The aim of the present study was to investigate the prognostic factors associated with progression-free survival (PFS) and overall survival (OS) times in patients with castration-resistant prostate cancer (CRPC) who received treatment with abiraterone acetate (AA) in routine clinical settings. A total of 93 patients treated with AA between September 2014 and February 2017 were selected and their medical records were analyzed retrospectively. The median PFS time of docetaxel (DTX)-naïve patients was 171 days, and that of post-DTX patients was 56 days. The OS time of DTX-naïve patients did not reach the median. The median OS time of post-DTX patients was 761 days. Multivariate analyses identified baseline prostate-specific antigen (PSA) level prior to treatment with AA and the PSA response rate as independent prognostic factors for PFS time, and baseline PSA prior to treatment with AA as the only independent prognostic factor for OS time. The results of the present study indicate that the baseline PSA level prior to treatment with AA is a notable prognostic factor in patients with CRPC.

  3. Treating nicotine dependence by targeting attention-deficit/ hyperactivity disorder (ADHD) with OROS methylphenidate: the role of baseline ADHD severity and treatment response.

    Science.gov (United States)

    Nunes, Edward V; Covey, Lirio S; Brigham, Gregory; Hu, Mei-Chen; Levin, Frances R; Somoza, Eugene C; Winhusen, Theresa M

    2013-10-01

    To determine whether treatment of attention-deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions. Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHD-RS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02). OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD

  4. Developing standardised treatment for adults with myositis and different phenotypes: an international survey of current prescribing preferences.

    Science.gov (United States)

    Tansley, Sarah; Shaddick, Gavin; Christopher-Stine, Lisa; Sharp, Charlotte; Dourmishev, Lyubomir; Maurer, Britta; Chinoy, Hector; McHugh, Neil

    2016-01-01

    The evidence base for treatment of the idiopathic inflammatory myopathies is extremely limited. The rarity and heterogeneity of these diseases has hampered the development of good quality clinical trials and while a range of immunomodulatory treatments are commonly used in clinical practice, as yet there are no clear guidelines directing their use. We aimed to establish current prescribing regimens used to treat adults with myositis internationally. An electronic survey based on different clinical scenarios was distributed internationally to clinicians involved in the treatment of patients with myositis. Participants were asked to select their first-line treatment preferences in each situation. A multinomial regression analysis was used to assess the influence of clinical scenario, respondent expertise and country of origin on first-line treatment choice. 107 survey responses were received. 57% of respondents considered themselves an expert in myositis and the majority of respondents were rheumatologists although responses from other specialities were also received. Pharmacological treatment with steroids and additional immunotherapy was the preference in most scenarios. First-line immunosuppressant choice was significantly influenced by the clinical scenario, the expertise of the treating physician and country of practice. Azathioprine, methotrexate and mycophenolate mofetil were the most commonly chosen agents. In the absence of available evidence, clinical experience and expert consensus often forms the basis of treatment guidelines. These results suggest that an international consensus approach would be possible in myositis and would overcome an urgent, yet unmet need for patients suffering with this difficult disease.

  5. A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants.

    Science.gov (United States)

    AlFaleh, Khalid; Alluwaimi, Eman; AlOsaimi, Ahlam; Alrajebah, Sheikha; AlOtaibi, Bashayer; AlRasheed, Fatima; AlKharfi, Turki; Paes, Bosco

    2015-04-22

    The management of a patent ductus arteriosus in preterm infants continues to be debated among neonatologists due to the absence of concrete evidence that precisely weighs the long term outcomes of active, early intervention against a conservative approach. In the majority of institutions, parents are encouraged to play an active role in the complex, decision -making processes with regard to the care of their infants. The objective of this study is to elicit maternal preferences for indomethacin prophylaxis versus treatment of a patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants, utilizing a decision aid instrument (DAI). Healthy and high risk pregnant women at 23-28 weeks gestation, and mothers of admitted ELBW infants were enrolled. A computer based, validated DAI was utilized during interviews. The DAI first provides information about prematurity and concurrent morbidities with comprehensive facts of the pros and cons about prophylactic versus treatment options. It subsequently coaches participants how to select values and preferences based on their decisions. A 17-item questionnaire assessed and valued each short and long term morbidity of extreme prematurity and preferred choice for PDA management. Two hundred ninety nine subjects were enrolled; 75% were healthy women at 23-28 weeks gestation, 19% were high risk and 6% recently delivered an ELBW infant. Eighty-two percent preferred a prophylactic indomethacin strategy versus symptomatic treatment for the management of PDA. Across a spectrum of potential morbidities, the occurrence of severe intraventricular hemorrhage was viewed by mothers as the most un-wanted outcome irrespective of the two proposed options. In contrast to neonatal practitioners, mothers who used this particular DAI strongly endorsed prophylactic indomethacin versus a treatment intervention for the management of PDA in preterm infants.

  6. Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking.

    Science.gov (United States)

    Liddon, Louise; Kingerlee, Roger; Barry, John A

    2018-03-01

    There is some evidence that men and women deal with stress in different ways; for example, a meta-analysis found that women prefer to focus on emotions as a coping strategy more than men do. However, sex differences in preferences for therapy is a subject little explored. A cross-sectional online survey. Participants (115 men and 232 women) were recruited via relevant websites and social media. The survey described therapies and asked participants how much they liked each. Their coping strategies and help-seeking behaviour were assessed too. Survey data were analysed using multiple linear regression. After familywise adjustment of the alpha for multiple testing to p men liked support groups more than women did (β = -.163, p women did (Exp[B] = .280, p women did (Exp[B] = .264, p men were only slightly more likely to prefer a female therapist whereas women were much more likely to prefer females (p men and women regarding therapy, our findings support the hypothesis that men and women show statistically significant differences of relevance to clinical psychologists. Men are less inclined than women to seek help for psychological issues This study demonstrates that men and women show significant differences in some aspects of therapy, coping behaviour, and help-seeking It is possible that men would be more inclined to seek help if therapies catered more for men's preferences Practitioners can learn to improve the success of their practice by taking the gender of clients into account. © 2017 The British Psychological Society.

  7. Evaluation of patient preferences towards treatment during extended hours for patients receiving radiation therapy for the treatment of cancer: A time trade-off study

    International Nuclear Information System (INIS)

    Brown, Alison M.; Atyeo, John; Field, Nikki; Cox, Jennifer; Bull, Colin; Gebski, Val J.

    2009-01-01

    Background: To reduce the waiting time between diagnosis and the start of radiation therapy, some departments have introduced appointments outside of conventional working hours, but the inconvenience this may cause to patients is unknown. We examined, from the patient's perspective, whether reduced waiting times to treatment would be sufficient to trade off against potentially inconvenient appointment times. Method: We interviewed patients receiving radiation therapy at a major teaching hospital between January and May 2005. Two patient groups were considered: those treated during conventional working hours (8.30 am to 4.30 pm), and those treated outside these hours. Patients were asked to trade a reduction in waiting time to the start of treatment against treatment outside conventional working hours. Results: Of 129 patients interviewed, 77 were treated during conventional working hours and 52 outside these hours. Fifty-seven (44%) were male and 52 (40%) were aged over 60 years. To prefer treatment out of working hours, patients being treated during conventional working hours required a larger reduction in waiting time (odds ratio 2.36, 95% CI 0.97-5.76). Patients with curable disease and those who had made few changes in their lifestyle throughout the treatment were more likely to accept treatment outside of conventional working hours. Conclusion: It is impractical to satisfy the treatment-time preferences of all patients. However, many patients prefer treatment outside of normal treatment times if this would reduce the time until the start of radiation therapy. Evaluating the effect of waiting times on patients' perceptions of their disease control provides important information in allocating treatment hours and appointment times

  8. Efficacy, safety, and patient preference of monoamine oxidase B inhibitors in the treatment of Parkinson’s disease

    Science.gov (United States)

    Robottom, Bradley J

    2011-01-01

    Parkinson’s disease (PD) is the second most common neurodegenerative disease and the most treatable. Treatment of PD is symptomatic and generally focuses on the replacement or augmentation of levodopa. A number of options are available for treatment, both in monotherapy of early PD and to treat complications of advanced PD. This review focuses on rasagiline and selegiline, two medications that belong to a class of antiparkinsonian drugs called monoamine oxidase B (MAO-B) inhibitors. Topics covered in the review include mechanism of action, efficacy in early and advanced PD, effects on disability, the controversy regarding disease modification, safety, and patient preference for MAO-B inhibitors. PMID:21423589

  9. Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study

    Science.gov (United States)

    Boëlle, Pierre-Yves; Magassouba, N’Faly; Bah, Elhadj Ibrahima; Koivogui, Lamine; Diallo, Boubacar; Diallo, Alpha Amadou; Keita, Sakoba; Konde, Mandy Kader; Fowler, Robert; Fall, Gamou; Cauchemez, Simon; Sall, Amadou Alpha

    2015-01-01

    Background The case fatality ratio (CFR) of Ebola virus disease (EVD) can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs. Methods and Findings We analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%–27%) for low viremia (V Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care. Conclusions Viremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may inform the ability of surveillance systems to detect EVD patients from the different severity strata. PMID:26625118

  10. Danish physicians' preferences for prescribing escitalopram over citalopram and sertraline to treatment-naïve patients

    DEFF Research Database (Denmark)

    Poulsen, Karen Killerup; Glintborg, Dorte; Moreno, Søren Ilsøe

    2013-01-01

    PURPOSE: To investigate whether general practitioners, hospital physicians and specialized practitioners in psychiatry have similar preferences for initiating treatment with expensive serotonin-specific reuptake inhibitors (SSRIs). METHODS: All first-time prescriptions for the SSRIs escitalopram....... Of the treatment-naïve patients, 19 % were initially prescribed escitalopram. Hospital physicians prescribed escitalopram to 34 % of their treatment-naïve patients, while practitioners specialized in psychiatry prescribed it to 25 %, and general practitioners prescribed it to 17 %. General practitioners, however......, were responsible for initiating 87 % of all treatment-naïve patients. CONCLUSION: The most expensive SSRI, escitalopram, is prescribed as first choice to one in five patients receiving their first antidepressant of escitalopram, citalopram or sertraline. General practitioners made the bulk of all first...

  11. Ego mechanisms of defense are associated with patients? preference of treatment modality independent of psychological distress in end-stage renal disease

    OpenAIRE

    Hyphantis, Thomas; Katsoudas, Spiros; Voudiclari, Sonia

    2010-01-01

    Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients? treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and ...

  12. Do consumers' preferences for improved provision of malaria treatment services differ by their socio-economic status and geographic location? A study in southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Tasie Nnenna G

    2010-01-01

    Full Text Available Abstract Background Improvement of utilization of malaria treatment services will depend on provision of treatment services that different population groups of consumers prefer and would want to use. Treatment of malaria in Nigeria is still problematic and this contributes to worsening burden of the disease in the country. Therefore this study explores the socio-economic and geographic differences in consumers' preferences for improved treatment of malaria in Southeast Nigeria and how the results can be used to improve the deployment of malaria treatment services. Methods This study was undertaken in Anambra state, Southeast Nigeria in three rural and three urban areas. A total of 2,250 randomly selected householders were interviewed using a pre tested interviewer administered questionnaire. Preferences were elicited using both a rating scale and ranking of different treatment provision sources by the respondents. A socio-economic status (SES index was used to examine for SES differences, whilst urban-rural comparison was used to examine for geographic differences, in preferences. Results The most preferred source of provision of malaria treatment services was public hospitals (30.5%, training of mothers (19% and treatment in Primary healthcare centres (18.1%. Traditional healers (4.8% and patent medicine dealers (4.2% were the least preferred strategies for improving malaria treatment. Some of the preferences differed by SES and by a lesser extent, the geographic location of the respondents. Conclusion Preferences for provision of improved malaria treatment services were influenced by SES and by geographic location. There should be re-invigoration of public facilities for appropriate diagnosis and treatment of malaria, in addition to improving the financial and geographic accessibility of such facilities. Training of mothers should be encouraged but home management will not work if the quality of services of patent medicine dealers and pharmacy

  13. The acceptability of an Internet-based exposure treatment for flying phobia with and without therapist guidance: patients’ expectations, satisfaction, treatment preferences, and usability

    Science.gov (United States)

    Campos, Daniel; Mira, Adriana; Bretón-López, Juana; Castilla, Diana; Botella, Cristina; Baños, Rosa Maria; Quero, Soledad

    2018-01-01

    Purpose Internet-based treatments have been tested for several psychological disorders. However, few studies have directly assessed the acceptability of these self-applied interventions in terms of expectations, satisfaction, treatment preferences, and usability. Moreover, no studies provide this type of data on Internet-based treatment for flying phobia (FP), with or without therapist guidance. The aim of this study was to analyze the acceptability of an Internet-based treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and real sounds. A secondary aim was to compare patients’ acceptance of two ways of delivering this treatment (with or without therapist guidance). Patients and methods The sample included 46 participants from a randomized controlled trial who had received the self-applied intervention with (n = 23) or without (n = 23) therapist guidance. All participants completed an assessment protocol conducted online and by telephone at both pre- and posttreatment. Results Results showed good expectations, satisfaction, opinion, and usability, regardless of the presence of therapist guidance, including low aversiveness levels from before to after the intervention. However, participants generally preferred the therapist-supported condition. Conclusion NO-FEAR Airlines is a well-accepted Internet-based treatment that can help enhance the application of the exposure technique, improving patient acceptance and access to FP treatment. PMID:29636613

  14. Simple, Efficient Estimators of Treatment Effects in Randomized Trials Using Generalized Linear Models to Leverage Baseline Variables

    Science.gov (United States)

    Rosenblum, Michael; van der Laan, Mark J.

    2010-01-01

    Models, such as logistic regression and Poisson regression models, are often used to estimate treatment effects in randomized trials. These models leverage information in variables collected before randomization, in order to obtain more precise estimates of treatment effects. However, there is the danger that model misspecification will lead to bias. We show that certain easy to compute, model-based estimators are asymptotically unbiased even when the working model used is arbitrarily misspecified. Furthermore, these estimators are locally efficient. As a special case of our main result, we consider a simple Poisson working model containing only main terms; in this case, we prove the maximum likelihood estimate of the coefficient corresponding to the treatment variable is an asymptotically unbiased estimator of the marginal log rate ratio, even when the working model is arbitrarily misspecified. This is the log-linear analog of ANCOVA for linear models. Our results demonstrate one application of targeted maximum likelihood estimation. PMID:20628636

  15. Simple, efficient estimators of treatment effects in randomized trials using generalized linear models to leverage baseline variables.

    Science.gov (United States)

    Rosenblum, Michael; van der Laan, Mark J

    2010-04-01

    Models, such as logistic regression and Poisson regression models, are often used to estimate treatment effects in randomized trials. These models leverage information in variables collected before randomization, in order to obtain more precise estimates of treatment effects. However, there is the danger that model misspecification will lead to bias. We show that certain easy to compute, model-based estimators are asymptotically unbiased even when the working model used is arbitrarily misspecified. Furthermore, these estimators are locally efficient. As a special case of our main result, we consider a simple Poisson working model containing only main terms; in this case, we prove the maximum likelihood estimate of the coefficient corresponding to the treatment variable is an asymptotically unbiased estimator of the marginal log rate ratio, even when the working model is arbitrarily misspecified. This is the log-linear analog of ANCOVA for linear models. Our results demonstrate one application of targeted maximum likelihood estimation.

  16. Intergenerational and cross-cultural differences in emotional wellbeing, mental health service utilisation, treatment-seeking preferences and acceptability of psychological treatments for Arab Australians.

    Science.gov (United States)

    Kayrouz, Rony; Dear, Blake F; Johnston, Luke; Keyrouz, Liliane; Nehme, Edmond; Laube, Roy; Titov, Nickolai

    2015-08-01

    Little is known about the intergenerational and cross-cultural differences in emotional wellbeing and acceptability of psychological treatments for Arab Australians. To contribute to the emerging data about the mental health status and needs of Arab Australians. An Internet survey examined psychological distress and functional impairment as measured by the Kessler 10 Item scale (K-10) and the Sheehan Disability Scale (SDS) among Arab Australians. Additional questions enquired about their help-seeking behaviours, barriers to accessing psychological treatments and preferences for delivery of psychological treatments. A total of 252 participants were recruited through public talks, media and online promotions. Forty-three percent of the respondents reported moderate-to-severe functional impairment (M = 9.5; standard deviation (SD) = 1.8), 32% reported high psychological distress (M = 28.5; SD = 5.4) and 30% were born overseas. First-generation Arab Australians experiencing high psychological distress (i.e. K-10 ≥ 22), reported a greater preference for Internet-delivered treatment when compared to their second-generation counterparts. Only 18% of the sample reported seeking help from a mental health professional in the past year. The significant barriers reported by respondents with high psychological distress were poor mental health literacy, lack of time and stigma. Respondents preferred face-to-face (90%) over Internet-delivered treatment (55%). Finally, Arab Australians experienced higher psychological distress and underutilised mental health services when compared to the Australian population. Targeted public health campaigns that make culturally relevant interventions such as modifying existing Internet-delivered treatment for Arab Australians may reduce barriers and increase treatment options for this population. © The Author(s) 2014.

  17. Patient preferences for clean intermittent catheterisation and transurethral indwelling catheterisation for treatment of abnormal post-void residual bladder volume after vaginal prolapse surgery

    NARCIS (Netherlands)

    Hakvoort, R. A.; Nieuwkerk, P. T.; Burger, M. P.; Emanuel, M. H.; Roovers, J. P.

    2011-01-01

    To determine patient preferences for clean intermittent catheterisation (CIC) relative to transurethral indwelling catheterisation (TIC) as the treatment of abnormal post-void residual bladder volume (PVR) following vaginal prolapse surgery. Scenario-based preference assessment during face-to-face

  18. Baseline depression levels do not affect efficacy of cognitive-behavioral self-help treatment for insomnia

    NARCIS (Netherlands)

    Lancee, J.; van den Bout, J.; van Straten, A.; Spoormaker, V.I.

    2013-01-01

    Background: Cognitive-behavioral therapy can effectively treat insomnia (CBT-I). Randomized controlled trials have shown efficacy of self-help CBT-I, but unclear is whether excluding depressive patients boosted treatment effects. Method: We administered unsupported self-help CBT-I to insomnia

  19. Baseline depression levels do not affect efficacy of cognitive-behavioral self-help treatment for insomnia

    NARCIS (Netherlands)

    Lancee, J.; van den Bout, J.; van Straten, A.; Spoormaker, V.I.

    2013-01-01

    Background Cognitive-behavioral therapy can effectively treat insomnia (CBT-I). Randomized controlled trials have shown efficacy of self-help CBT-I, but unclear is whether excluding depressive patients boosted treatment effects. Method We administered unsupported self-help CBT-I to insomnia patients

  20. The predictive value of baseline variables in the treatment of benign prostatic hyperplasia using high-energy transurethral microwave thermotherapy

    NARCIS (Netherlands)

    D'Ancona, F. C.; Francisca, E. A.; Hendriks, J. C.; Debruyne, F. M.; de la Rosette, J. J.

    1998-01-01

    To evaluate the combination of patient age, prostate size, grade of outlet obstruction and total amount of energy, all independent predictive variables of treatment outcome in patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) treated with high-energy

  1. Differential item functioning (DIF) in the EORTC QLQ-C30: a comparison of baseline, on-treatment and off-treatment data

    DEFF Research Database (Denmark)

    Scott, Neil W.; Fayers, Peter M.; Aaronson, Neil K.

    2009-01-01

    Differential item functioning (DIF) analyses can be used to explore translation, cultural, gender or other differences in the performance of quality of life (QoL) instruments. These analyses are commonly performed using "baseline" or pretreatment data. We previously reported DIF analyses to examine...

  2. Sound attenuation and preferred music in the treatment of problem behavior maintained by escape from noise.

    Science.gov (United States)

    Kettering, Tracy L; Fisher, Wayne W; Kelley, Michael E; LaRue, Robert H

    2018-06-06

    We examined the extent to which different sounds functioned as motivating operations (MO) that evoked problem behavior during a functional analysis for two participants. Results suggested that escape from loud noises reinforced the problem behavior for one participant and escape from arguing reinforced problem behavior for the other participant. Noncontingent delivery of preferred music through sound-attenuating headphones decreased problem behavior without the use of extinction for both participants. We discuss the results in terms of the abolishing effects of the intervention. © 2018 Society for the Experimental Analysis of Behavior.

  3. Are gastroenterologists less tolerant of treatment risks than patients? Benefit-risk preferences in Crohn's disease management.

    Science.gov (United States)

    Johnson, F Reed; Hauber, Brett; Özdemir, Semra; Siegel, Corey A; Hass, Steven; Sands, Bruce E

    2010-10-01

    Crohn's disease is a serious and debilitating gastrointestinal disorder with a high, unmet need for new treatments. Biologic agents have the potential to alter the natural course of Crohn's disease but present known risks of potential serious adverse events (SAEs). Previous studies have shown that patients are willing to accept elevated SAE risks in exchange for clinical efficacy. Gastroenterologists and patients may have similar goals of maximizing treatment benefit while minimizing risk; however, gastroenterologists may assess the relative importance of risk differently than patients. To (a) understand how gastroenterologists caring for patients with Crohn's disease balance benefits and risks in their treatment decisions and (b) compare their treatment preferences with those of adult patients with Crohn's disease. Both patient and gastroenterologist treatment preferences were elicited using a web-based, choice-format conjoint survey instrument. The conjoint questions required subjects to choose between 2 hypothetical treatment options with differing levels of treatment attributes. Patients evaluated the treatment options for themselves, and gastroenterologists evaluated the treatment options for each of 3 hypothetical patient types: (a) female aged 25 years with no history of Crohn's disease surgery (young), (b) male aged 45 years with 1 Crohn's disease surgery (middleaged), and (c) female older than 70 years with 4 Crohn's disease surgeries (older). Treatment attributes represented the expected outcomes of treatment: severity of daily symptoms, frequency of flare-ups, serious disease complications, oral steroid use, and the risks of 3 potentially fatal SAEs - lymphoma, serious or opportunistic infections, and progressive multifocal leukoencephalopathy (PML) - during 10 years of treatment. Maximum acceptable risk (MAR), defined as the highest level of SAE risk that subjects would accept in return for a given improvement in efficacy (i.e., the increase in

  4. An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

    Science.gov (United States)

    Barterian, Justin A; Sanchez, Joel M; Magen, Jed; Siroky, Allison K; Mash, Brittany L; Carlson, John S

    2018-01-01

    This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

  5. Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kauffman KS

    2014-12-01

    Full Text Available Karen S Kauffman,1 Megan Doede,1 Montserrat Diaz-Abad,2 Steven M Scharf,2,3 Wanda Bell-Farrell,2 Valerie E Rogers,1 Jeanne Geiger-Brown1 1Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA; 2Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD, USA; 3The University of Maryland Sleep Disorders Center, Baltimore, MD, USA Abstract: Persons with chronic obstructive pulmonary disease (COPD are known to have poor sleep quality. Acceptance of and adherence to therapies for sleep problems may depend on how the person with COPD regards the source of his sleep problem, yet little is known about their attribution as to the cause of these sleep symptoms. The objective of this study was to describe the subjective sleep complaints of individuals with COPD along with their attributions as to the cause of these symptoms, and their treatment preferences for insomnia. Three focus groups were conducted (N=18 with participants who have moderate to severe COPD. Focus group data were transcribed, compared and contrasted to identify themes of attribution. Participants reported difficulty falling asleep, staying asleep, and daytime sleepiness. They attributed their sleep problems primarily to their pulmonary symptoms, but also poor air quality (thick humid air and death anxiety when awake during the night. There was no clear preference for type of treatment to remedy this problem (medication, cognitive therapy, although they indicated that traveling to the clinic was difficult and should be avoided as much as possible. These data suggest that environmental manipulation to improve air quality (eg, air conditioning and modifications to reduce death anxiety could be beneficial to persons with COPD. In-person multi-session therapy may not be acceptable to persons with moderate to severe COPD, however internet-based therapy might make treatment more accessible. Keywords

  6. Use of binaural beat tapes for treatment of anxiety: a pilot study of tape preference and outcomes.

    Science.gov (United States)

    Le Scouarnec, R P; Poirier, R M; Owens, J E; Gauthier, J; Taylor, A G; Foresman, P A

    2001-01-01

    Recent studies and anecdotal reports suggest that binaural auditory beats can affect mood, performance on vigilance tasks, and anxiety. To determine whether mildly anxious people would report decreased anxiety after listening daily for 1 month to tapes imbedded with tones that create binaural beats, and whether they would show a definite tape preference among 3 tapes. A 1-group pre-posttest pilot study. Patients' homes. A volunteer sample of 15 mildly anxious patients seen in the Clinique Psyché, Montreal, Quebec. Participants were asked to listen at least 5 times weekly for 4 weeks to 1 or more of 3 music tapes containing tones that produce binaural beats in the electroencephalogram delta/theta frequency range. Participants also were asked to record tape usage, tape preference, and anxiety ratings in a journal before and after listening to the tape or tapes. Anxiety ratings before and after tape listening, pre- and post-study State-Trait Anxiety Inventory scores, and tape preferences documented in daily journals. Listening to the binaural beat tapes resulted in a significant reduction in the anxiety score reported daily in patients' diaries. The number of times participants listened to the tapes in 4 weeks ranged from 10 to 17 (an average of 1.4 to 2.4 times per week) for approximately 30 minutes per session. End-of-study tape preferences indicated that slightly more participants preferred tape B, with its pronounced and extended patterns of binaural beats, over tapes A and C. Changes in pre- and posttest listening State-Trait Anxiety Inventory scores trended toward a reduction of anxiety, but these differences were not statistically significant. Listening to binaural beat tapes in the delta/theta electroencephalogram range may be beneficial in reducing mild anxiety. Future studies should account for music preference among participants and include age as a factor in outcomes, incentives to foster tape listening, and a physiologic measure of anxiety reduction. A

  7. Natural speech algorithm applied to baseline interview data can predict which patients will respond to psilocybin for treatment-resistant depression.

    Science.gov (United States)

    Carrillo, Facundo; Sigman, Mariano; Fernández Slezak, Diego; Ashton, Philip; Fitzgerald, Lily; Stroud, Jack; Nutt, David J; Carhart-Harris, Robin L

    2018-04-01

    Natural speech analytics has seen some improvements over recent years, and this has opened a window for objective and quantitative diagnosis in psychiatry. Here, we used a machine learning algorithm applied to natural speech to ask whether language properties measured before psilocybin for treatment-resistant can predict for which patients it will be effective and for which it will not. A baseline autobiographical memory interview was conducted and transcribed. Patients with treatment-resistant depression received 2 doses of psilocybin, 10 mg and 25 mg, 7 days apart. Psychological support was provided before, during and after all dosing sessions. Quantitative speech measures were applied to the interview data from 17 patients and 18 untreated age-matched healthy control subjects. A machine learning algorithm was used to classify between controls and patients and predict treatment response. Speech analytics and machine learning successfully differentiated depressed patients from healthy controls and identified treatment responders from non-responders with a significant level of 85% of accuracy (75% precision). Automatic natural language analysis was used to predict effective response to treatment with psilocybin, suggesting that these tools offer a highly cost-effective facility for screening individuals for treatment suitability and sensitivity. The sample size was small and replication is required to strengthen inferences on these results. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a Female Sexual Medicine Program.

    Science.gov (United States)

    Carter, Jeanne; Stabile, Cara; Seidel, Barbara; Baser, Raymond E; Gunn, Abigail R; Chi, Stephanie; Steed, Rebecca F; Goldfarb, Shari; Goldfrank, Deborah J

    2015-08-01

    The purpose of this study is to characterize patients seeking treatment at a Female Sexual Medicine and Women's Health Program and examine their sexual/vaginal health issues. Data from clinical assessment forms were extracted from 509 women referred to the Female Sexual Medicine and Women's Health Program during/after cancer treatment. The form consists of a Vaginal Assessment Scale (VAS), vaginal health items, patient-reported outcomes (PROs) (Sexual Activity Questionnaire [SAQ], Sexual Self-Schema Scale [SSS], Female Sexual Function Index [FSFI]), and exploratory items. Of 509 patients, 493 (97 %) completed PROs; 253 (50 %) received a pelvic examination. The majority had a history of breast (n = 260, 51 %), gynecologic (n = 184, 36 %), or colorectal/anal (n = 35, 7 %) cancer. Mean age was 51.2 years; 313 (62 %) were married/partnered. Approximately two thirds had elevated vaginal pH scores (5-6.5 [35 %] or 6.5+ [33 %]) and minimal (62 %) or no (5 %) vaginal moisture. Eighty-seven patients (44 %) experienced pain during their exam (23 % mild, 11 % moderate, 1.5 % severe, and 8.5 % not indicated). Fifty-three percent engaged in sexual activity with a partner; only 43 % felt confident about future sexual activity. Ninety-three percent were somewhat to very concerned/worried about sexual function/vaginal health. Approximately half had moderate/severe dryness (n = 133, 51 %) and dyspareunia (n = 120, 46 %). The mean SSS score was 60.7, indicating a slightly positive sexual self-view. However, 93.5 % (n = 429) had an FSFI score <26.55, suggesting sexual dysfunction. At initial consult, women reported vaginal dryness, pain, and sexual dysfunction. For many women, pelvic exams showed elevated vaginal pH, lack of moisture, and discomfort with the exam itself. Future analyses will examine changes over time.

  9. Parents' and Adolescents' Preferences for Intensified or Reduced Treatment in Randomized Lymphoblastic Leukemia Trials

    DEFF Research Database (Denmark)

    Tulstrup, Morten; Larsen, Hanne Bækgaard; Castor, Anders

    2015-01-01

    compared to younger children in trials with different toxicity profiles. PROCEDURE: Age-dependent participation rates in three consecutive, randomized childhood leukemia trials conducted by the Nordic Society of Paediatric Haematology and Oncology were evaluated. The ALL2000 dexamethasone/vincristine (Dx...... prospectively registered by the treating physicians. RESULTS: Parents of young children favored treatment intensifications (Dx/VCR: 12% refusal; 6MP: 14%; ASP: 21%), whereas parents of adolescents favored treatment reductions (Dx/VCR: 52% refusal; 6MP: 30%; ASP: 8%). Adolescents were more likely to refuse...... intensification trials than young children (adjusted ORs 6.3; P treatment (adjusted OR for median consolidation length 0.15; P = 0...

  10. Treatment preferences in Turkey for open fracture of the tibial diaphysis

    Directory of Open Access Journals (Sweden)

    Güzelali Özdemir

    2017-03-01

    Conclusion: A wide variation was observed among orthopedics and traumatology specialists in Turkey regarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study together with the available literature may be useful to further develop therapeutic approaches.

  11. Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

    NARCIS (Netherlands)

    van Dijk, J. Marc C.; Groen, Rob J. M.; Ter Laan, Mark; Jeltema, Johanna Rinck; Mooij, Jan Jacob A.; Metzemaekers, Jan D. M.

    2011-01-01

    In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly

  12. Emotion reactivity and regulation in late-life generalized anxiety disorder: Functional connectivity at baseline and post-treatment

    Science.gov (United States)

    Andreescu, Carmen; Sheu, Lei K.; Tudorascu, Dana; Gross, James J.; Walker, Sarah; Banihashemi, Layla; Aizenstein, Howard

    2014-01-01

    Objectives Generalized Anxiety Disorder (GAD) is one of the most prevalent mental disorders in the elderly, but its functional neuroanatomy is not well understood. Given the role of emotion dysregulation in GAD, we sought to describe the neural bases of emotion regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience Network and the Executive Control Network during worry induction and worry reappraisal. Design, setting and participants Twenty-eight elderly GAD and thirty-one non-anxious comparison participants were included. Twelve elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry script that alternates blocks of worry induction and reappraisal. We assessed network FC, employing the following seeds: anterior insula (AI), dorso-lateral prefrontal cortex (dlPFC), the bed nucleus of stria terminalis (BNST), the paraventricular nucleus (PVN). Results GAD participants exhibited greater FC during worry induction between the left AI and the right orbito-frontal cortex (OFC), and between the BNST and the subgenual cingulate. During worry reappraisal, the non-anxious participants had greater FC between the left dlPFC and the medial PFC, as well as between the left AI and the medial PFC, while elderly GAD had greater FC between the PVN and the amygdala. Following twelve weeks of pharmacotherapy, GAD participants had greater connectivity between the dlPFC and several prefrontal regions during worry reappraisal. Conclusion FC during worry induction and reappraisal points toward abnormalities in both worry generation and worry reappraisal. Following successful pharmacologic treatment, we observed greater connectivity in the prefrontal nodes of the Executive Control Network during reappraisal of worry. PMID:24996397

  13. Baseline HCV Antibody Prevalence and Risk Factors among Drug Users in China's National Methadone Maintenance Treatment Program.

    Directory of Open Access Journals (Sweden)

    Changhe Wang

    Full Text Available Hepatitis C virus (HCV is the most common viral infection among injecting drug users worldwide. We aimed to assess HCV antibody prevalence and associated risk factors among clients in the Chinese national methadone maintenance treatment (MMT program.Data from 296,209 clients who enrolled in the national MMT program between March 2004 and December 2012 were analyzed to assess HCV antibody prevalence, associated risk factors, and geographical distribution.Anti-HCV screening was positive for 54.6% of clients upon MMT entry between 2004 and 2012. HCV antibody prevalence at entry declined from 66.8% in 2005 to 45.9% in 2012. The most significant predictors of HCV seropositivity were injecting drug use (adjusted odds ratio [AOR]: 8.34, 95% confidence interval [CI]: 8.17-8.52, p<0.0001 and a history of drug use ≥9 years (AOR: 2.01, 95% CI: 1.96-2.06, p<0.0001. Being female, of Uyghur or Zhuang ethnicity, and unmarried were identified as demographic risk factors (all p-values<0.0001. Of the 28 provincial-level divisions included in the study, we found that 5 divisions had HCV antibody prevalence above 70% and 20 divisions above 50%. The HCV screening rate within 6 months after MMT entry greatly increased from 30.4% in 2004 to 93.1% in 2012.The current HCV antibody prevalence remains alarmingly high among MMT clients throughout most provincial-level divisions in China, particularly among injecting drug users and females. A comprehensive prevention strategy is needed to control the HCV epidemic among MMT clients in China.

  14. Assessment of early treatment response to neoadjuvant chemotherapy in breast cancer using non-mono-exponential diffusion models: a feasibility study comparing the baseline and mid-treatment MRI examinations

    Energy Technology Data Exchange (ETDEWEB)

    Bedair, Reem; Manavaki, Roido; Gill, Andrew B.; Abeyakoon, Oshaani; Gilbert, Fiona J. [University of Cambridge, Department of Radiology, School of Clinical Medicine, Cambridge (United Kingdom); Priest, Andrew N.; Patterson, Andrew J. [Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Addenbrookes Hospital, Cambridge (United Kingdom); McLean, Mary A. [Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Addenbrookes Hospital, Cambridge (United Kingdom); University of Cambridge, Li Ka Shing Centre, Cancer Research UK Cambridge Institute, Cambridge (United Kingdom); Graves, Martin J. [University of Cambridge, Department of Radiology, School of Clinical Medicine, Cambridge (United Kingdom); Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Addenbrookes Hospital, Cambridge (United Kingdom); Griffiths, John R. [University of Cambridge, Li Ka Shing Centre, Cancer Research UK Cambridge Institute, Cambridge (United Kingdom)

    2017-07-15

    To assess the feasibility of the mono-exponential, bi-exponential and stretched-exponential models in evaluating response of breast tumours to neoadjuvant chemotherapy (NACT) at 3 T. Thirty-six female patients (median age 53, range 32-75 years) with invasive breast cancer undergoing NACT were enrolled for diffusion-weighted MRI (DW-MRI) prior to the start of treatment. For assessment of early response, changes in parameters were evaluated on mid-treatment MRI in 22 patients. DW-MRI was performed using eight b values (0, 30, 60, 90, 120, 300, 600, 900 s/mm{sup 2}). Apparent diffusion coefficient (ADC), tissue diffusion coefficient (D{sub t}), vascular fraction (Florin), distributed diffusion coefficient (DDC) and alpha (α) parameters were derived. Then t tests compared the baseline and changes in parameters between response groups. Repeatability was assessed at inter- and intraobserver levels. All patients underwent baseline MRI whereas 22 lesions were available at mid-treatment. At pretreatment, mean diffusion coefficients demonstrated significant differences between groups (p < 0.05). At mid-treatment, percentage increase in ADC and DDC showed significant differences between responders (49 % and 43 %) and non-responders (21 % and 32 %) (p = 0.03, p = 0.04). Overall, stretched-exponential parameters showed excellent repeatability. DW-MRI is sensitive to baseline and early treatment changes in breast cancer using non-mono-exponential models, and the stretched-exponential model can potentially monitor such changes. (orig.)

  15. Assessment of early treatment response to neoadjuvant chemotherapy in breast cancer using non-mono-exponential diffusion models: a feasibility study comparing the baseline and mid-treatment MRI examinations

    International Nuclear Information System (INIS)

    Bedair, Reem; Manavaki, Roido; Gill, Andrew B.; Abeyakoon, Oshaani; Gilbert, Fiona J.; Priest, Andrew N.; Patterson, Andrew J.; McLean, Mary A.; Graves, Martin J.; Griffiths, John R.

    2017-01-01

    To assess the feasibility of the mono-exponential, bi-exponential and stretched-exponential models in evaluating response of breast tumours to neoadjuvant chemotherapy (NACT) at 3 T. Thirty-six female patients (median age 53, range 32-75 years) with invasive breast cancer undergoing NACT were enrolled for diffusion-weighted MRI (DW-MRI) prior to the start of treatment. For assessment of early response, changes in parameters were evaluated on mid-treatment MRI in 22 patients. DW-MRI was performed using eight b values (0, 30, 60, 90, 120, 300, 600, 900 s/mm"2). Apparent diffusion coefficient (ADC), tissue diffusion coefficient (D_t), vascular fraction (Florin), distributed diffusion coefficient (DDC) and alpha (α) parameters were derived. Then t tests compared the baseline and changes in parameters between response groups. Repeatability was assessed at inter- and intraobserver levels. All patients underwent baseline MRI whereas 22 lesions were available at mid-treatment. At pretreatment, mean diffusion coefficients demonstrated significant differences between groups (p < 0.05). At mid-treatment, percentage increase in ADC and DDC showed significant differences between responders (49 % and 43 %) and non-responders (21 % and 32 %) (p = 0.03, p = 0.04). Overall, stretched-exponential parameters showed excellent repeatability. DW-MRI is sensitive to baseline and early treatment changes in breast cancer using non-mono-exponential models, and the stretched-exponential model can potentially monitor such changes. (orig.)

  16. Treatment preferences in juvenile idiopathic arthritis – a comparative analysis in two health care systems

    Directory of Open Access Journals (Sweden)

    Hugle Boris

    2013-01-01

    Full Text Available Abstract Background Variations in the treatment of juvenile idiopathic arthritis (JIA may impact on quality of care. The objective of this study was to identify and compare treatment approaches for JIA in two health care systems. Methods Paediatric rheumatologists in Canada (n=58 and Germany/Austria (n=172 were surveyed by email, using case-based vignettes for oligoarticular and seronegative polyarticular JIA. Data were analysed using descriptive statistics; responses were compared using univariate analysis. Results Total response rate was 63%. Physicians were comparable by age, level of training and duration of practice, with more Canadians based in academic centres. For initial treatment of oligoarthritis, only approximately half of physicians in both groups used intra-articular steroids. German physicians were more likely to institute DMARD treatment in oligoarthritis refractory to NSAID (p Conclusions Treatment of oligo- and polyarticular JIA with DMARD is mostly uniform, with availability and funding obviously influencing physician choice. Usage of intra-articular steroids is variable within physician groups. Physiotherapy has a fundamentally different role in the two health care systems.

  17. Testing of a Model with Latino Patients That Explains the Links Among Patient-Perceived Provider Cultural Sensitivity, Language Preference, and Patient Treatment Adherence.

    Science.gov (United States)

    Nielsen, Jessica D Jones; Wall, Whitney; Tucker, Carolyn M

    2016-03-01

    Disparities in treatment adherence based on race and ethnicity are well documented but poorly understood. Specifically, the causes of treatment nonadherence among Latino patients living in the USA are complex and include cultural and language barriers. The purpose of this study was to examine whether patients' perceptions in patient-provider interactions (i.e., trust in provider, patient satisfaction, and patient sense of interpersonal control in patient-provider interactions) mediate any found association between patient-perceived provider cultural sensitivity (PCS) and treatment adherence among English-preferred Latino (EPL) and Spanish-preferred Latino (SPL) patients. Data from 194 EPL patients and 361 SPL patients were obtained using questionnaires. A series of language-specific structural equation models were conducted to test the relationship between patient-perceived PCS and patient treatment adherence and the examined mediators of this relationship among the Latino patients. No significant direct effects of patient-perceived PCS on general treatment adherence were found. However, as hypothesized, several significant indirect effects emerged. Preferred language appeared to have moderating effects on the relationships between patient-perceived PCS and general treatment adherence. These results suggest that interventions to promote treatment adherence among Latino patients should likely include provider training to foster patient-defined PCS, trust in provider, and patient satisfaction with care. Furthermore, this training needs to be customized to be suitable for providing care to Latino patients who prefer speaking Spanish and Latino patients who prefer speaking English.

  18. Baseline characteristics and treatment of patients in prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial (PARADIGM-HF).

    Science.gov (United States)

    McMurray, John J V; Packer, Milton; Desai, Akshay S; Gong, Jianjian; Lefkowitz, Martin; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Solomon, Scott D; Swedberg, Karl; Zile, Michael R

    2014-07-01

    To describe the baseline characteristics and treatment of the patients randomized in the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and morbidity in Heart Failure) trial, testing the hypothesis that the strategy of simultaneously blocking the renin-angiotensin-aldosterone system and augmenting natriuretic peptides with LCZ696 200 mg b.i.d. is superior to enalapril 10 mg b.i.d. in reducing mortality and morbidity in patients with heart failure and reduced ejection fraction. Key demographic, clinical and laboratory findings, along with baseline treatment, are reported and compared with those of patients in the treatment arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) and more contemporary drug and device trials in heart failure and reduced ejection fraction. The mean age of the 8442 patients in PARADIGM-HF is 64 (SD 11) years and 78% are male, which is similar to SOLVD-T and more recent trials. Despite extensive background therapy with beta-blockers (93% patients) and mineralocorticoid receptor antagonists (60%), patients in PARADIGM-HF have persisting symptoms and signs, reduced health related quality of life, a low LVEF (mean 29 ± SD 6%) and elevated N-terminal-proB type-natriuretic peptide levels (median 1608 inter-quartile range 886-3221 pg/mL). PARADIGM-HF will determine whether LCZ696 is more beneficial than enalapril when added to other disease-modifying therapies and if further augmentation of endogenous natriuretic peptides will reduce morbidity and mortality in heart failure and reduced ejection fraction. © 2014 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

  19. Pharmacogenetic testing prior to carbamazepine treatment of epilepsy: patients' and physicians' preferences for testing and service delivery.

    Science.gov (United States)

    Powell, Graham; Holmes, Emily A F; Plumpton, Catrin O; Ring, Adele; Baker, Gus A; Jacoby, Ann; Pirmohamed, Munir; Marson, Anthony G; Hughes, Dyfrig A

    2015-11-01

    Pharmacogenetic studies have identified the presence of the HLA-A*31:01 allele as a predictor of cutaneous adverse drugs reactions (ADRs) to carbamazepine. This study aimed to ascertain the preferences of patients and clinicians to inform carbamazepine pharmacogenetic testing services. Attributes of importance to people with epilepsy and neurologists were identified through interviews and from published sources. Discrete choice experiments (DCEs) were conducted in 82 people with epilepsy and 83 neurologists. Random-effects logit regression models were used to determine the importance of the attributes and direction of effect. In the patient DCE, all attributes (seizure remission, reduction in seizure frequency, memory problems, skin rash and rare, severe ADRs) were significant. The estimated utility of testing was greater, at 0.52 (95% CI 0.19, 1.00) than not testing at 0.33 (95% CI -0.07, 0.81). In the physician DCE, cost, inclusion in the British National Formulary, coverage, negative predictive value (NPV) and positive predictive value (PPV) were significant. Marginal rates of substitution indicated that neurologists were willing to pay £5.87 for a 1 percentage point increase in NPV and £3.99 for a 1 percentage point increase in PPV. The inclusion of both patients' and clinicians' perspectives represents an important contribution to the understanding of preferences towards pharmacogenetic testing prior to initiating carbamazepine. Both groups identified different attributes but had generally consistent preferences. Patients' acceptance of a decrease in treatment benefit for a reduced chance of severe ADRs adds support for the implementation of HLA-A*31:01 testing in routine practice. © 2015 The British Pharmacological Society.

  20. Patient's needs and preferences in routine follow-up after treatment for breast cancer

    NARCIS (Netherlands)

    de Bock, GH; Bonnema, J; Zwaan, RE; de Velde, CJH; Kievit, J; Stiggelbout, AM

    2004-01-01

    The purpose of the study was to analyse the needs of women who participated in a routine follow-up programme after treatment for primary breast cancer. A cross-sectional survey was conducted using a postal questionnaire among women without any sign of relapse during the routine follow-up period. The

  1. [Surgery or physiotherapy for urinary stress incontinence; what is the preferred treatment in women?

    NARCIS (Netherlands)

    Labrie, J.; Berghmans, L.C.M.; Fischer, K.; Lagro-Janssen, A.; Vaart, C.H. van der

    2014-01-01

    OBJECTIVE: To compare midurethral sling surgery and pelvic floor physiotherapy as initial treatment in women with moderate to severe urinary stress incontinence. DESIGN: Multicentre randomised trial. METHOD: The study population was made up of women aged 35 to 80 years with moderate to severe stress

  2. Why we prefer levetiracetam over phenytoin for treatment of status epilepticus.

    Science.gov (United States)

    Zaccara, G; Giorgi, F S; Amantini, A; Giannasi, G; Campostrini, R; Giovannelli, F; Paganini, M; Nazerian, P

    2018-06-01

    Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine-resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time-consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine-resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Survey of eye practitioners' preference of diagnostic tests and treatment modalities for dry eye in Ghana.

    Science.gov (United States)

    Asiedu, Kofi; Kyei, Samuel; Ayobi, Benedict; Agyemang, Frank Okyere; Ablordeppey, Reynolds Kwame

    2016-12-01

    This study sought to provide an evidence-based profile of the diagnosis, treatment and knowledge or opinions on dry eye among optometrists and ophthalmologists in Ghana. This was a cross-sectional survey RESULTS: The responses of 162 participants are included in the analysis. The most commonly used test to diagnosed dry eye disease was tear break-up time followed by patient history. The most common symptom doctors heard from dry eye patients were burning sensation followed by foreign body sensation. The most often prescribed first- line treatment for dry eye was aqueous-based artificial tears followed by lipid-based artificial tears. Most practitioners considered meibomian gland dysfunction as the most common cause of dry eye followed by pterygium. The most often used test to guide or gauge therapeutic effect is patient history followed closely by tear break-up time. Most practitioners reported that 10%-20% of all their patients they see in a day are diagnosed of dry eye. This study showed tear break up time was the main test majority of practitioners in Ghana used to diagnose dry eye but patient history was the main test used to gauge therapeutic effect over time. Burning sensation was the commonest symptom practitioners heard from dry eye patients whilst artificial tears was their main and first-line treatment for dry eye. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  4. Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences.

    Science.gov (United States)

    Sanghani, Ruchi M; Moler, Alexander K

    2015-01-01

    Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors' scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients.

  5. Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences

    Directory of Open Access Journals (Sweden)

    Ruchi M. Sanghani

    2015-01-01

    Full Text Available Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors’ scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients.

  6. Treatment comfort, time perception, and preference for conventional and digital impression techniques: A comparative study in young patients.

    Science.gov (United States)

    Burhardt, Lukasz; Livas, Christos; Kerdijk, Wouter; van der Meer, Wicher Joerd; Ren, Yijin

    2016-08-01

    The aim of this crossover study was to assess perceptions and preferences for impression techniques in young orthodontic patients receiving alginate and 2 different digital impressions. Thirty-eight subjects aged 10 to 17 years requiring impressions for orthodontic treatment were randomly allocated to 3 groups that differed in the order that an alginate impressions and 2 different intraoral scanning procedures were administered. After each procedure, the patients were asked to score their perceptions on a 5-point Likert scale for gag reflex, queasiness, difficulty to breathe, uncomfortable feeling, perception of the scanning time, state of anxiety, and use of a powder, and to select the preferred impression system. Chairside time and maximal mouth opening were also registered. More queasiness (P = 0.00) and discomfort (P = 0.02) during alginate impression taking of the maxilla were perceived compared with the scans with the CEREC Omnicam (Sirona Dental Systems, Bensheim, Germany). There were no significant differences in perceptions between the alginate impressions and the Lava C.O.S. (3M ESPE, St Paul, Minn) and between the 2 scanners. Chairside times for the alginate impressions (9.7 ± 1.8 minutes) and the CEREC Omnicam (10.7 ± 1.8 minutes) were significantly lower (P <0.001) than for the Lava C.O.S. (17.8 ± 4.0 minutes). Digital impressions were favored by 51% of the subjects, whereas 29% chose alginate impressions, and 20% had no preference. Regardless of the significant differences in the registered times among the 3 impression-taking methods, the distributions of the Likert scores of time perception and maximal mouth opening were similar in all 3 groups. Young orthodontic patients preferred the digital impression techniques over the alginate method, although alginate impressions required the shortest chairside time. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  7. Current health and preferences for life-prolonging treatments: an application of prospect theory to end-of-life decision making.

    Science.gov (United States)

    Winter, Laraine; Parker, Barbara

    2007-10-01

    As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.

  8. Lack of Associations of CHRNA5-A3-B4 Genetic Variants with Smoking Cessation Treatment Outcomes in Caucasian Smokers despite Associations with Baseline Smoking.

    Directory of Open Access Journals (Sweden)

    Rachel F Tyndale

    Full Text Available CHRNA5-A3-B4 variants, rs16969968, rs588765 and rs578776, are consistently associated with tobacco consumption among smokers, but the association with smoking cessation is less consistent. Among the studies that reported significant associations with cessation, the effects were observed in smokers treated with placebo treatment in some studies and conversely in those receiving active pharmacological therapy (bupropion and nicotine replacement therapies in others. Thus, it remains unclear whether CHRNA5-A3-B4 is a useful marker for optimizing smoking cessation. Using data from 654 Caucasian smokers treated with placebo, nicotine patch or varenicline, we investigated whether CHRNA5-A3-B4 variants were associated with smoking cessation outcomes, and whether there were significant genotype-by-treatment or haplotype-by-treatment interactions. We observed no significant associations between CHRNA5-A3-B4 variants and smoking cessation, despite replicating previous associations with baseline tobacco consumption. At end of treatment the effect size on smoking cessation in the placebo, patch and varenicline groups for rs16969968 [GG vs. GA+AA] was OR = 0.66 (P = 0.23, OR = 1.01 (P = 0.99, and OR = 1.30 (P = 0.36 respectively, of rs588765 [CC vs. CT+TT] was OR = 0.96 (P = 0.90, OR = 0.84 (P = 0.58, and OR = 0.74 (P = 0.29 respectively, and for rs578776 [GG vs. GA+AA] on smoking cessation was OR = 1.02 (P = 0.95, OR = 0.75 (P = 0.35, and OR = 1.20 (P = 0.51 respectively. Furthermore, we observed no associations with cessation using the CHRNA5-A3-B4 haplotype (constructed using rs16969968 and rs588765, nor did we observe any significant genotype-by-treatment interactions, with or without adjusting for the rate of nicotine metabolism (all P>0.05. We also observed no significant genetic associations with 6 month or 12 month smoking abstinence. In conclusion, we found no association between CHRNA5-A3-B4 variants and smoking cessation rates in this clinical

  9. The predictive value of baseline NAA/Cr for treatment response of first-episode schizophrenia: A ¹H MRS study.

    Science.gov (United States)

    Liu, Weibo; Yu, Hualiang; Jiang, Biao; Pan, Bing; Yu, Shaohua; Li, Huichun; Zheng, Leilei

    2015-07-23

    The study focused on the predictive value of baseline metabolite ratios in bilateral hippocampus of first-episode schizophrenia by using proton magnetic resonance spectroscopy ((1)H MRS). (1)H MRS data were acquired from 23 hallucination and 17 non-hallucination first-episode schizophrenia patients compared with 17 healthy participants. Clinical characteristics of patients were rated using the Positive and Negative Syndrome Scale (PANSS) before and after 3-month treatment. The schizophrenia patients showed lower NAA/Cr ratio than healthy participants respectively (p=0.024; p=0.001), and non-hallucination patients had even lower NAA/Cr ratio than hallucination patients (p=0.033). After 3-month treatment, hallucination patients had greater improvement in negative symptoms than non-hallucination patients (p=0.018). The reduction of PANSS total score and negative factor score was positively correlated with the left NAA/Cr in both group patients (pNAA/Cr had predictive value for the whole treatment response, and the left hippocampal NAA/Cr can predict the prognosis of negative symptoms during acute phase medication in first-episode schizophrenia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Oumar Faye

    2015-12-01

    Full Text Available The case fatality ratio (CFR of Ebola virus disease (EVD can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs.We analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%-27% for low viremia (V < 104.4 copies/ml to 53% (95% CI 44%-61% for intermediate viremia (104.4 ≤ V < 105.2 copies/ml and 81% (95% CI 75%-87% for high viremia (V ≥ 105.2 copies/ml. Compared to adults (15-44 y old [y.o.], the CFR was larger in young children (0-4 y.o. (odds ratio [OR]: 2.44; 95% CI 1.02-5.86 and older adults (≥ 45 y.o. (OR: 2.84; 95% CI 1.81-4.46 but lower in children (5-14 y.o. (OR: 0.46; 95% CI 0.24-0.86. An order of magnitude increase in mean viremia in cases after July 2014 compared to those before coincided with a 14% increase in the CFR. Our findings come from a large hospital-based study in Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care.Viremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may inform the

  11. The majority of men with lifelong premature ejaculation prefer daily drug treatment: an observation study in a consecutive group of Dutch men

    NARCIS (Netherlands)

    Waldinger, Marcel D.; Zwinderman, Aeilko H.; Olivier, Berend; Schweitzer, Dave H.

    2007-01-01

    INTRODUCTION: Whether men with lifelong premature ejaculation (PE) prefer on-demand drug treatment to delay ejaculation time to daily drug treatment, has never been studied as a separate study question. AIM: To study how men with lifelong PE feel about the use of serotonergic antidepressants, and

  12. The Best of Both Worlds: An Example Mixed Methods Approach to Understand Men's Preferences for the Treatment of Lower Urinary Tract Symptoms.

    Science.gov (United States)

    Ikenwilo, Divine; Heidenreich, Sebastian; Ryan, Mandy; Mankowski, Colette; Nazir, Jameel; Watson, Verity

    2018-02-01

    Discrete choice experiments (DCEs) are widely used to quantify individuals' preferences for healthcare. Guidelines recommend the design of DCEs should be informed by qualitative research. However, only a few studies go beyond guidelines by fully presenting qualitative and quantitative research jointly together in a mixed methods approach (MMA). Using an example study about men's preferences for medical treatment of lower urinary tract symptoms (LUTS), we demonstrate how qualitative research can complement DCEs to gain a rich understanding of individuals' preferences. We were the first to combine online discussion groups (ODGs) with an online DCE. A thematic analysis of the ODGs and a conceptual map provided insights into men's quality of life (QoL) with LUTS and relevant treatment attitudes. This was used to design the DCE. Men's willingness to pay (WTP) for these attributes was estimated. Findings from ODGs and DCE were compared to understand WTP and preference heterogeneity. Men mostly valued medicine that reduced urgency and night-time frequencies of urination but avoided sexual side effects. We find heterogeneity in the effect of sexual side effects on men's preferences. The ODGs suggest this is because several men may be sexually inactive due to their age, being widowed or having comorbidities. The ODGs also raised concern about men's awareness of LUTS. We argue that the insights gained into men's preferences for treatment and how LUTS affects men's QoL could not have been obtained by either the qualitative research or the DCE alone.

  13. Improvement of Quality of Life (QOL in Osteoporotic Patients by Elcatonin Treatment: A Trial Taking the Participants’ Preference into Account

    Directory of Open Access Journals (Sweden)

    K. Yoh

    2012-01-01

    Full Text Available Osteoporosis is associated with compromised quality of life (QOL, to which pain has the most important contribution. Elcatonin, a derivative of calcitonin, is widely used in the treatment of osteoporosis in two ways. One is as the inhibitor of osteoclastic bone resorption. The other is for osteoporosis-related pain based on the unique analgesic effects of elcatonin. Since pain is subjective in nature, and QOL is the only clinical outcome representing the patients’ subjective perception of health status, pain associated with osteoporosis would be best evaluated based on QOL assessment. Evidence based medicine gives the highest remarks to the double-blinded, randomized controlled trial, which, however, cannot be free from methodological problems on some occasions. For example, it is practically impossible to remain blinded in the trial of a potent analgesia, which in turn causes biases. Thus, the significance of taking the patients’ preference into account is increasingly acknowledged. In this study, 45 osteoporotic patients were given brochures describing the pros and cons on the three treatment choices; calcium and alfacalcidol, additional use of elcatonin, and additional use of bisphosphonate. Those who favored elcatonin were older, had more vertebral fractures, and lower QOL scores. QOL was evaluated before and three months after the treatment using SF-8; the most widely used generic questionnaire, and RDQ; a lumbago-specific measure. Elcatonin treatment improved physical function, general health, and vitality of SF-8, and RDQ score. Although this is a preliminary study, our results suggest that patients with vertebral fracture(s have impaired QOL and more likely to favor elcatonin treatment expecting analgesia.

  14. Treatment acceptability and preferences for managing severe health anxiety: Perceptions of internet-delivered cognitive behaviour therapy among primary care patients.

    Science.gov (United States)

    Soucy, Joelle N; Hadjistavropoulos, Heather D

    2017-12-01

    While cognitive behaviour therapy (CBT) is an established treatment for health anxiety, there are barriers to service access. Internet-delivered cognitive behaviour therapy (ICBT) has demonstrated effectiveness and has the potential to improve access to treatment. Nevertheless, it is unknown how patients perceive ICBT relative to other interventions for health anxiety and what factors predict ICBT acceptability. This study investigated these questions. Primary care patients (N = 116) who reported elevated levels of health anxiety were presented three treatment vignettes that each described a different protocol for health anxiety (i.e., medication, CBT, ICBT). Acceptability and credibility of the treatments were assessed following the presentation of each vignette. Participants then ranked the three treatments and provided a rational for their preferences. The treatments were similarly rated as moderately acceptable. Relative to medication and ICBT, CBT was perceived as the most credible treatment for health anxiety. The highest preference ranks were for CBT and medication. Regression analyses indicated that lower computer anxiety, past medication use, and lower ratings of negative cognitions about difficulty coping with an illness significantly predicted greater ICBT acceptability. Health anxiety was not assessed with a diagnostic interview. Primary care patients were recruited through a Qualtrics panel. Patients did not have direct experience with treatment but learned about treatment options through vignettes. Medication and CBT are preferred over ICBT. If ICBT is to increase treatment access, methods of improving perceptions of this treatment option are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Preferences for Life-Sustaining Treatments and Associations With Accurate Prognostic Awareness and Depressive Symptoms in Terminally Ill Cancer Patients' Last Year of Life.

    Science.gov (United States)

    Tang, Siew Tzuh; Wen, Fur-Hsing; Hsieh, Chia-Hsun; Chou, Wen-Chi; Chang, Wen-Cheng; Chen, Jen-Shi; Chiang, Ming-Chu

    2016-01-01

    The stability of life-sustaining treatment (LST) preferences at end of life (EOL) has been established. However, few studies have assessed preferences more than two times. Furthermore, associations of LST preferences with modifiable variables of accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms have been investigated in cross-sectional studies only. To explore longitudinal changes in LST preferences and their associations with accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms in terminally ill cancer patients' last year. LST preferences (cardiopulmonary resuscitation, intensive care unit [ICU] care, intubation, and mechanical ventilation) were measured approximately every two weeks. Changes in LST preferences and their associations with independent variables were examined by hierarchical generalized linear modeling with logistic regression. Participants (n = 249) predominantly rejected cardiopulmonary resuscitation, ICU care, intubation, and mechanical ventilation at EOL without significant changes as death approached. Patients with inaccurate prognostic awareness were significantly more likely than those with accurate understanding to prefer ICU care, intubation, and mechanical ventilation than to reject these LSTs. Patients with more severe depressive symptoms were less likely to prefer ICU care and to be undecided about wanting ICU care and mechanical ventilation than to reject such LSTs. LST preferences were not associated with physician-patient EOL care discussions, which were rare in our sample. LST preferences are stable in cancer patients' last year. Facilitating accurate prognostic awareness and providing adequate psychological support may counteract the increasing trend for aggressive EOL care and minimize emotional distress during EOL care decisions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights

  16. Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open.

    Science.gov (United States)

    Yao, Christopher M; Kahane, Alyssa; Monteiro, Eric; Gentili, Fred; Zadeh, Gelareh; de Almeida, John R

    2017-08-01

    Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results  There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p  < 0.001) and watchful waiting (0.88 vs.0.74; p  = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p  = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting ( p  = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores ( p  = 0.017). Conclusion  The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

  17. Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mark W. Vander Weg

    2018-03-01

    Full Text Available Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP, a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American. Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.

  18. MO-FG-CAMPUS-TeP3-01: A Model of Baseline Shift to Improve Robustness of Proton Therapy Treatments of Moving Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Souris, K; Barragan Montero, A; Di Perri, D; Geets, X; Lee, J [Universite catholique de Louvain, Brussels (Belgium); Sterpin, E [Universite catholique de Louvain, Brussels (Belgium); KU Leuven, Leuven (Belgium)

    2016-06-15

    Purpose: The shift in mean position of a moving tumor also known as “baseline shift”, has been modeled, in order to automatically generate uncertainty scenarios for the assessment and robust optimization of proton therapy treatments in lung cancer. Methods: An average CT scan and a Mid-Position CT scan (MidPCT) of the patient at the planning time are first generated from a 4D-CT data. The mean position of the tumor along the breathing cycle is represented by the GTV contour in the MidPCT. Several studies reported both systematic and random variations of the mean tumor position from fraction to fraction. Our model can simulate this baseline shift by generating a local deformation field that moves the tumor on all phases of the 4D-CT, without creating any non-physical artifact. The deformation field is comprised of normal and tangential components with respect to the lung wall in order to allow the tumor to slip within the lung instead of deforming the lung surface. The deformation field is eventually smoothed in order to enforce its continuity. Two 4D-CT series acquired at 1 week of interval were used to validate the model. Results: Based on the first 4D-CT set, the model was able to generate a third 4D-CT that reproduced the 5.8 mm baseline-shift measured in the second 4D-CT. Water equivalent thickness (WET) of the voxels have been computed for the 3 average CTs. The root mean square deviation of the WET in the GTV is 0.34 mm between week 1 and week 2, and 0.08 mm between the simulated data and week 2. Conclusion: Our model can be used to automatically generate uncertainty scenarios for robustness analysis of a proton therapy plan. The generated scenarios can also feed a TPS equipped with a robust optimizer. Kevin Souris, Ana Barragan, and Dario Di Perri are financially supported by Televie Grants from F.R.S.-FNRS.

  19. Technology Use and Preferences for Mobile Phone–Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research

    Science.gov (United States)

    Winder, Terrell JA; Lea III, Charles Herbert; Tan, Diane; Boyd, Donte; Novak, David

    2017-01-01

    Background Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts. Objective The aim of our study was to understand BYMSM’s preferences for mobile phone–based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population. Methods Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone–based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software. Results Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM. Conclusions Mobile phone–based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions. PMID:28408360

  20. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research.

    Science.gov (United States)

    Holloway, Ian W; Winder, Terrell Ja; Lea, Charles Herbert; Tan, Diane; Boyd, Donte; Novak, David

    2017-04-13

    Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts. The aim of our study was to understand BYMSM's preferences for mobile phone-based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population. Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone-based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software. Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM. Mobile phone-based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions. ©Ian W Holloway, Terrell JA Winder, Charles Herbert Lea III, Diane Tan, Donte Boyd, David Novak. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.04.2017.

  1. Ego mechanisms of defense are associated with patients' preference of treatment modality independent of psychological distress in end-stage renal disease.

    Science.gov (United States)

    Hyphantis, Thomas; Katsoudas, Spiros; Voudiclari, Sonia

    2010-03-24

    Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients' treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirty-seven patients (53.4%) had chosen hemodialysis and 21 (46.6%) peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804-0.988), had received more education (OR, 8.84; 95% CI: 1.301-60.161), and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P psychological distress. Our findings indicate that the patient's personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive-aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.

  2. Preference for brand-name buprenorphine is related to severity of addiction among outpatients in opioid maintenance treatment.

    Science.gov (United States)

    Binder, Philippe; Messaadi, Nassir; Perault-Pochat, Marie-Christine; Gagey, Stéphanie; Brabant, Yann; Ingrand, Pierre

    2016-01-01

    As a form of opioid maintenance treatment, high-dose buprenorphine is increasingly being used in the United States. On the French market since 1996, it is the most commonly prescribed and frequently employed opioid maintenance treatment. For unknown reasons, the brand-name form is used far more often than the generic form (76-24%). The objective was to show that the patients' levels of addiction were differentiated according to the form of buprenorphine currently being used and to their previous experience of a different form. An observational study in 9 sites throughout France used self-assessment questionnaires filled out in retail pharmacies by all patients to whom their prescribed buprenorphine treatment was being delivered. The 151 canvassed pharmacies solicited 879 patients, of whom 724 completed the questionnaires. Participants were statistically similar to non-participants. The patients using the brand-name form subsequent to experience with the generic form exhibited a more elevated addiction severity index and a higher dosage than brand-name form users with no experience of a different form. Compared to generic users, their doses were higher, their was addiction more severe, and their alcohol consumption was more excessive; they were also more likely to make daily use of psychotropic substances. However, the level of misuse or illicit consumption was similar between these groups. Preferring the brand-name buprenorphine form to the generic form is associated with a higher level of severe addiction, a more frequent need for daily psychotropics, and excessive drinking; but the study was unable to show a causal link.

  3. Treatment preferences and trade-offs for ovulation induction in clomiphene citrate-resistant patients with polycystic ovary syndrome

    NARCIS (Netherlands)

    Bayram, Neriman; van Wely, Madelon; van der Veen, Fulco; Bossuyt, Patrick M. M.; Nieuwkerk, Pythia

    2005-01-01

    Objective: To investigate patient preferences and trade-offs for laparoscopic electrocautery of the ovaries relative to ovulation induction with recombinant FSH (rFSH) in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). Design: Assessment of preferences and

  4. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in an homogenous patient population

    International Nuclear Information System (INIS)

    Dinapoli, Nicola; Parrilla, Claudio; Galli, Jacopo

    2010-01-01

    To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO 2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined. (orig.)

  5. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in an homogenous patient population

    Energy Technology Data Exchange (ETDEWEB)

    Dinapoli, Nicola [Catholic Univ. of the Sacred Heart, Rome (Italy). Dept. of Radiation Oncology; Parrilla, Claudio; Galli, Jacopo [Catholic Univ. of the Sacred Heart, Rome (IT). Dept. of Otorhinolaryngoiatry] (and others)

    2010-11-15

    To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO{sub 2} surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined. (orig.)

  6. School Psychologists and the Secret Illness: Perceived Knowledge, Role Preferences, and Training Needs regarding the Prevention and Treatment of Internalizing Disorders

    Science.gov (United States)

    Miller, David N.; Jome, LaRae M.

    2010-01-01

    This descriptive study examined the perceptions of a national sample of school psychologists in the United States regarding their perceived knowledge, preferred roles, and training needs in the prevention and treatment of nine prominent child and adolescent internalizing disorders. The results indicated that participants perceived the prevention…

  7. Preferred and Perceived Participation of Younger and Older Patients in Decision Making About Treatment for Early Breast Cancer: A Prospective Study.

    Science.gov (United States)

    Hamelinck, Victoria C; Bastiaannet, Esther; Pieterse, Arwen H; van de Velde, Cornelis J H; Liefers, Gerrit-Jan; Stiggelbout, Anne M

    2018-04-01

    Older patients are believed to prefer a more passive role in treatment decision making, but studies reporting this relation were conducted over a decade ago or were retrospective. We prospectively compared younger (40-64 years) versus older (≥ 65 years) breast cancer patients' preferences for decision-making roles and their perceived actual roles. A prospective multicenter study was conducted in Leiden, The Hague, and Tilburg over a 2-year period. Early-stage breast cancer patients were surveyed about their preferred and perceived decision-making roles (active, shared, or passive) concerning surgery type (breast-conserving vs. mastectomy) (n = 74), adjuvant chemotherapy (aCT, n = 43), and adjuvant hormonal therapy (aHT, n = 39). For all decisions, both age groups most frequently preferred a shared role before consultation, except for decisions about aHT, for which younger patients more commonly preferred an active role. The proportion of patients favoring an active or passive role in each decision was lower for the older than the younger patients, but none of the differences was significant. Regarding perceived actual roles, both groups most frequently reported an active role in the surgical decision after consultation. In deciding about both aCT and aHT, a larger proportion of older patients perceived having had a passive role compared to younger patients, and a greater proportion of younger patients perceived having been active. Again, differences were not statistically significant. Most older patients preferred to decide together with their clinician, but preferences varied widely. Older patients more often than younger patients perceived they had not been involved in decisions about systemic therapy. Clinicians should invite all patients to participate in decision making and elicit their preferred role. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Independent preferences

    DEFF Research Database (Denmark)

    Vind, Karl

    1991-01-01

    A simple mathematical result characterizing a subset of a product set is proved and used to obtain additive representations of preferences. The additivity consequences of independence assumptions are obtained for preferences which are not total or transitive. This means that most of the economic ...... theory based on additive preferences - expected utility, discounted utility - has been generalized to preferences which are not total or transitive. Other economic applications of the theorem are given...

  9. Abriendo Puertas: baseline findings from an integrated intervention to promote prevention, treatment and care among FSW living with HIV in the Dominican Republic.

    Directory of Open Access Journals (Sweden)

    Yeycy Donastorg

    Full Text Available Female sex workers (FSW are often the focus of primary HIV prevention efforts. However, little attention has been paid to the prevention, treatment, and care needs of FSW living with HIV. Based on formative research, we developed an integrated model to promote prevention and care for FSW living with HIV in Santo Domingo, Dominican Republic, including (1 individual counseling and education; (2 peer navigation; (3 clinical provider training; and (4 community mobilization. We enrolled 268 FSW living with HIV into the intervention and conducted socio-behavioral surveys, sexually transmitted infection (STI testing, and viral load (VL assessments. We used multivariate logistic regression to identify behavioral and socio-demographic factors associated with detectable VL (>50 copies/mL and STI prevalence. Over half of all participants (51.9% had a detectable VL, even though most received HIV-related care in the last 6 months (85.1% and were currently on anti-retroviral treatment (ART (72.4%. Factors positively associated with a detectable VL included being 18-35 years of age (Adjusted Odds Ratio [AOR] 2.46, 95% CI 1.31-4.60, having ever used drugs (AOR 2.34, 95% CI 1.14-4.79, and having ever interrupted ART (AOR 3.09, 95% CI 1.44-6.59. Factors protective against having a detectable VL included being single (AOR 0.45, 95% 0.20-0.98 and being currently on ART (AOR 0.17, 95% CI 0.07-0.41. Nearly one-quarter (23.1% had an STI, which was associated with being single (AOR 3.21, 95% CI 1.27-8.11 and using drugs in the last 6 months (AOR 3.54, 95% CI 1.32-9.45. Being on ART was protective against STI (AOR 0.51, 95% CI 0.26-1.00. Baseline findings indicate significant barriers to VL suppression and STI prevention among FSW living with HIV and highlight gaps in the continuum of HIV care and treatment. These findings have important implications for both the individual health of FSW and population-level HIV transmission dynamics.

  10. Surveying treatment preferences in U.S. Iraq-Afghanistan Veterans with PTSD symptoms: a step toward veteran-centered care.

    Science.gov (United States)

    Crawford, Eric F; Elbogen, Eric B; Wagner, H Ryan; Kudler, Harold; Calhoun, Patrick S; Brancu, Mira; Straits-Troster, Kristy A

    2015-04-01

    This study examined health care barriers and preferences among a self-selected sample of returning U.S. veterans drawn from a representative, randomly selected frame surveyed about posttraumatic stress disorder (PTSD) symptomatology and mental health utilization in the prior year. Comparisons between treated (n = 160) and untreated (n = 119) veterans reporting PTSD symptoms were conducted for measures of barriers and preferences, along with logistic models regressing mental health utilization on clusters derived from these measures. Reported barriers corroborated prior research findings as negative beliefs about treatment and stigma were strongly endorsed, but only privacy concerns were associated with lower service utilization (B = -0.408, SE = 0.142; p = .004). The most endorsed preference (91.0%) was for assistance with benefits, trailed by help for physical problems, and particular PTSD symptoms. Help-seeking veterans reported stronger preferences for multiple interventions, and desire for services for families (B = 0.468, SE = 0.219; p = .033) and specific PTSD symptoms (B = 0.659, SE = 0.302; p = .029) were associated with increased utilization. Outcomes of the study suggested PTSD severity drove help-seeking in this cohort. Results also support the integration of medical and mental health services, as well as coordination of health and benefits services. Finally, the study suggested that outreach about privacy protections and treatment options could well improve engagement in treatment. Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.

  11. Patients’ and physicians’ preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment

    Directory of Open Access Journals (Sweden)

    Morillas C

    2015-10-01

    Full Text Available Carlos Morillas,1 Rosa Feliciano,2 Pablo Fernández Catalina,3 Carla Ponte,4 Marta Botella,5 João Rodrigues,6 Enric Esmatjes,7 Javier Lafita,8 Luis Lizán,9 Ignacio Llorente,10 Cristóbal Morales,11 Jorge Navarro-Pérez,12 Domingo Orozco-Beltran,13 Silvia Paz,9 Antonio Ramirez de Arellano,14 Cristina Cardoso,15 Maribel Tribaldos Causadias9 1Hospital Universitario Dr Peset, Valencia, Spain; 2USF São Domingos, Santarém, Portugal; 3Hospital Montecelo de Pontevedra, Galicia, Spain; 4USF Porta do Sol, Matosinhos, Portugal; 5Hospital Universitario Principe de Asturias, Madrid, Spain; 6USF Serra da Lousã, Lousã, Portugal; 7Hospital Clinic, Barcelona, Spain; 8Hospital de Navarra, Navarra, Spain; 9Outcomes’10, Universidad Jaume I, Castellón, Spain; 10Hospital Universitario Nuestra Señora de la Candelaria, Canarias, Spain; 11Hospital Universitario Virgen de la Macarena, Sevilla, Spain; 12INCLIVA, CIBERESP, Universidad de Valencia, Valencia, Spain; 13Sociedad Española de Medicina Familiar y Comunitaria, Valencia, Spain; 14Novo Nordisk EU-HEOR Europe, Madrid, Spain; 15Novo Nordisk, Lisbon, Portugal Objective: To assess Spanish and Portuguese patients’ and physicians’ preferences regarding type 2 diabetes mellitus (T2DM treatments and the monthly willingness to pay (WTP to gain benefits or avoid side effects.Methods: An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model.Results: Three-hundred and thirty (n=330 patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body

  12. Conducting a Discrete-Choice Experiment Study Following Recommendations for Good Research Practices: An Application for Eliciting Patient Preferences for Diabetes Treatments.

    Science.gov (United States)

    Janssen, Ellen M; Hauber, A Brett; Bridges, John F P

    2018-01-01

    To consolidate and illustrate good research practices in health care to the application and reporting of a study measuring patient preferences for type 2 diabetes mellitus medications, given recent methodological advances in stated-preference methods. The International Society for Pharmacoeconomics and Outcomes Research good research practices and other recommendations were used to conduct a discrete-choice experiment. Members of a US online panel with type 2 diabetes mellitus completed a Web-enabled, self-administered survey that elicited choices between treatment pairs with six attributes at three possible levels each. A D-efficient experimental design blocked 48 choice tasks into three 16-task surveys. Preference estimates were obtained using mixed logit estimation and were used to calculate choice probabilities. A total of 552 participants (51% males) completed the survey. Avoiding 90 minutes of nausea was valued the highest (mean -10.00; 95% confidence interval [CI] -10.53 to -9.47). Participants wanted to avoid low blood glucose during the day and/or night (mean -3.87; 95% CI -4.32 to -3.42) or one pill and one injection per day (mean -7.04; 95% CI -7.63 to -6.45). Participants preferred stable blood glucose 6 d/wk (mean 4.63; 95% CI 4.15 to 5.12) and a 1% decrease in glycated hemoglobin (mean 5.74; 95% CI 5.22 to 6.25). If cost increased by $1, the probability that a treatment profile would be chosen decreased by 1%. These results are consistent with the idea that people have strong preferences for immediate consequences of medication. Despite efforts to produce recommendations, ambiguity surrounding good practices remains and various judgments need to be made when conducting stated-preference studies. To ensure transparency, these judgments should be described and justified. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. Characterization of chemically induced ovarian carcinomas in an ethanol-preferring rat model: influence of long-term melatonin treatment.

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo A Chuffa

    Full Text Available Ovarian cancer is the fourth most common cause of cancer deaths among women, and chronic alcoholism may exert co-carcinogenic effects. Because melatonin (mel has oncostatic properties, we aimed to investigate and characterize the chemical induction of ovarian tumors in a model of ethanol-preferring rats and to verify the influence of mel treatment on the overall features of these tumors. After rats were selected to receive ethanol (EtOH, they were surgically injected with 100 µg of 7,12-dimethyl-benz[a]anthracene (DMBA plus sesame oil directly under the left ovarian bursa. At 260 days old, half of the animals received i.p. injections of 200 µg mel/100 g b.w. for 60 days. Four experimental groups were established: Group C, rats bearing ovarian carcinomas (OC; Group C+EtOH, rats voluntarily consuming 10% (v/v EtOH and bearing OC; Group C+M, rats bearing OC and receiving mel; and Group C+EtOH+M, rats with OC consuming EtOH and receiving mel. Estrous cycle and nutritional parameters were evaluated, and anatomopathological analyses of the ovarian tumors were conducted. The incidence of ovarian tumors was higher in EtOH drinking animals 120 days post-DMBA administration, and mel efficiently reduced the prevalence of some aggressive tumors. Although mel promoted high EtOH consumption, it was effective in synchronizing the estrous cycle and reducing ovarian tumor mass by 20%. While rats in the C group displayed cysts containing serous fluid, C+EtOH rats showed solid tumor masses. After mel treatment, the ovaries of these rats presented as soft and mobile tissues. EtOH consumption increased the incidence of serous papillary carcinomas and sarcomas but not clear cell carcinomas. In contrast, mel reduced the incidence of sarcomas, endometrioid carcinomas and cystic teratomas. Combination of DMBA with EtOH intake potentiated the incidence of OC with malignant histologic subtypes. We concluded that mel reduces ovarian masses and the incidence of

  14. Ego mechanisms of defense are associated with patients’ preference of treatment modality independent of psychological distress in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Thomas Hyphantis

    2010-02-01

    Full Text Available Thomas Hyphantis1, Spiros Katsoudas2, Sonia Voudiclari31Associate Professor of Psychiatry, Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece; 2Nephrologist, Renal Clinic, Hippocration General Hospital, Athens, Greece; 3Department of Nephrology, University of Athens, GreeceAbstract: Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD. The nephrology community suggests that patient preference should be the prime determinant of modality choice. We aimed to test whether ego mechanisms of defense are associated with patients’ treatment modality preferences, independent of psychological distress. In 58 eligible ESRD patients who had themselves chosen their treatment modality, we administered the Symptom Distress Checklist-90-R and the Defense Style Questionnaire. Thirtyseven patients (53.4% had chosen hemodialysis and 21 (46.6% peritoneal dialysis. Patients who preferred peritoneal dialysis were younger (odds ratio [OR], 0.89; 95% confidence interval [CI]: 0.804–0.988, had received more education (OR, 8.84; 95% CI: 1.301–60.161, and were twice as likely to adopt an adaptive defense style as compared to patients who preferred hemodialysis (57.1% vs 27.0%, respectively; P < 0.033. On the contrary, the latter were more likely to adopt an image-distorting defense style (35.1% vs 14.3%; P = 0.038 and passive–aggressive defenses (OR, 0.73: 95% CI: 0.504–1.006. These results were independent of psychological distress. Our findings indicate that the patient’s personality should be taken into account, if we are to better define which modalities are best suited to which patients. Also, physicians should bear in mind passive–aggressive behaviors that warrant attention and intervention in patients who preferred hemodialysis.Keywords: end-stage renal disease, hemodialysis, peritoneal dialysis, ego mechanisms of defense, DSQ, psychopathology

  15. Assessment of Physician's Systemic Treatment Preferences for Patients with Advanced Desmoid-Type Fibromatosis: Experience-Based Medicine in the Absence of High-Level Evidence.

    Science.gov (United States)

    Schöffski, Patrick; Requilé, Annelies; van Cann, Tom

    2018-01-01

    The treatment of advanced desmoid-type fibromatosis (DF) is poorly standardized and primarily based on physician's choice. We assessed systemic treatment preferences for advanced DF among European experts, with the aim to define a control treatment for prospective randomized trials. A structured questionnaire was sent to a group of physicians involved in DF treatment. 54 experts from 14 countries (Europe, Israel) responded. Disease progression and failure of local therapy were typical indications for systemic therapy. Treatment preferences for patients with sporadic DF versus DF associated with Gardner's syndrome were similar. Physicians use at least 5 different classes of drugs (27 agents). The most frequently used compounds were anti-estrogens and non-steroidal anti-inflammatory agents (NSAIDs), in combination or as single agents. The second and third most common systemic approach was chemotherapy based on methotrexate or an anthracycline. Trial activity was limited to 1 country/1 multicentric study. There is an unmet medical need for evidence-based treatments and well-designed studies. Clinical trials with systemic agents should ideally select a homogeneous DF population with advanced, progressive, ideally symptomatic disease and/or functional impairment after failure of wait-and-see and/or local treatments, and should be randomized, with placebo, anti-estrogens, NSAIDs, or physician's choice as comparator. © 2018 S. Karger GmbH, Freiburg.

  16. Low frequency of cardniac arrhythmias and lack of structural heart disease in medically-naïve acromegaly patients: a prospective study at baseline and after 1 year of somatostatin analogs treatment.

    Science.gov (United States)

    Warszawski, Leila; Kasuki, Leandro; Sá, Rodrigo; Dos Santos Silva, Cintia Marques; Volschan, Isabela; Gottlieb, Ilan; Pedrosa, Roberto Coury; Gadelha, Mônica R

    2016-12-01

    The incidence of arrhythmias may be increased in acromegaly, but the pathophysiologic mechanisms involved are still unclear, and it has never been correlated with structural heart changes analyzed by the gold-standard method cardiac magnetic resonance (CMR). Evaluate the frequency of arrhythmias in drug-naïve acromegaly patients at baseline and after 1 year of somatostatin analogs (SA) treatment and to correlate the occurrence of arrhythmias with the presence of structural heart changes. Consecutive drug-naïve acromegaly patients were recruited. The occurrence of arrhythmias and structural heart changes were studied through 24-h Holter and CMR, respectively, at baseline and after 1-year SA treatment. Thirty-six patients were studied at baseline and 28 were re-evaluated after 1 year of SA treatment. There were 13 females and median age was 48 years (20-73 years). Nine patients (32 %) were controlled after treatment. No sustained arrhythmias were reported in the 24-h Holter. No arrhythmia-related symptoms were observed. Only two patients presented left ventricular hypertrophy and three patients presented fibrosis at baseline. There was no correlation of the left ventricular mass with the number of episodes of arrhythmias and they were not more prevalent in the patients presenting cardiac fibrosis. We found no sustained arrhythmias and a lack of arrhythmia-related symptoms at baseline and after 1 year of SA treatment in a contemporary cohort of acromegaly patients that also present a low frequency of structural heart changes, indicating that these patients may have a lower frequency of heart disease than previously reported.

  17. Ego mechanisms of defense are associated with patients’ preference of treatment modality independent of psychological distress in end-stage renal disease

    OpenAIRE

    Thomas Hyphantis; Spiros Katsoudas; Sonia Voudiclari

    2010-01-01

    Thomas Hyphantis1, Spiros Katsoudas2, Sonia Voudiclari31Associate Professor of Psychiatry, Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece; 2Nephrologist, Renal Clinic, Hippocration General Hospital, Athens, Greece; 3Department of Nephrology, University of Athens, GreeceAbstract: Several parameters mediate the selection of treatment modality in end-stage renal disease (ESRD). The nephrology community suggests that patient preference should be the prime deter...

  18. Lamivudine monotherapy-based cART is efficacious for HBV treatment in HIV/HBV co-infection when baseline HBV DNA<20,000IU/ml

    Science.gov (United States)

    LI, Yijia; XIE, Jing; HAN, Yang; WANG, Huanling; ZHU, Ting; WANG, Nidan; LV, Wei; GUO, Fuping; QIU, Zhifeng; LI, Yanling; DU, Shanshan; SONG, Xiaojing; THIO, Chloe L; LI, Taisheng

    2016-01-01

    Background Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV co-infected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pre-treatment HBV DNA. Methods Prospective study of 151 Chinese HIV/HBV co-infected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance. Results Baseline HBV DNA≥20,000 IU/ml was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P=0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these two groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P>0.999) in subjects with baseline HBV DNAHBV DNA ≥20,000 IU/ml, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P=0.002). In stratified multivariate regression, TDF use (RR 1.98, P=0.010) and baseline HBV DNA (per 1 log increase in IU/ml, RR 0.74, PHBV DNA suppression only when baseline HBV DNA≥20,000IU/ml. Conclusion This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV co-infection when baseline HBV DNA<20,000IU/ml. Studies with long-term follow-up are warranted to determine if this finding persists. PMID:26745828

  19. Difference between observed and predicted glycated hemoglobin at baseline and treatment response to vildagliptin-based dual oral therapy in patients with type 2 diabetes.

    Science.gov (United States)

    Wang, Jun-Sing; Hung, Yi-Jen; Lu, Yung-Chuan; Tsai, Cheng-Lin; Yang, Wei-Shiung; Lee, Ting-I; Hsiao, Ya-Chun; Sheu, Wayne Huey-Herng

    2018-04-01

    We aimed to investigate the association of difference between observed and predicted glycated hemoglobin (dopHbA1c) and HbA1c reduction after vildagliptin-based oral therapy in patients with type 2 diabetes (T2D). This was a prospective observational study. Adults ≥ 20 years old with T2D and HbA1c ≧7% treated with oral anti-diabetic drugs (OADs) were eligible if their OADs were shifted to vildagliptin-based dual oral therapy. Fasting plasma glucose (FPG) and HbA1c were recorded at baseline, week 12, and week 24. To determine baseline dopHbA1c, a predicted HbA1c was calculated by inserting baseline FPG into a regression equation (HbA1c = FPG ∗ 0.0225 + 4.3806) developed from linear relationship between HbA1c and FPG in an independent cohort of 3239 outpatients with T2D (dopHbA1c = observed HbA1c - predicted HbA1c). Patients were assigned to low (≦0) or high (>0) dopHbA1c group according to their baseline dopHbA1c levels. The study endpoint was changes from baseline to week 24 in HbA1c levels. A total of 1224 patients were enrolled. Patients with a dopHbA1c >0 had a greater HbA1c reduction after vildagliptin-based dual oral therapy than those with a dopHbA1c ≦0 (-1.5 ± 2.0 vs. -0.4 ± 1.0%, p vildagliptin-based dual oral therapy. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

    International Nuclear Information System (INIS)

    Lin, Peggy L.; Hao, Yanni; Xie, Jipan; Li, Nanxin; Zhong, Yichen; Zhou, Zhou; Signorovitch, James E.; Wu, Eric Q.

    2015-01-01

    Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self-reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community-based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET-based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first-line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus-based (EVE, 34%) and fulvestrant-based (FUL, 15%) therapy. After first-line ET, the most preferred second- and third-line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first-line ET, ET mono- or combination therapy was commonly used for the second- and third-line treatments and CT

  1. Comparison of Two Multi-Criteria Decision Techniques for Eliciting Treatment Preferences in People with Neurological Disorders

    NARCIS (Netherlands)

    IJzerman, Maarten Joost; van Til, Janine Astrid; Snoek, Govert J.

    2008-01-01

    Objective: To present and compare two multi-criteria decision techniques (analytic hierarchy process [AHP] and conjoint analysis [CA]) for eliciting preferences in patients with cervical spinal cord injury (SCI) who are eligible for surgical augmentation of hand function, either with or without

  2. 77 FR 18899 - To Modify Duty-Free Treatment Under the Generalized System of Preferences and For Other Purposes

    Science.gov (United States)

    2012-03-29

    ... Generalized System of Preferences (GSP) if such country fails to act in good faith in recognizing as binding or in enforcing arbitral awards in favor of United States citizens or a corporation, partnership, or... faith in enforcing arbitral awards in favor of United States citizens or a corporation, partnership, or...

  3. Influence of 1-MCP treatments on eating quality and consumer preferences of ‘Qinmei’ kiwifruit during shelf life

    Science.gov (United States)

    Consumers and growers in China sometime complain that Kiwifruits treated with an ethylene action inhibitor 1-MCP are difficult to ripen and show poor eating quality. This study addresses the quality parameters affecting consumer preferences and reevaluates the necessity of 1-MCP application for stor...

  4. Comparison between neurostimulation techniques rapid transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Magnezi R

    2016-08-01

    Full Text Available Racheli Magnezi,1 Emanuel Aminov,1 Dikla Shmuel,2 Merav Dreifuss,1 Pinhas Dannon1,2 1Public Health and Health Systems Management Program, Department of Management, Bar-Ilan University, Ramat Gan, 2Beer Yaakov Mental Health Center affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Objectives: Major depressive disorder (MDD is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD is generally defined as a failure to achieve remission, despite therapeutic interventions. Aim: The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT, and transcranial magnetic stimulation (TMS. Here we compared the clinical effectiveness of ECT and TMS, including success rates, patient responses, side-effect profiles, and financial worthiness. Results: We found that ECT (P<0.0001 was more effective than TMS (P<0.012 (not statistically significant in group effect in TRD patients. However, ECT patients reported a higher percentage of side effects (P<0.01 and the TMS treatment scored better in terms of patient preference. The cost benefit of ECT was higher than that of TMS (US$2075 vs US$814. Patient’s preferences for treatment could be more intense in the TMS, if the TMS is included in the Health Maintenance Organization’s service list. Conclusion: We propose that both of these treatment options should be available in psychiatric wards, thus expanding the therapeutic toolkit for TRD. Keywords: ECT, TMS, treatment-resistant depression, cost benefit, patient preference

  5. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial.

    Science.gov (United States)

    Freedman, Stephen B; Willan, Andrew R; Boutis, Kathy; Schuh, Suzanne

    2016-05-10

    Gastroenteritis is a common pediatric illness. Electrolyte maintenance solution is recommended to treat and prevent dehydration. Its advantage in minimally dehydrated children is unproven. To determine if oral hydration with dilute apple juice/preferred fluids is noninferior to electrolyte maintenance solution in children with mild gastroenteritis. Randomized, single-blind noninferiority trial conducted between the months of October and April during the years 2010 to 2015 in a tertiary care pediatric emergency department in Toronto, Ontario, Canada. Study participants were children aged 6 to 60 months with gastroenteritis and minimal dehydration. Participants were randomly assigned to receive color-matched half-strength apple juice/preferred fluids (n=323) or apple-flavored electrolyte maintenance solution (n=324). Oral rehydration therapy followed institutional protocols. After discharge, the half-strength apple juice/preferred fluids group was administered fluids as desired; the electrolyte maintenance solution group replaced losses with electrolyte maintenance solution. The primary outcome was a composite of treatment failure defined by any of the following occurring within 7 days of enrollment: intravenous rehydration, hospitalization, subsequent unscheduled physician encounter, protracted symptoms, crossover, and 3% or more weight loss or significant dehydration at in-person follow-up. Secondary outcomes included intravenous rehydration, hospitalization, and frequency of diarrhea and vomiting. The noninferiority margin was defined as a difference between groups of 7.5% for the primary outcome and was assessed with a 1-sided α=.025. If noninferiority was established, a 1-sided test for superiority was conducted. Among 647 randomized children (mean age, 28.3 months; 331 boys [51.1%]; 441 (68.2%) without evidence of dehydration), 644 (99.5%) completed follow-up. Children who were administered dilute apple juice experienced treatment failure less often than those

  6. Comparison between neurostimulation techniques repetitive transcranial magnetic stimulation vs electroconvulsive therapy for the treatment of resistant depression: patient preference and cost-effectiveness.

    Science.gov (United States)

    Magnezi, Racheli; Aminov, Emanuel; Shmuel, Dikla; Dreifuss, Merav; Dannon, Pinhas

    2016-01-01

    Major depressive disorder (MDD) is a common disorder, widely distributed in the population, and is often associated with severe symptoms and functional impairment. It has been estimated that 30% of MDD patients do not benefit adequately from therapeutic interventions, including pharmacotherapy and psychotherapy. Treatment-resistant depression (TRD) is generally defined as a failure to achieve remission, despite therapeutic interventions. The most effective treatment alternatives for TRD are hospitalization, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS). Here we compared the clinical effectiveness of ECT and TMS, including success rates, patient responses, side-effect profiles, and financial worthiness. We found that ECT (P<0.0001) was more effective than TMS (P<0.012) (not statistically significant in group effect) in TRD patients. However, ECT patients reported a higher percentage of side effects (P<0.01) and the TMS treatment scored better in terms of patient preference. The cost benefit of ECT was higher than that of TMS (US$2075 vs US$814). Patient's preferences for treatment could be more intense in the TMS, if the TMS is included in the Health Maintenance Organization's service list. We propose that both of these treatment options should be available in psychiatric wards, thus expanding the therapeutic toolkit for TRD.

  7. Do health workers’ preferences influence their practices? Assessment of providers’ attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania

    Directory of Open Access Journals (Sweden)

    Masanja Irene M

    2012-11-01

    Full Text Available Abstract Background Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ was replaced by sulfadoxine-pyrimethamine (SP for management of uncomplicated malaria and by late 2006, SP was replaced by artemether-lumefantrine (AL. We assessed health workers’ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Methods Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: i children below 5; ii older children and adults; and iii pregnant women. Practice was ascertained by asking which antimalarial was used in the last malaria episode by the health worker him/herself and/or dependants. Univariate and multivariate logistic regression was used to identify factors associated with reported attitudes and practices towards the new treatment recommendations. Results A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. SP was less preferred antimalarial in hospitals and private health facilities (p Conclusion Following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that, other factors than providers’ attitude may have more influence in their personal treatment practices.

  8. What do the patients with medication overuse headache expect from treatment and what are the preferred sources of information?

    DEFF Research Database (Denmark)

    Munksgaard, S B; Allena, M; Tassorelli, C

    2011-01-01

    % requested effective prevention and fast relief of the headache episodes. 80 and 75%, respectively expected reduction in frequency and intensity. A total of 64% expected information about self-management and 52% expected to receive education on their headaches. The study demonstrates that patients...... in specialized headache centres prefer personal information, that expectations are very high, and that education and information are important. Providing the right information and thus give patients realistic expectations might enhance compliance and improve outcome....

  9. Program reference schedule baseline

    International Nuclear Information System (INIS)

    1986-07-01

    This Program Reference Schedule Baseline (PRSB) provides the baseline Program-level milestones and associated schedules for the Civilian Radioactive Waste Management Program. It integrates all Program-level schedule-related activities. This schedule baseline will be used by the Director, Office of Civilian Radioactive Waste Management (OCRWM), and his staff to monitor compliance with Program objectives. Chapter 1 includes brief discussions concerning the relationship of the PRSB to the Program Reference Cost Baseline (PRCB), the Mission Plan, the Project Decision Schedule, the Total System Life Cycle Cost report, the Program Management Information System report, the Program Milestone Review, annual budget preparation, and system element plans. Chapter 2 includes the identification of all Level 0, or Program-level, milestones, while Chapter 3 presents and discusses the critical path schedules that correspond to those Level 0 milestones

  10. Long Baseline Observatory (LBO)

    Data.gov (United States)

    Federal Laboratory Consortium — The Long Baseline Observatory (LBO) comprises ten radio telescopes spanning 5,351 miles. It's the world's largest, sharpest, dedicated telescope array. With an eye...

  11. Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process.

    Science.gov (United States)

    Kim, Ho-Joong; Park, Jae-Young; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2015-02-01

    In a preference-based shared decision-making system, several subjective and/or objective factors such as pain severity, degree of disability, and the radiological severity of canal stenosis may influence the final surgical decision for the treatment of lumbar spinal stenosis (LSS). However, our understanding of the shared decision-making process and the significance of each factor remain primitive. In the present study, we aimed to investigate which factors influence the surgical decision for the treatment of LSS when using a preference-based, shared decision-making process. We included 555 patients, aged 45-80 years, who used a preference-based shared decision-making process and were treated conservatively or surgically for chronic leg and/or back pain caused by LSS from April 2012 to December 2012. Univariate and multivariable-adjusted logistic regression analyses were used to assess the association of surgical decision making with age, sex, body mass index, symptom duration, radiologic stenotic grade, Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, Short Form-36 (SF-36) subscales, and motor weakness. In univariate analysis, the following variables were associated with a higher odds of a surgical decision for LSS: male sex; the VAS score for leg pain; ODI; morphological stenotic grades B, C, and D; motor weakness; and the physical function, physical role, bodily pain, social function, and emotional role of the SF-36 subscales. Multivariate analysis revealed that male sex, ODI, morphological stenotic grades C and D, and motor weakness were significantly associated with a higher possibility of a surgical decision. Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process.

  12. The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: a case study

    Directory of Open Access Journals (Sweden)

    Hagedorn Hildi J

    2010-06-01

    Full Text Available Abstract Background The Organizational Readiness to Change Assessment (ORCA is a measure of organizational readiness for implementing practice change in healthcare settings that is organized based on the core elements and sub-elements of the Promoting Action on Research Implementation in Health Services (PARIHS framework. General support for the reliability and factor structure of the ORCA has been reported. However, no published study has examined the utility of the ORCA in a clinical setting. The purpose of the current study was to examine the relationship between baseline ORCA scores and implementation of hepatitis prevention services in substance use disorders (SUD clinics. Methods Nine clinic teams from Veterans Health Administration SUD clinics across the United States participated in a six-month training program to promote evidence-based practices for hepatitis prevention. A representative from each team completed the ORCA evidence and context subscales at baseline. Results Eight of nine clinics reported implementation of at least one new hepatitis prevention practice after completing the six-month training program. Clinic teams were categorized by level of implementation-high (n = 4 versus low (n = 5-based on how many hepatitis prevention practices were integrated into their clinics after completing the training program. High implementation teams had significantly higher scores on the patient experience and leadership culture subscales of the ORCA compared to low implementation teams. While not reaching significance in this small sample, high implementation clinics also had higher scores on the research, clinical experience, staff culture, leadership behavior, and measurement subscales as compared to low implementation clinics. Conclusions The results of this study suggest that the ORCA was able to measure differences in organizational factors at baseline between clinics that reported high and low implementation of practice

  13. Terminally Ill Taiwanese Cancer Patients' and Family Caregivers' Agreement on Patterns of Life-Sustaining Treatment Preferences Is Poor to Fair and Declines Over a Decade: Results From Two Independent Cross-Sectional Studies.

    Science.gov (United States)

    Liu, Tsang-Wu; Wen, Fur-Hsing; Wang, Cheng-Hsu; Hong, Ruey-Long; Chow, Jyh-Ming; Chen, Jen-Shi; Chiu, Chang-Fang; Tang, Siew Tzuh

    2017-07-01

    Temporal changes have not been examined in patient-caregiver agreement on life-sustaining treatment (LST) preferences at end of life (EOL). We explored the extent of and changes in patient-caregiver agreement on LST-preference patterns for two independent cohorts of Taiwanese cancer patient-family caregiver dyads recruited a decade apart. We surveyed preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, tube feeding, and dialysis among 1049 and 1901 dyads in 2003-2004 and 2011-2012, respectively. LST-preference patterns were examined by multi-group latent class analysis. Extent of patient-caregiver agreement on LST-preference patterns was determined by percentage agreement and kappa coefficients. For both patients and family caregivers, we identified seven distinct LST-preference classes. Patient-caregiver agreement on LST-preference patterns was poor to fair across both study cohorts, indicated by 24.4%-43.5% agreement and kappa values of 0.06 (95% CI: 0.04, 0.09) to 0.27 (0.23, 0.30), and declined significantly over time. Agreement on LST-preference patterns was most likely when both patients and caregivers uniformly rejected LSTs. When patients disagreed with caregivers on LST-preference patterns, discrepancies were most likely when patients totally rejected LSTs but caregivers uniformly preferred LSTs or preferred nutritional support but rejected other treatments. Patients and family caregivers had poor-to-fair agreement on LST-preference patterns, and agreement declined significantly over a decade. Encouraging an open dialogue between patients and their family caregivers about desired EOL care would facilitate patient-caregiver agreement on LST-preference patterns, thus honoring terminally ill cancer patients' wishes when they cannot make EOL-care decisions. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc

  14. Danish physicians' preferences for prescribing escitalopram over citalopram and sertraline to treatment-naïve patients: a national, register-based study.

    Science.gov (United States)

    Poulsen, Karen Killerup; Glintborg, Dorte; Moreno, Søren Ilsøe; Thirstrup, Steffen; Aagaard, Lise; Andersen, Stig Ejdrup

    2013-05-01

    To investigate whether general practitioners, hospital physicians and specialized practitioners in psychiatry have similar preferences for initiating treatment with expensive serotonin-specific reuptake inhibitors (SSRIs). All first-time prescriptions for the SSRIs escitalopram, citalopram and sertraline reported to the Danish National Register of Medicinal Product Statistics from April 1, 2009 until March 31, 2010 were analysed with regard to treatment naivety and type of prescriber. A prescription was considered as first time if the patient had not received a prescription for the same drug within the last 2 years. Patients who had not received a prescription for an antidepressant within 6 months prior to the date of redemption were classified as treatment-naïve. We included 82,702 first-time prescriptions, 65,313 (79 %) of which were for treatment-naïve patients. Of the treatment-naïve patients, 19 % were initially prescribed escitalopram. Hospital physicians prescribed escitalopram to 34 % of their treatment-naïve patients, while practitioners specialized in psychiatry prescribed it to 25 %, and general practitioners prescribed it to 17 %. General practitioners, however, were responsible for initiating 87 % of all treatment-naïve patients. The most expensive SSRI, escitalopram, is prescribed as first choice to one in five patients receiving their first antidepressant of escitalopram, citalopram or sertraline. General practitioners made the bulk of all first-time SSRI prescriptions to treatment-naïve patients.

  15. Comparing Analytic Hierarchy Process and Discrete-Choice Experiment to Elicit Patient Preferences for Treatment Characteristics in Age-Related Macular Degeneration.

    Science.gov (United States)

    Danner, Marion; Vennedey, Vera; Hiligsmann, Mickaël; Fauser, Sascha; Gross, Christian; Stock, Stephanie

    2017-09-01

    In this study, we conducted an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to elicit the preferences of patients with age-related macular degeneration using identical attributes and levels. To compare preference-based weights for age-related macular degeneration treatment attributes and levels generated by two elicitation methods. The properties of both methods were assessed, including ease of instrument use. A DCE and an AHP experiment were designed on the basis of five attributes. Preference-based weights were generated using the matrix multiplication method for attributes and levels in AHP and a mixed multinomial logit model for levels in the DCE. Attribute importance was further compared using coefficient (DCE) and weight (AHP) level ranges. The questionnaire difficulty was rated on a qualitative scale. Patients were asked to think aloud while providing their judgments. AHP and DCE generated similar results regarding levels, stressing a preference for visual improvement, frequent monitoring, on-demand and less frequent injection schemes, approved drugs, and mild side effects. Attribute weights derived on the basis of level ranges led to a ranking that was opposite to the AHP directly calculated attribute weights. For example, visual function ranked first in the AHP and last on the basis of level ranges. The results across the methods were similar, with one exception: the directly measured AHP attribute weights were different from the level-based interpretation of attribute importance in both DCE and AHP. The dependence/independence of attribute importance on level ranges in DCE and AHP, respectively, should be taken into account when choosing a method to support decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  16. Prediction of outcome of bright light treatment in patients with seasonal affective disorder: Discarding the early response, confirming a higher atypical balance, and uncovering a higher body mass index at baseline as predictors of endpoint outcome.

    Science.gov (United States)

    Dimitrova, Tzvetelina D; Reeves, Gloria M; Snitker, Soren; Lapidus, Manana; Sleemi, Aamar R; Balis, Theodora G; Manalai, Partam; Tariq, Muhammad M; Cabassa, Johanna A; Karim, Naila N; Johnson, Mary A; Langenberg, Patricia; Rohan, Kelly J; Miller, Michael; Stiller, John W; Postolache, Teodor T

    2017-11-01

    We tested the hypothesis that the early improvement in mood after the first hour of bright light treatment compared to control dim-red light would predict the outcome at six weeks of bright light treatment for depressed mood in patients with Seasonal Affective Disorder (SAD). We also analyzed the value of Body Mass Index (BMI) and atypical symptoms of depression at baseline in predicting treatment outcome. Seventy-eight adult participants were enrolled. The first treatment was controlled crossover, with randomized order, and included one hour of active bright light treatment and one hour of control dim-red light, with one-hour washout. Depression was measured on the Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD version (SIGH-SAD). The predictive association of depression scores changes after the first session. BMI and atypical score balance with treatment outcomes at endpoint were assessed using multivariable linear and logistic regressions. No significant prediction by changes in depression scores after the first session was found. However, higher atypical balance scores and BMI positively predicted treatment outcome. Absence of a control intervention for the six-weeks of treatment (only the first session in the laboratory was controlled). Exclusion of patients with comorbid substance abuse, suicidality and bipolar I disorder, and patients on antidepressant medications, reducing the generalizability of the study. Prediction of outcome by early response to light treatment was not replicated, and the previously reported prediction of baseline atypical balance was confirmed. BMI, a parameter routinely calculated in primary care, was identified as a novel predictor, and calls for replication and then exploration of possible mediating mechanisms. Published by Elsevier B.V.

  17. First Grade Baseline Evaluation

    Science.gov (United States)

    Center for Innovation in Assessment (NJ1), 2013

    2013-01-01

    The First Grade Baseline Evaluation is an optional tool that can be used at the beginning of the school year to help teachers get to know the reading and language skills of each student. The evaluation is composed of seven screenings. Teachers may use the entire evaluation or choose to use those individual screenings that they find most beneficial…

  18. Levodopa/carbidopa and entacapone in the treatment of Parkinson’s disease: efficacy, safety and patient preference

    Directory of Open Access Journals (Sweden)

    Thomas Müller

    2009-01-01

    Full Text Available Thomas Müller1,21Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Berlin, Germany; 2IGSN, Ruhr University of Bochum, Bochum, GermanyAbstract: Levodopa (LD is the oldest, most efficacious and best-tolerated drug for dopaminergic substitution of patients with Parkinson’s disease (PD. Its main drawback is its short half-life, which supports onset of motor complications in the long term. Therefore well-informed PD patients mostly accept LD therapy as late as possible. Recent LD trials indicate that a combination of LD with carbidopa (CD and the catechol-O-methyltransferase (COMT inhibitor entacapone (EN may reduce the onset of these motor complications to a certain extent. This observation is further supported by pharmacokinetic trials and experimental research, but there is still a need to confirm this in a clinical trial, which is under way. Additionally, combined LD/CD/EN was superior to LD/CD administration regarding cognition, muscle behavior and gastrointestinal function in small clinical trials. Moreover there is accumulating evidence that combined COMT inhibition with LD administration reduces homocysteine synthesis. In the long term, homocysteine elevation supports onset of arteriosclerosis-related disorders, which are more frequent in PD patients according to epidemiological studies than in the normal healthy population. The introduction of LD/CD/EN in one tablet supported patients’ preference of COMT inhibition as an essential component of LD/DDI therapy, as this combination reduced number and size of tablets.Keywords: levodopa, entacapone, Parkinson’s disease, preference, compliance, acceptance

  19. HaemoPREF: Further evaluation of patient perception and preference for treatment in a real world setting.

    Science.gov (United States)

    Bonanad, S; Schulz, M; Gordo, A; Spurden, D; Cicchetti, M; Cappelleri, J C; Tolley, C; Staunton, H; Brohan, E

    2017-11-01

    Adherence to haemophilia A (HA) treatment may be influenced by patients' beliefs about their condition and treatment. Furthermore, difficulties administering treatment may lead to poor adherence. New treatment strategies aim to reduce the burden associated with administration and to improve patient perception of treatment, which, in turn, increase adherence levels. This study aimed to examine patient perception of HA treatment and related factors using patient-reported outcome (PRO) questionnaires and to confirm the psychometric properties of a recently developed questionnaire, the HaemoPREF. A non-interventional, cross-sectional, questionnaire study was conducted with adult HA patients in Spain (n=31), Germany (n=10) and Italy (n=48), who were using ReFacto AF with the FuseNGo administration device. Patients completed the HaemoPREF and other questionnaires measuring related constructs: treatment adherence, satisfaction and well-being, online at two time points. Correlational, regression and psychometric analyses were conducted. PRO scores indicated that patients are satisfied with and adherent to their treatment. Multivariate regression of the HaemoPREF global score identified a number of significant predictors (P≤.05). The HaemoPREF Global Score had a moderate relationship with subscales on the related questionnaires (mean correlation=0.43; range=0.39-0.48). The HaemoPREF demonstrated good test-retest reliability (intraclass correlation coefficient=0.82), internal consistency reliability (Cronbach's alpha range=0.69-0.82) and convergent validity with measures of treatment satisfaction (Spearman correlation coefficient, r=.48) and well-being (r=.41). The findings suggest that patients using ReFacto AF with FuseNGo were satisfied with and adherent to their treatment. The HaemoPREF can identify important concepts relating to patient treatment experience in HA. © 2017 John Wiley & Sons Ltd.

  20. Patterns of Change in Collaboration Are Associated with Baseline Characteristics and Predict Outcome and Dropout Rates in Treatment of Multi-Problem Families. A Validation Study

    Directory of Open Access Journals (Sweden)

    Egon Bachler

    2017-07-01

    Full Text Available Objective: The present study validates the Multi-Problem Family (MPF-Collaboration Scale, which measures the progress of goal directed collaboration of patients in the treatment of families with MPF and its relation to drop-out rates and treatment outcome.Method: Naturalistic study of symptom and competence-related changes in children of ages 4–18 and their caregivers.Setting: Integrative, structural outreach family therapy.Measures: The data of five different groups of goal directed collaboration (deteriorating collaboration, stable low collaboration, stable medium collaboration, stable high collaboration, improving collaboration were analyzed in their relation to treatment expectation, individual therapeutic goals (ITG, family adversity index, severity of problems and global assessment of a caregiver’s functioning, child, and relational aspects.Results: From N = 810 families, 20% displayed stable high collaboration (n = 162 and 21% had a pattern of improving collaboration. The families with stable high or improving collaboration rates achieved significantly more progress throughout therapy in terms of treatment outcome expectancy (d = 0.96; r = 0.43, reaching ITG (d = 1.17; r = 0.50, family adversities (d = 0.55; r = 0.26, and severity of psychiatric symptoms (d = 0.31; r = 0.15. Furthermore, families with stable high or improving collaboration maintained longer treatments and had a bigger chance of finishing the therapy as planned. The odds of having a stable low or deteriorating collaboration throughout treatment were significantly higher for subjects who started treatment with low treatment expectation or high family-related adversities.Conclusion: The positive outcomes of homebased interventions for multi-problem families are closely related to “stable high” and an “improving” collaboration as measured with the MPF-Collaboration Scale. Patients who fall into these groups have a high treatment outcome expectancy and reduce

  1. Hypothyroid Patients Encoding Combined MCT10 and DIO2 Gene Polymorphisms May Prefer L-T3 + L-T4 Combination Treatment - Data Using a Blind, Randomized, Clinical Study

    DEFF Research Database (Denmark)

    Carlé, Allan; Faber, Jens; Steffensen, Rudi

    2017-01-01

    on the cellular membrane transport-facilitating monocarboxylate transporter (MCT10) gene (rs17606253), and asked in which of the 2 treatment periods patients felt better (i.e., which treatment was preferred). RESULTS: 27 out of 45 patients (60%) preferred the combination therapy. Two polymorphisms (rs225014 (DIO2......, Thr92Ala) and rs17606253 (MCT10)) were combined yielding 3 groups: none vs. 1 of 2 vs. both SNPs present, and 42 vs. 63 vs. 100% of our patients in the 3 groups preferred the combined treatment (Jongheere-Terpstra trend test, p = 0.009). CONCLUSION: The present study indicates that the combination...... of polymorphisms in DIO2 (rs225014) and MCT10 (rs17606253) enhances hypothyroid patients' preference for L-T4 + L-T3 replacement therapy. In the future, combination therapy may be restricted or may be even recommended to individuals harbouring certain polymorphisms....

  2. Rationing with baselines

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    2013-01-01

    We introduce a new operator for general rationing problems in which, besides conflicting claims, individual baselines play an important role in the rationing process. The operator builds onto ideas of composition, which are not only frequent in rationing, but also in related problems...... such as bargaining, choice, and queuing. We characterize the operator and show how it preserves some standard axioms in the literature on rationing. We also relate it to recent contributions in such literature....

  3. The TDAQ Baseline Architecture

    CERN Multimedia

    Wickens, F J

    The Trigger-DAQ community is currently busy preparing material for the DAQ, HLT and DCS TDR. Over the last few weeks a very important step has been a series of meetings to complete agreement on the baseline architecture. An overview of the architecture indicating some of the main parameters is shown in figure 1. As reported at the ATLAS Plenary during the February ATLAS week, the main area where the baseline had not yet been agreed was around the Read-Out System (ROS) and details in the DataFlow. The agreed architecture has: Read-Out Links (ROLs) from the RODs using S-Link; Read-Out Buffers (ROB) sited near the RODs, mounted in a chassis - today assumed to be a PC, using PCI bus at least for configuration, control and monitoring. The baseline assumes data aggregation, in the ROB and/or at the output (which could either be over a bus or in the network). Optimization of the data aggregation will be made in the coming months, but the current model has each ROB card receiving input from 4 ROLs, and 3 such c...

  4. A pilot study on the sexual side effects of finasteride as related to hand preference for men undergoing treatment of male pattern baldness.

    Science.gov (United States)

    Motofei, Ion G; Rowland, David L; Georgescu, Simona R; Baconi, Daniela L; Dimcevici, Nicoleta P; Paunica, Stana; Constantin, Vlad D; Balalau, Cristian

    2013-04-01

    To investigate the relationships between pharmacologically induced deprivation of dihydrotestosterone, sexual arousal, libido and hand preference, by comparing the self-reported sexual response prior to and during reception of the anti-androgen finasteride in men undergoing treatment for male pattern baldness. In total, 33 sexually healthy Romanian men participated in this study. Patients prospectively provided information regarding their sexual functioning (over 4 weeks), as measured by the International Index of Erectile Function (IIEF) prior to and after commencing treatment with 1 mg finasteride for male pattern baldness. Overall IIEF scores as well as the erectile function, orgasmic function, sexual desire and overall satisfaction subscales showed group, treatment and group by treatment effects. The intercourse satisfaction subscale showed group and group by treatment effects. On most subscales, right-handed men showed no effect or lower sexual function whereas left-handed men reported no effect or improved sexual function, primarily. These results suggest that the sexual effects of dihydrotestosterone deprivation may depend on handedness--a proxy variable that may represent cognitive style--which lends further support to the idea of two distinct neuroendocrine psychosexual axes. They further suggest that detection of such sexual effects may be enhanced by using research methodologies and communication strategies that increase patients' sensitization to such effects. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

  5. Social preferences

    DEFF Research Database (Denmark)

    Gulløv, Eva

    2014-01-01

    The focus of this article is social divisions among preschool children in daycare centers. Based on ethnographic fieldwork in three daycare centers in Denmark, the analysis concerns young children’s social preferences. The ethnographic material shows that despite an explicit political ambition...... of daycares as means for social and cultural integration, lines of division do exist amongst the children. Such divisions are established in the daily interactions of the daycare, but they also reflect those of the broader society. With a focus on children’s interactions and social preferences, the material...... indicates that children’s choices of playmates run along lines of ethnic and class divisions. The article will address this pattern and analyze its causes in order to understand why such lines of divisions are to be found in an institutional context designed to overcome social inequality and prevent social...

  6. Baseline demographics, clinical features, and treatment protocols of 240 patients with optic neuropathy: experiences from a neuro-ophthalmological clinic in the Aegean region of Turkey.

    Science.gov (United States)

    Karti, Omer; Karti, Dilek Top; Kilic, İlay Hilal; Gokcay, Figen; Celebisoy, Nese

    2017-12-19

    To analyze the demographic patterns, clinical characteristics, and treatment protocols of optic neuropathies. The hospital data of patients with optic neuropathy admitted to the Department of Neuro-ophthalmology in a tertiary referral center in Turkey between January 2010 to January 2017 were retrospectively analyzed. Demographic patterns, clinical features, treatment protocols, and the natural disease courses were assessed. The total number of patients with optic neuropathy seen over this period was 240, which consist of 43 with idiopathic optic neuritis (17.9%), 40 with multiple sclerosis-related optic neuritis (16.7%), 12 with chronic relapsing inflammatory optic neuritis (5.0%), 12 with atypical optic neuritis (5.0%), 11 with neuromyelitis optica spectrum disorders-related optic neuritis (4.6%), 90 with non-arteritic ischemic optic neuropathy (37.5%), 4 with arteritic ischemic optic neuropathy (1.7%), 10 with traumatic optic neuropathy (4.1%), 6 with compressive optic neuropathy (2.5%), and 12 with mitochondrial optic neuropathy [9 with toxic optic neuropathy (3.7%) and 3 with Leber's hereditary optic neuropathy (1.2%)]. There were 101 males (42%) and 139 females (58%). The mean age was 43.34 ± 15.86 years. This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.

  7. Endoscopic management is the preferred treatment modality for a Grade III vesicoureteric reflux with breakthrough infections in a young girl

    Directory of Open Access Journals (Sweden)

    S S Joshi

    2008-01-01

    Full Text Available Endoscopic injection treatment for VUR appears to have less success rate than open surgical treatment, even in Gr 3 VUR. Economics of use of deflux injection and its success rate do not suit Indian milieu. To achieve high success rate of Atlanta group in endoscopic injection treatmnent , requires a longer learning curve and yet it has not achieved success rate of 96-98% achieved by open surgical techniques. Recent addition of modified extravesical reimplantation technique has reduced significantly the post operative pain and patient can be discharged within 2 days from the hospital.

  8. What do the patients with medication overuse headache expect from treatment and what are the preferred sources of information?

    DEFF Research Database (Denmark)

    Munksgaard, S B; Allena, M; Tassorelli, C

    2011-01-01

    Lack of knowledge on patients' expectations to treatment may lead to misunderstandings and prevent successful outcome. Presently, treatment of medication overuse headache (MOH) leads to improvement in up to 75% of patients, but the relapse rate may exceed 40%. This study aimed to evaluate......% requested effective prevention and fast relief of the headache episodes. 80 and 75%, respectively expected reduction in frequency and intensity. A total of 64% expected information about self-management and 52% expected to receive education on their headaches. The study demonstrates that patients...

  9. Understanding kidney transplant patients' treatment choices: The interaction of emotion with medical and social influences on risk preferences.

    Science.gov (United States)

    Harrington, Jean; Morgan, Myfanwy

    2016-04-01

    Following renal transplantation patients experience on-going immunosuppressant medication to reduce the risk of graft rejection. Over the long term the side effects of immunosuppressive drugs may affect graft survival and significantly increase risks of cancers, stroke and cardiovascular disease. To reduce these risks research is underway to develop a biomarker test to identify those patients who are likely to be 'tolerant' to their graft and therefore able to reduce immunosuppression. Biomarker tests may however incorrectly identify some patients as tolerant, thus jeopardising their graft. Following a quantitative assessment of risk preferences we undertook a qualitative study to investigate the range of influences that shaped the substantial variations found in the level of risk transplant recipients were hypothetically willing to take. In-depth interviews were carried out in the United Kingdom between May 2013 and July 2014 with 24 transplant recipients all of whom had stable kidney graft function. These interviews identified a range of factors that patients take into account when making risk assessments, including familial views, trust and the ritual of 'gift exchange' that permeates the social space of kidney transplantation. Our data support the notion that emotion is not part of a linear process, preceding and separate to reason, but is intertwined with personal understanding and perception of risk and involves a complex interplay between different influences on decision-making. Our data also support Lupton's view that risk judgements are shared and collective rather than located within the individual and suggests that patient choice rather than involving a purely rational weighing of medical benefit is often based on influences that may not accord with the framework nor intention of medical professionals and medical research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences.

    Science.gov (United States)

    Rood, Janneke A J; van Zuuren, Florence J; Stam, Frank; van der Ploeg, Tjeerd; Eeltink, Corien; Verdonck-de Leeuw, Irma M; Huijgens, Peter C

    2015-06-01

    For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL) and information satisfaction, we compiled a questionnaire based on existing validated questionnaires. A total of 458 patients diagnosed with a haematological malignancy participated. The perceived need for information was moderate to high (40-70%). Multivariate regression analyses showed that a higher need for information was related to younger age, worse QoL, being member of a patient society and moderate comorbidity. The need for disease and treatment-related information was higher than the need for psychosocial information. A higher need for disease and treatment-related information was associated to being diagnosed with multiple myeloma. A higher need for psychosocial information was related to a lower educational level. The information provision could be improved according to 41% of the patients. Higher satisfaction with provided information was associated with better QoL. Most patients (62%) reported that they wanted to be fully informed about their illness and actively involved in treatment decision-making. The results contribute to improving patient-tailored information provision and shared decision-making in clinical practice. Copyright © 2014 John Wiley & Sons, Ltd.

  11. Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences.

    NARCIS (Netherlands)

    Rood, J.A.; van Zuuren, F.J.; Stam, F.; van der Ploeg, T.; Eeltink, C.M.; de Leeuw, I.M.; Huijgens, P.C.

    2015-01-01

    For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL)

  12. Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences

    NARCIS (Netherlands)

    Rood, J.A.J.; van Zuuren, F.J.; Stam, F.; van der Ploeg, T.; Eeltink, C.; Verdonck-de Leeuw, I.M.; Huijgens, P.C.

    2015-01-01

    For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL)

  13. Treatment with the first TNF inhibitor in rheumatoid arthritis patients in the Hellenic Registry of Biologic Therapies improves quality of life especially in young patients with better baseline functional status.

    Science.gov (United States)

    Boubouchairopoulou, Nadia; Flouri, Irini; Drosos, Alexandros A; Boki, Kyriaki; Settas, Loukas; Zisopoulos, Dimitrios; Skopouli, Fotini N; Papadopoulos, Ioannis; Iliopoulos, Alexios; Kyriopoulos, John; Boumpas, Dimitrios T; Athanasakis, Konstantinos; Sidiropoulos, Prodromos

    2016-01-01

    To assess in daily practice in patients with rheumatoid arthritis (RA) the effect of treatment with first tumour necrosis factor-α inhibitor (TNFi) in quality of life (Qol), disease activity and depict possible baseline predictors for gains in Qol. Patients followed prospectively by the Hellenic Registry of Biologic Therapies were analysed. Demographics were recorded at baseline, while RA-related characteristics at baseline and every 6 months. Paired t-tests were used to detect divergences between patient-reported (Health Assessment Questionnaire (HAQ), EuroQol (EQ-5D)) and clinical tools (Disease Activity Score-28 joints (DAS28)). Clinical versus self-reported outcomes were examined via cross-tabulation analysis. Multiple regression analysis was performed for identifying baseline predictors of improvements in QALYs. We analysed 255 patients (age (mean±SD) 57.1±13.0, disease duration 9.2±9.1 years, prior non-biologic disease-modifying anti-rheumatic drugs 2.3±1.2). Baseline EQ-5D, HAQ and DAS28 were 0.36 (0.28), 1.01 (0.72) and 5.9 (1.3), respectively, and were all significantly improved after 12 months (0.77 (0.35), 0.50 (0.66), 3.9 (1.5), respectively, p<0.05 for all). 90% of patients who improved from high to a lower DAS28 status (low-remission or moderate) had clinically important improvement in Qol (phi-coefficient=0.531,p<0.05). Independent predictors of gains in Qol were lower baseline HAQ, VAS global and younger age (adjusted R2=0.27). In daily practice TNFi improve both disease activity and Qol for the first 12 months of therapy. 90% of patients who improved from high to a lower DAS28 status had clinically important improvement in Qol. Younger patients starting with lower HAQ and VAS global are more likely to benefit.

  14. Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance.

    Science.gov (United States)

    Broughman, James R; Basak, Ramsankar; Nielsen, Matthew E; Reeve, Bryce B; Usinger, Deborah S; Spearman, Kiayni C; Godley, Paul A; Chen, Ronald C

    2018-04-01

    Men with early-stage prostate cancer have multiple options that have similar oncologic efficacy but vary in terms of their impact on quality of life. In low-risk cancer, active surveillance is the option that best preserves patients' sexual function, but it is unknown if patient preference affects treatment selection. Our objectives were to identify patient characteristics associated with a strong preference to preserve sexual function and to determine whether patient preference and baseline sexual function level are associated with receipt of active surveillance in low-risk cancer. In this population-based cohort of men with localized prostate cancer, baseline patient-reported sexual function was assessed using a validated instrument. Patients were also asked whether preservation of sexual function was very, somewhat, or not important. Prostate cancer disease characteristics and treatments received were abstracted from medical records. A modified Poisson regression model with robust standard errors was used to compute adjusted risk ratio (aRR) estimates. All statistical tests were two-sided. Among 1194 men, 52.6% indicated a strong preference for preserving sexual function. Older men were less likely to have a strong preference (aRR = 0.98 per year, 95% confidence interval [CI] = 0.97 to 0.99), while men with normal sexual function were more likely (vs poor function, aRR = 1.59, 95% CI = 1.39 to 1.82). Among 568 men with low-risk cancer, there was no clear association between baseline sexual function or strong preference to preserve function with receipt of active surveillance. However, strong preference may differnetially impact those with intermediate baseline function vs poor function (Pinteraction = .02). Treatment choice may not always align with patients' preferences. These findings demonstrate opportunities to improve delivery of patient-centered care in early prostate cancer.

  15. Stakeholder Engagement in Trial Design: Survey of Visitors to Critically Ill Patients Regarding Preferences for Outcomes and Treatment Options during Weaning from Mechanical Ventilation.

    Science.gov (United States)

    Burns, Karen E A; Jacob, Sonu Karottaiyamvelil; Aguirre, Valeria; Gomes, Janice; Mehta, Sangeeta; Rizvi, Leena

    2016-11-01

    Stakeholder engagement in research is expected to provide unique insights, make research investments more accountable and transparent, and ensure that future research is applicable to patients and family members. To inform the design of a trial of strategies for weaning from mechanical ventilation, we sought to identify preferences of patient visitors regarding outcome and treatment measures. We conducted an interviewer-administered questionnaire of visitors of critically ill patients in two family waiting rooms serving three intensive care units (ICUs) in Toronto, Canada. Respondents rated the importance of general and ventilation-related outcomes in two hypothetical scenarios (before a first spontaneous breathing trial, and after a failed spontaneous breathing trial) and selected a preferred technique for the breathing trials. With regard to the patient they were visiting, respondents identified the most important outcome to them at ICU admission, during the ICU stay, and at ICU discharge. We analyzed 322 questionnaires (95.5% response rate). All outcomes were highly rated (average range: 7.82-9.74). Across scenarios, outcomes rated as most important were ICU and hospital survival (9.72, 9.70), avoiding complications (9.45), quality of life (9.394), patient comfort (9.393), and returning to previous living arrangements (9.31). Overall, the most important ventilation-related outcomes were being ventilator-free (8.95), avoiding reintubation (8.905), and passing a spontaneous breathing trial (8.903). Passing a spontaneous breathing trial assumed greater importance after an initial failed attempt. "Time to event" outcomes were less important to visitors. We did not identify a preferred spontaneous breathing trial technique. Although ICU survival was the most important outcome at ICU admission and during the ICU stay, visitors rated quality of life higher than hospital survival at ICU discharge. Visitors to critically ill patients prioritized two general outcomes (ICU

  16. Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Elena Losina

    Full Text Available Arthroscopic partial meniscectomy (APM is extensively used to relieve pain in patients with symptomatic meniscal tear (MT and knee osteoarthritis (OA. Recent studies have failed to show the superiority of APM compared to other treatments. We aim to examine whether existing evidence is sufficient to reject use of APM as a cost-effective treatment for MT+OA.We built a patient-level microsimulation using Monte Carlo methods and evaluated three strategies: Physical therapy ('PT' alone; PT followed by APM if subjects continued to experience pain ('Delayed APM'; and 'Immediate APM'. Our subject population was US adults with symptomatic MT and knee OA over a 10 year time horizon. We assessed treatment outcomes using societal costs, quality-adjusted life years (QALYs, and calculated incremental cost-effectiveness ratios (ICERs, incorporating productivity costs as a sensitivity analysis. We also conducted a value-of-information analysis using probabilistic sensitivity analyses.Calculated ICERs were estimated to be $12,900/QALY for Delayed APM as compared to PT and $103,200/QALY for Immediate APM as compared to Delayed APM. In sensitivity analyses, inclusion of time costs made Delayed APM cost-saving as compared to PT. Improving efficacy of Delayed APM led to higher incremental costs and lower incremental effectiveness of Immediate APM in comparison to Delayed APM. Probabilistic sensitivity analyses indicated that PT had 3.0% probability of being cost-effective at a willingness-to-pay (WTP threshold of $50,000/QALY. Delayed APM was cost effective 57.7% of the time at WTP = $50,000/QALY and 50.2% at WTP = $100,000/QALY. The probability of Immediate APM being cost-effective did not exceed 50% unless WTP exceeded $103,000/QALY.We conclude that current cost-effectiveness evidence does not support unqualified rejection of either Immediate or Delayed APM for the treatment of MT+OA. The amount to which society would be willing to pay for additional information

  17. Patient preference compared with random allocation in short-term psychodynamic supportive psychotherapy with indicated addition of pharmacotherapy for depression.

    NARCIS (Netherlands)

    Van, H.L.; Dekker, J.J.M.; Koelen, J.; Kool, S.; van Aalst, G.; Hendriksen, I.J.M.; Peen, J.; Schoevers, R.A.

    2009-01-01

    Depressed patients randomized to psychotherapy were compared with those who had been chosen for psychotherapy in a treatment algorithm, including addition of an antidepressant in case of early nonresponse. There were no differences between randomized and by-preference patients at baseline in

  18. Baseline levels of bioaerosols and volatile organic compounds around a municipal waste incinerator prior to the construction of a mechanical-biological treatment plant

    International Nuclear Information System (INIS)

    Vilavert, Lolita; Nadal, Marti; Inza, Isabel; Figueras, Maria J.; Domingo, Jose L.

    2009-01-01

    New waste management programs are currently aimed at developing alternative treatment technologies such as mechanical-biological treatment (MBT) and composting plants. However, there is still a high uncertainty concerning the chemical and microbiological risks for human health, not only for workers of these facilities, but also for the population living in the neighborhood. A new MBT plant is planned to be constructed adjacently to a municipal solid waste incinerator (MSWI) in Tarragona (Catalonia, Spain). In order to evaluate its potential impact and to differentiate the impacts of MSWI from those of the MBT when the latter is operative, a pre-operational survey was initiated by determining the concentrations of 20 volatile organic compounds (VOCs) and bioaerosols (total bacteria, Gram-negative bacteria, fungi and Aspergillus fumigatus) in airborne samples around the MSWI. The results indicated that the current concentrations of bioaerosols (ranges: 382-3882, 18-790, 44-926, and 3 for fungi at 25 deg. C, fungi at 37 deg. C, total bacteria, and Gram-negative bacteria, respectively) and VOCs (ranging from 0.9 to 121.2 μg/m 3 ) are very low in comparison to reported levels in indoor and outdoor air in composting and MBT plants, as well in urban and industrial zones. With the exception of total bacteria, no correlations were observed between the environmental concentrations of biological agents and the direction/distance from the facility. However, total bacteria presented significantly higher levels downwind. Moreover, a non-significant increase of VOCs was detected in sites closer to the incinerator, which means that the MSWI could have a very minor impact on the surrounding environment.

  19. Understanding malaria treatment-seeking preferences within the public sector amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods study.

    Science.gov (United States)

    Win, Aung Ye Naung; Maung, Thae Maung; Wai, Khin Thet; Oo, Tin; Thi, Aung; Tipmontree, Rungrawee; Soonthornworasiri, Ngamphol; Kengganpanich, Mondha; Kaewkungwal, Jaranit

    2017-11-13

    Migration flows and the emerging resistance to artemisinin-based combination therapy in the Greater Mekong Sub-region (GMS) create programmatic challenges to meeting the AD 2030 malaria elimination target in Myanmar. The National Malaria Control Programme (NMCP) targeted migrant workers based mainly on the stability of their worksites (categories 1: permanent work-setting; categories 2 and 3: less stable work-settings). This study aims to assess the migration patterns, malaria treatment-seeking preferences, and challenges encountered by mobile/migrant workers at remote sites in a malaria-elimination setting. A mixed-methods explanatory sequential study retrospectively analysed the secondary data acquired through migrant mapping surveys (2013-2015) in six endemic regions (n = 9603). A multivariate logistic regression model was used to ascertain the contributing factors. A qualitative strand (2016-2017) was added by conducting five focus-group discussions (n = 50) and five in-depth interviews with migrant workers from less stable worksites in Shwegyin Township, Bago Region. The contiguous approach was used to integrate quantitative and qualitative findings. Among others, migrant workers from Bago Region were significantly more likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal mobility (40% vs. 35%). Particularly in less stable settings, a very low proportion of migrant workers (17%) preferred to seek malaria treatment from the public sector and was significantly influenced by the worksite stability (adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration of stay (adjusted OR = 3.5); and adjusted OR malaria messages, knowledge of malaria symptoms and awareness of means of malaria diagnosis. Qualitative data further elucidated their preference for the informal healthcare sector, due to convenience, trust and good relations, and put migrant workers at risk of substandard care. Moreover, the

  20. Investigations of morning and laboratory dream recall and content in depressive patients during baseline conditions and under antidepressive treatment with trimipramine.

    Science.gov (United States)

    Riemann, D; Löw, H; Schredl, M; Wiegand, M; Dippel, B; Berger, M

    1990-06-01

    REM sleep abnormalities like shortened REM (rapid eye movement) latency, prolongation of the first REM period and heightening of REM density often found in patients with a major depression have prompted an increasing number of studies investigating the neurobiology and neurophysiology of REM sleep in depressive patients, as well as in healthy humans and animals. On the other hand, since the early 1970s investigation of the psychological concomitant of REM sleep, i.e., dreaming, in depressive patients has been extremely sparse. The present study aimed at investigating morning and laboratory dream recall and content in patients with a major depressive disorder to shed more light on this neglected area. In short, morning as well as laboratory dream recall in depressive inpatients was drastically reduced. The low number of scorable dream reports collected did not reveal a heightened incidence of "masochistic" or "negative" content, indeed were rather mundane. In contrast, depressive outpatients (probably less depressed) had a higher rate of morning dream recall. Interestingly, antidepressive treatment with trimipramine (an antidepressant which does not suppress REM sleep) led to a positive influence on patients' mood that was paralleled by a change of dream mood in a positive direction.

  1. Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate.

    Science.gov (United States)

    Reimherr, Fred W; Marchant, Barrie K; Gift, Thomas E; Steans, Tammy A; Wender, Paul H

    2015-06-01

    Much recent research describes the importance of emotional symptoms in ADHD. While there is no accepted system for including emotionality in diagnosing ADHD, the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) provides a tool to facilitate this. It assesses a range of adult ADHD symptoms which load on two factors: inattentive and emotional dysregulation. The consistently high inattentive factor was used to define significant elevation on the more variable emotional dysregulation factor (which contains four WRAADDS domains: hyperactivity/restlessness, temper, affective lability, and emotional over-reactivity) allowing the definition of two ADHD diagnostic types. We compared these two types on a broad range of adult subject characteristics, including response to methylphenidate (MPH) treatment assessed during two clinical trials. Marked impairment in three of the four emotional domains reflected a symptom severity level equivalent to that of the inattentive factor. 59 % met this threshold, defining them as ADHD emotion dysregulation presentation, as opposed to 41 % with ADHD inattentive presentation. Cluster analysis validated these groups by generating similar clusters with 85 % agreement regarding membership. ADHD emotional dysregulation presentation subjects showed more childhood ADHD symptoms, adult symptoms of oppositional defiant disorder, and evidence of personality disorder. Both types showed similar improvement during the double-blind MPH arm of the trials and during a 6-month open-label phase. Based on the presence of symptoms of emotional dysregulation, ADHD in adults can be conceptualized as two types. Impairment and comorbidity in adults with ADHD are largely concentrated in ADHD emotional dysregulation presentation patients.

  2. 2017 Annual Technology Baseline

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Hand, M. M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Eberle, Annika [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Beiter, Philipp C [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kurup, Parthiv [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Turchi, Craig S [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Feldman, David J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Margolis, Robert M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Augustine, Chad R [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Maness, Michael [Formerly NREL; O' Connor, Patrick [Oak Ridge National Laboratory

    2018-03-26

    Consistent cost and performance data for various electricity generation technologies can be difficult to find and may change frequently for certain technologies. With the Annual Technology Baseline (ATB), the National Renewable Energy Laboratory annually provides an organized and centralized set of such cost and performance data. The ATB uses the best information from the Department of Energy national laboratories' renewable energy analysts as well as information from the Energy Information Administration for fuel-based technologies. The ATB has been reviewed by experts and it includes the following electricity generation technologies: land-based wind, offshore wind, utility-scale solar photovoltaics (PV), commercial-scale solar PV, residential-scale solar PV, concentrating solar power, geothermal power, hydropower, coal, natural gas, nuclear, and conventional biopower. This webinar presentation introduces the 2017 ATB.

  3. Can you change my preferences? Effect of social influence on intertemporal choice behavior.

    Science.gov (United States)

    Calluso, Cinzia; Tosoni, Annalisa; Fortunato, Gianfranco; Committeri, Giorgia

    2017-07-14

    The present study presents a novel social observation paradigm to examine whether temporal discounting (TD) can be modulated in a specific direction. In particular, after estimating a baseline discount rate, we exposed subjects to a pattern of choice that was opposite to their baseline preferences, i.e., subjects preferring immediate over delayed rewards were exposed to a farsighted pattern of behavior and vice-versa. The results showed a significant decrease of the discount rate in the discounter group and an increase in the farsighted group. The effect was mainly guided by a modification of the subjective values at short time delays and was stronger in subjects with extreme, compared to mild, baseline preferences. Importantly, the magnitude and direction of the effect predicted the baseline preferences. These findings have potentially very relevant implications for the prevention and treatment of clinical conditions, such as addition-related disorders, characterized by severe impairments of decision-making mechanisms. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Are patients’ preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations

    Science.gov (United States)

    2013-01-01

    Background Today, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. However, patients often visit the provider that is recommended by their general practitioner (GP). The introduction of patient choice requires GPs to support patients to be involved, actively, in the choice of a healthcare provider. We aim to investigate whether policy on patient choice is reflected in practice, i.e. what the role of the patient is in their choices of healthcare providers at the point of referral and to what extent GPs’ and patients’ healthcare paths influence the role that patients play in the referral decision. Methods In 2007–2008, we videotaped Dutch GP-patient consultations. For this study, we selected, at random, 72 videotaped consultations between 72 patients and 39 GPs in which the patient was referred to a healthcare provider. These were analysed using an observation protocol developed by the researchers. Results The majority of the patients had little or no input into the choice of a healthcare provider at the point of referral by their GP. Their GPs did not support them in actively choosing a provider and the patients often agreed with the provider that the GP proposed. Patients who were referred for diagnostic purposes seem to have had even less input into their choice of a provider than patients who were referred for treatment. Conclusions We found that the GP chooses a healthcare provider on behalf of the patient in most consultations, even though policy on patient choice expects from patients that they choose, actively, a provider. On the one hand, this could indicate that the policy needs adjustments. On the other hand, adjustments may be needed to practice. For instance, GPs could help patients to make an active choice of provider. However, certain patients prefer to let their GP decide as their agent. Even then, GPs need to know patients’ preferences, because in a principal-agent relationship

  5. Are patients' preferences regarding the place of treatment heard and addressed at the point of referral: an exploratory study based on observations of GP-patient consultations.

    Science.gov (United States)

    Victoor, Aafke; Noordman, Janneke; Sonderkamp, Johan A; Delnoij, Diana M J; Friele, Roland D; van Dulmen, Sandra; Rademakers, Jany J D J M

    2013-12-10

    Today, in several north-western European countries, patients are encouraged to choose, actively, a healthcare provider. However, patients often visit the provider that is recommended by their general practitioner (GP). The introduction of patient choice requires GPs to support patients to be involved, actively, in the choice of a healthcare provider. We aim to investigate whether policy on patient choice is reflected in practice, i.e. what the role of the patient is in their choices of healthcare providers at the point of referral and to what extent GPs' and patients' healthcare paths influence the role that patients play in the referral decision. In 2007-2008, we videotaped Dutch GP-patient consultations. For this study, we selected, at random, 72 videotaped consultations between 72 patients and 39 GPs in which the patient was referred to a healthcare provider. These were analysed using an observation protocol developed by the researchers. The majority of the patients had little or no input into the choice of a healthcare provider at the point of referral by their GP. Their GPs did not support them in actively choosing a provider and the patients often agreed with the provider that the GP proposed. Patients who were referred for diagnostic purposes seem to have had even less input into their choice of a provider than patients who were referred for treatment. We found that the GP chooses a healthcare provider on behalf of the patient in most consultations, even though policy on patient choice expects from patients that they choose, actively, a provider. On the one hand, this could indicate that the policy needs adjustments. On the other hand, adjustments may be needed to practice. For instance, GPs could help patients to make an active choice of provider. However, certain patients prefer to let their GP decide as their agent. Even then, GPs need to know patients' preferences, because in a principal-agent relationship, it is necessary that the agent is fully

  6. Biofuels Baseline 2008

    Energy Technology Data Exchange (ETDEWEB)

    Hamelinck, C.; Koper, M.; Berndes, G.; Englund, O.; Diaz-Chavez, R.; Kunen, E.; Walden, D.

    2011-10-15

    The European Union is promoting the use of biofuels and other renewable energy in transport. In April 2009, the Renewable Energy Directive (2009/28/EC) was adopted that set a 10% target for renewable energy in transport in 2020. The directive sets several requirements to the sustainability of biofuels marketed in the frame of the Directive. The Commission is required to report to the European Parliament on a regular basis on a range of sustainability impacts resulting from the use of biofuels in the EU. This report serves as a baseline of information for regular monitoring on the impacts of the Directive. Chapter 2 discusses the EU biofuels market, the production and consumption of biofuels and international trade. It is derived where the feedstock for EU consumed biofuels originally come from. Chapter 3 discusses the biofuel policy framework in the EU and major third countries of supply. It looks at various policy aspects that are relevant to comply with the EU sustainability requirements. Chapter 4 discusses the environmental and social sustainability aspects associated with EU biofuels and their feedstock. Chapter 5 discusses the macro-economic effects that indirectly result from increased EU biofuels consumption, on commodity prices and land use. Chapter 6 presents country factsheets for main third countries that supplied biofuels to the EU market in 2008.

  7. Baseline conditions at Olkiluoto

    International Nuclear Information System (INIS)

    2003-09-01

    The main purpose of this report is to establish a reference point - defined as the data collected up until the end of year 2002 - for the coming phases of the Finnish spent nuclear fuel disposal programme. The focus is: to define the current surface and underground conditions at the site, both as regards the properties for which a change is expected and for the properties which are of particular interest for long-term safety or environmental impact; to establish, as far as possible, the natural fluctuation of properties that are potentially affected by construction of the underground laboratory, the ONKALO, and to provide references to data on parameters or use in model development and testing and to use models to assist in understanding and interpreting the data. The emphasis of the baseline description is on bedrock characteristics that are relevant to the long-term safety of a spent fuel repository and, hence, to include the hydrogeological, hydrogeochemical, rock mechanical, tectonic and seismic conditions of the site. The construction of the ONKALO will also affect some conditions on the surface, and, therefore, a description of the main characteristics of the nature and the man-made constructions at Olkiluoto is also given. This report is primarily a road map to the available information on the prevailing conditions at the Olkiluoto site and a framework for understanding of data collected. Hence, it refers to numerous available background reports and other archived information produced over the past 20 years or more, and forms a recapitulation and revaluation of the characterisation data of the Olkiluoto site. (orig.)

  8. Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries

    Directory of Open Access Journals (Sweden)

    Littrell Megan

    2011-10-01

    Full Text Available Abstract Background Access to artemisinin-based combination therapy (ACT remains limited in high malaria-burden countries, and there are concerns that the poorest people are particularly disadvantaged. This paper presents new evidence on household treatment-seeking behaviour in six African countries. These data provide a baseline for monitoring interventions to increase ACT coverage, such as the Affordable Medicines Facility for malaria (AMFm. Methods Nationally representative household surveys were conducted in Benin, the Democratic Republic of Congo (DRC, Madagascar, Nigeria, Uganda and Zambia between 2008 and 2010. Caregivers responded to questions about management of recent fevers in children under five. Treatment indicators were tabulated across countries, and differences in case management provided by the public versus private sector were examined using chi-square tests. Logistic regression was used to test for association between socioeconomic status and 1 malaria blood testing, and 2 ACT treatment. Results Fever treatment with an ACT is low in Benin (10%, the DRC (5%, Madagascar (3% and Nigeria (5%, but higher in Uganda (21% and Zambia (21%. The wealthiest children are significantly more likely to receive ACT compared to the poorest children in Benin (OR = 2.68, 95% CI = 1.12-6.42; the DRC (OR = 2.18, 95% CI = 1.12-4.24; Madagascar (OR = 5.37, 95% CI = 1.58-18.24; and Nigeria (OR = 6.59, 95% CI = 2.73-15.89. Most caregivers seek treatment outside of the home, and private sector outlets are commonly the sole external source of treatment (except in Zambia. However, children treated in the public sector are significantly more likely to receive ACT treatment than those treated in the private sector (except in Madagascar. Nonetheless, levels of testing and ACT treatment in the public sector are low. Few caregivers name the national first-line drug as most effective for treating malaria in Madagascar (2%, the DRC (2%, Nigeria (4% and Benin (10

  9. Intrafractional baseline drift during free breathing breast cancer radiation therapy.

    Science.gov (United States)

    Jensen, Christer Andre; Acosta Roa, Ana María; Lund, Jo-Åsmund; Frengen, Jomar

    2017-06-01

    Intrafraction motion in breast cancer radiation therapy (BCRT) has not yet been thoroughly described in the literature. It has been observed that baseline drift occurs as part of the intrafraction motion. This study aims to measure baseline drift and its incidence in free-breathing BCRT patients using an in-house developed laser system for tracking the position of the sternum. Baseline drift was monitored in 20 right-sided breast cancer patients receiving free breathing 3D-conformal RT by using an in-house developed laser system which measures one-dimensional distance in the AP direction. A total of 357 patient respiratory traces from treatment sessions were logged and analysed. Baseline drift was compared to patient positioning error measured from in-field portal imaging. The mean overall baseline drift at end of treatment sessions was -1.3 mm for the patient population. Relatively small baseline drift was observed during the first fraction; however it was clearly detected already at the second fraction. Over 90% of the baseline drift occurs during the first 3 min of each treatment session. The baseline drift rate for the population was -0.5 ± 0.2 mm/min in the posterior direction the first minute after localization. Only 4% of the treatment sessions had a 5 mm or larger baseline drift at 5 min, all towards the posterior direction. Mean baseline drift in the posterior direction in free breathing BCRT was observed in 18 of 20 patients over all treatment sessions. This study shows that there is a substantial baseline drift in free breathing BCRT patients. No clear baseline drift was observed during the first treatment session; however, baseline drift was markedly present at the rest of the sessions. Intrafraction motion due to baseline drift should be accounted for in margin calculations.

  10. Results from an international multicenter trial evaluating the ease-of-use of and preference for a newly developed disposable injection pen for the treatment of growth hormone deficiency in treatment-naïve children and adults

    Science.gov (United States)

    Pleil, Andreas M; Darendeliler, Feyza; Dörr, Helmuth G; Hutchinson, Katherine; Wollmann, Hartmut A

    2014-01-01

    Previous research has reported that ease of use of and preference for a delivery device are associated with greater patient compliance – an important factor in achieving optimal therapeutic results. The objective of this study was to assess the ease-of-use of a new disposable pen (GoQuick®, Pfizer, Inc.) versus the current reusable pen (GENOTROPIN Pen®, Pfizer, Inc.) to inject a daily dose of recombinant DNA origin human growth hormone, Genotropin® (somatropin) in standard practice. In this randomized, crossover, multicenter, multinational, open-label study, ease-of-use of and preference for the two pens were assessed in three treatment-naïve populations: 1) parents of very young children; 2) parent–child dyads; and 3) adults via use of a validated self-report Injection Pen Assessment Questionnaire (IPAQ) after 2 months of at-home-use experience. The primary endpoint was the proportion of participants who reported the new disposable pen to be no different from or easier to use than the current reusable pen. Safety was also assessed and reported according to local legal requirements. Of the 120 screened patients, 119 were included in the ease-of-use analysis and all were included in the safety analyses. In all, 67.2% found the new somatropin disposable pen to be no different from or easier to use than the reusable pen (95% confidence interval: 58.8–75.7). Most adverse events were mild or moderate. No deaths or device- or treatment-related serious adverse events were reported. These results suggest that improvements made to the reusable somatropin pen are tangible and recognizable to treatment-naïve patients and their caregivers, child–caregiver dyads, and adults, and may positively impact continued compliance with therapy. Registry information ClinicalTrials.gov identifier: NCT01112865. PMID:24748824

  11. Diet-induced mating preference in Drosophila

    OpenAIRE

    Rosenberg, Eugene; Zilber-Rosenberg, Ilana; Sharon, Gil; Segal, Daniel

    2018-01-01

    Diet-induced mating preference was initially observed by Dodd (1). Subsequently, we reported that diet-induced mating preference occurred in Drosophila melanogaster. Treatment of the flies with antibiotics abolished the mating preference, suggesting that fly-associated commensal bacteria were responsible for the phenomenon (2). The hypothesis was confirmed when it was shown that colonizing antibiotic-treated flies with Lactobacillus plantarum reestablished mating preference in multiple-choice...

  12. Performance Measurement Baseline Change Request

    Data.gov (United States)

    Social Security Administration — The Performance Measurement Baseline Change Request template is used to document changes to scope, cost, schedule, or operational performance metrics for SSA's Major...

  13. Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices.

    Science.gov (United States)

    Wilson, Leslie; Loucks, Aimee; Bui, Christine; Gipson, Greg; Zhong, Lixian; Schwartzburg, Amy; Crabtree, Elizabeth; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles

    2014-09-15

    Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, pbenefit (OR=3.68, pbenefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Baseline Biomarkers for Outcome of Melanoma Patients Treated with Pembrolizumab

    NARCIS (Netherlands)

    Weide, Benjamin; Martens, Alexander; Hassel, Jessica C.; Berking, Carola; Postow, Michael A.; Bisschop, Kees; Simeone, Ester; Mangana, Johanna; Schilling, Bastian; Di Giacomo, Anna Maria; Brenner, Nicole; Kaehler, Katharina; Heinzerling, Lucie; Gutzmer, Ralf; Bender, Armin; Gebhardt, Christoffer; Romano, Emanuela; Meier, Friedegund; Martus, Peter; Maio, Michele; Blank, Christian; Schadendorf, Dirk; Dummer, Reinhard; Ascierto, Paolo A.; Hospers, Geke; Garbe, Claus; Wolchok, Jedd D.

    2016-01-01

    Purpose: Biomarkers for outcome after immune-checkpoint blockade are strongly needed as these may influence individual treatment selection or sequence. We aimed to identify baseline factors associated with overall survival (OS) after pembrolizumab treatment in melanoma patients. Experimental Design:

  15. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis

    DEFF Research Database (Denmark)

    Huynh, Tuan Khai; Ostergaard, Ann; Egsmose, Charlotte

    2014-01-01

    of a biologic corresponding to current available options, given that effects, adverse effects, and financial costs were identical for the different choices. The subjects were also asked to justify their preferences. The chi-square goodness-of-fit test was used to examine the distributions over different...... preferences. Proportions were compared using Fisher's exact test. RESULTS: Forty-one patients were currently treated with subcutaneous self-injections at home (SCH) and 66 intravenously at the clinic (IVC). IVC was preferred by 85% of patients currently treated with IVC (P

  16. Baseline Polymorphisms and Emergence of Drug Resistance in the NS3/4A Protease of Hepatitis C Virus Genotype 1 following Treatment with Faldaprevir and Pegylated Interferon Alpha 2a/Ribavirin in Phase 2 and Phase 3 Studies.

    Science.gov (United States)

    Berger, K L; Scherer, J; Ranga, M; Sha, N; Stern, J O; Quinson, A-M; Kukolj, G

    2015-10-01

    Analysis of data pooled from multiple phase 2 (SILEN-C1 to 3) and phase 3 studies (STARTVerso1 to 4) of the hepatitis C virus (HCV) nonstructural protein 3/4A (NS3/4A) protease inhibitor faldaprevir plus pegylated interferon alpha/ribavirin (PR) provides a comprehensive evaluation of baseline and treatment-emergent NS3/4A amino acid variants among HCV genotype-1 (GT-1)-infected patients. Pooled analyses of GT-1a and GT-1b NS3 population-based pretreatment sequences (n = 3,124) showed that faldaprevir resistance-associated variants (RAVs) at NS3 R155 and D168 were rare (<1%). No single, noncanonical NS3 protease or NS4A cofactor baseline polymorphism was associated with a reduced sustained virologic response (SVR) to faldaprevir plus PR, including Q80K. The GT-1b NS3 helicase polymorphism T344I was associated with reduced SVR to faldaprevir plus PR (P < 0.0001) but was not faldaprevir specific, as reduced SVR was also observed with placebo plus PR. Among patients who did not achieve SVR and had available NS3 population sequences (n = 507 GT-1a; n = 349 GT-1b), 94% of GT-1a and 83% of GT-1b encoded faldaprevir treatment-emergent RAVs. The predominant GT-1a RAV was R155K (88%), whereas GT-1b encoded D168 substitutions (78%) in which D168V was predominant (67%). The novel GT-1b NS3 S61L substitution emerged in 7% of virologic failures as a covariant with D168V, most often among the faldaprevir breakthroughs; S61L in combination with D168V had a minimal impact on faldaprevir susceptibility compared with that for D168V alone (1.5-fold difference in vitro). The median time to loss of D168 RAVs among GT-1b-infected patients who did not have a sustained virologic response at 12 weeks posttreatment (non-SVR12) after virologic failure was 5 months, which was shorter than the 14 months for R155 RAVs among GT-1a-infected non-SVR12 patients, suggesting that D168V is less fit than R155K in the absence of faldaprevir selective pressure. Copyright © 2015, American Society for

  17. VIERS- User Preference Service

    Data.gov (United States)

    Department of Veterans Affairs — The Preferences service provides a means to store, retrieve, and manage user preferences. The service supports definition of enterprise wide preferences, as well as...

  18. Comparison of emerald ash borer preference for ash of different species, sun exposure, age, and stress treatments in relation to foliar volatiles and nutrition

    Science.gov (United States)

    Therese M. Poland; Deepa S. Pureswaran; Yigen Chen

    2009-01-01

    We investigated the host selection behavior and feeding preference of the emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) on six different species of ash including Manchurian ash (F...

  19. The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis

    Science.gov (United States)

    Mattsson, Susanne; Olsson, Erik Martin Gustaf

    2016-01-01

    Background The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified. Objective The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions. Methods Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods. Results The preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished

  20. DairyBISS Baseline report

    NARCIS (Netherlands)

    Buizer, N.N.; Berhanu, Tinsae; Murutse, Girmay; Vugt, van S.M.

    2015-01-01

    This baseline report of the Dairy Business Information Service and Support (DairyBISS) project presents the findings of a baseline survey among 103 commercial farms and 31 firms and advisors working in the dairy value chain. Additional results from the survey among commercial dairy farms are

  1. Program Baseline Change Control Procedure

    International Nuclear Information System (INIS)

    1993-02-01

    This procedure establishes the responsibilities and process for approving initial issues of and changes to the technical, cost, and schedule baselines, and selected management documents developed by the Office of Civilian Radioactive Waste Management (OCRWM) for the Civilian Radioactive Waste Management System. This procedure implements the OCRWM Baseline Management Plan and DOE Order 4700.1, Chg 1. It streamlines the change control process to enhance integration, accountability, and traceability of Level 0 and Level I decisions through standardized Baseline Change Proposal (BCP) forms to be used by the Level 0, 1, 2, and 3 Baseline Change Control Boards (BCCBs) and to be tracked in the OCRWM-wide Configuration Information System (CIS) Database.This procedure applies to all technical, cost, and schedule baselines controlled by the Energy System Acquisition Advisory Board (ESAAB) BCCB (Level 0) and, OCRWM Program Baseline Control Board (PBCCB) (Level 1). All baseline BCPs initiated by Level 2 or lower BCCBs, which require approval from ESAAB or PBCCB, shall be processed in accordance with this procedure. This procedure also applies to all Program-level management documents controlled by the OCRWM PBCCB

  2. Oscillation Baselining and Analysis Tool

    Energy Technology Data Exchange (ETDEWEB)

    2017-03-27

    PNNL developed a new tool for oscillation analysis and baselining. This tool has been developed under a new DOE Grid Modernization Laboratory Consortium (GMLC) Project (GM0072 - “Suite of open-source applications and models for advanced synchrophasor analysis”) and it is based on the open platform for PMU analysis. The Oscillation Baselining and Analysis Tool (OBAT) performs the oscillation analysis and identifies modes of oscillations (frequency, damping, energy, and shape). The tool also does oscillation event baselining (fining correlation between oscillations characteristics and system operating conditions).

  3. Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

    Science.gov (United States)

    Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

    2017-12-01

    Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

  4. Transitivity of Preferences

    Science.gov (United States)

    Regenwetter, Michel; Dana, Jason; Davis-Stober, Clintin P.

    2011-01-01

    Transitivity of preferences is a fundamental principle shared by most major contemporary rational, prescriptive, and descriptive models of decision making. To have transitive preferences, a person, group, or society that prefers choice option "x" to "y" and "y" to "z" must prefer "x" to…

  5. 324 Building Baseline Radiological Characterization

    Energy Technology Data Exchange (ETDEWEB)

    R.J. Reeder, J.C. Cooper

    2010-06-24

    This report documents the analysis of radiological data collected as part of the characterization study performed in 1998. The study was performed to create a baseline of the radiological conditions in the 324 Building.

  6. Baseline restoration using current conveyors

    International Nuclear Information System (INIS)

    Morgado, A.M.L.S.; Simoes, J.B.; Correia, C.M.

    1996-01-01

    A good performance of high resolution nuclear spectrometry systems, at high pulse rates, demands restoration of baseline between pulses, in order to remove rate dependent baseline shifts. This restoration is performed by circuits named baseline restorers (BLRs) which also remove low frequency noise, such as power supply hum and detector microphonics. This paper presents simple circuits for baseline restoration based on a commercial current conveyor (CCII01). Tests were performed, on two circuits, with periodic trapezoidal shaped pulses in order to measure the baseline restoration for several pulse rates and restorer duty cycles. For the current conveyor based Robinson restorer, the peak shift was less than 10 mV, for duty cycles up to 60%, at high pulse rates. Duty cycles up to 80% were also tested, being the maximum peak shift 21 mV. The peak shift for the current conveyor based Grubic restorer was also measured. The maximum value found was 30 mV at 82% duty cycle. Keeping the duty cycle below 60% improves greatly the restorer performance. The ability of both baseline restorer architectures to reject low frequency modulation is also measured, with good results on both circuits

  7. Naloxone treatment alters gene expression in the mesolimbic reward system in 'junk food' exposed offspring in a sex-specific manner but does not affect food preferences in adulthood.

    Science.gov (United States)

    Gugusheff, J R; Ong, Z Y; Muhlhausler, B S

    2014-06-22

    We have previously reported that the opioid receptor blocker, naloxone, is less effective in reducing palatable food intake in offspring exposed to a maternal cafeteria diet during the perinatal period, implicating a desensitization of the central opioid pathway in the programming of food preferences. The present study aimed to investigate the effect of a maternal cafeteria diet and naloxone treatment on the development of the mesolimbic reward pathway and food choices in adulthood. We measured mRNA expression of key components of the reward pathway (mu-opioid receptor, proenkephalin, tyrosine hydroxylase, D1 and D2 receptors and the dopamine active transporter (DAT)) in the nucleus accumbens (NAc) and ventral tegmental area (VTA) of the offspring of control and cafeteria fed (JF) dams at weaning and after a 10-day naloxone treatment post-weaning and determined food preferences in adulthood in the remaining offspring. Naloxone treatment decreased the expression of DAT by 8.2 fold in female control offspring but increased it by 4.3 fold in female offspring of JF dams relative to the saline-injected reference groups. Proenkephalin mRNA expression was higher in the NAc of female JF offspring compared to controls, independent of naloxone treatment (Pfood preferences in adulthood in either control or JF offspring. These data indicate that prenatal exposure to a cafeteria diet alters the impact of opioid signaling blockade in the early post-weaning period on gene expression in the central reward pathway in a sex specific manner, but that these changes in gene expression do not appear to have any persistent impact on food preferences in adulthood. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Activation instead of blocking mesolimbic dopaminergic reward circuitry is a preferred modality in the long term treatment of reward deficiency syndrome (RDS: a commentary

    Directory of Open Access Journals (Sweden)

    Waite Roger L

    2008-11-01

    Full Text Available Abstract Background and hypothesis Based on neurochemical and genetic evidence, we suggest that both prevention and treatment of multiple addictions, such as dependence to alcohol, nicotine and glucose, should involve a biphasic approach. Thus, acute treatment should consist of preferential blocking of postsynaptic Nucleus Accumbens (NAc dopamine receptors (D1-D5, whereas long term activation of the mesolimbic dopaminergic system should involve activation and/or release of Dopamine (DA at the NAc site. Failure to do so will result in abnormal mood, behavior and potential suicide ideation. Individuals possessing a paucity of serotonergic and/or dopaminergic receptors, and an increased rate of synaptic DA catabolism due to high catabolic genotype of the COMT gene, are predisposed to self-medicating any substance or behavior that will activate DA release, including alcohol, opiates, psychostimulants, nicotine, gambling, sex, and even excessive internet gaming. Acute utilization of these substances and/or stimulatory behaviors induces a feeling of well being. Unfortunately, sustained and prolonged abuse leads to a toxic" pseudo feeling" of well being resulting in tolerance and disease or discomfort. Thus, a reduced number of DA receptors, due to carrying the DRD2 A1 allelic genotype, results in excessive craving behavior; whereas a normal or sufficient amount of DA receptors results in low craving behavior. In terms of preventing substance abuse, one goal would be to induce a proliferation of DA D2 receptors in genetically prone individuals. While in vivo experiments using a typical D2 receptor agonist induce down regulation, experiments in vitro have shown that constant stimulation of the DA receptor system via a known D2 agonist results in significant proliferation of D2 receptors in spite of genetic antecedents. In essence, D2 receptor stimulation signals negative feedback mechanisms in the mesolimbic system to induce mRNA expression causing

  9. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01] - study protocol and baseline practice and provider characteristics

    Science.gov (United States)

    2013-01-01

    Background Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. Methods/design The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider’s rate of inappropriate antibiotic prescribing relative to top

  10. Developing RESRAD-BASELINE for environmental baseline risk assessment

    International Nuclear Information System (INIS)

    Cheng, Jing-Jy.

    1995-01-01

    RESRAD-BASELINE is a computer code developed at Argonne developed at Argonne National Laboratory for the US Department of Energy (DOE) to perform both radiological and chemical risk assessments. The code implements the baseline risk assessment guidance of the US Environmental Protection Agency (EPA 1989). The computer code calculates (1) radiation doses and cancer risks from exposure to radioactive materials, and (2) hazard indexes and cancer risks from exposure to noncarcinogenic and carcinogenic chemicals, respectively. The user can enter measured or predicted environmental media concentrations from the graphic interface and can simulate different exposure scenarios by selecting the appropriate pathways and modifying the exposure parameters. The database used by PESRAD-BASELINE includes dose conversion factors and slope factors for radionuclides and toxicity information and properties for chemicals. The user can modify the database for use in the calculation. Sensitivity analysis can be performed while running the computer code to examine the influence of the input parameters. Use of RESRAD-BASELINE for risk analysis is easy, fast, and cost-saving. Furthermore, it ensures in consistency in methodology for both radiological and chemical risk analyses

  11. 'Green' preferences as regulatory policy instrument

    International Nuclear Information System (INIS)

    Brennan, Timothy J.

    2006-01-01

    We examine here the suggestion that if consumers in sufficient numbers are willing to pay the premium to have power generated using low-emission technologies, tax or permit policies become less necessary or stringent. While there are implementation difficulties with this proposal, our purpose is more fundamental: Can economics make sense of using preferences as a regulatory instrument? If 'green' preferences are exogenously given, to what extent can or should they be regarded as a substitute for other policies? Even with 'green' preferences, production and consumption of polluting goods continue to impose social costs not borne in the market. Moreover, if green preferences are regarded as a policy instrument, the 'no policy' baseline would require a problematic specification of counterfactual 'non-green' preferences. Viewing green preferences as a regulatory policy instrument is conceptually sensible if the benchmark for optimal emissions is based on value judgments apart from the preferences consumers happen to have. If so, optimal environmental protection would be defined by reference to ethical theory, or, even less favorably, by prescriptions from policy advocates who give their own preferences great weight while giving those of the public at large (and the costs they bear) very little consideration. (author)

  12. The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment

    Science.gov (United States)

    2003-01-01

    psychological stress (Ruderman, 1985), and physical threats, such as 27 DIETARY ADHERENCE AND FAT PREFERENCE an anticipated electric shock...effects of stress and eating. Health Psychology, 11(2), 97-100. Guinard, J.X., Sechevich, P.J., Meaker, K., Jonnalagadda, S.S., & Kris-Etherton, P...ounces each) 1/4 cup chicken or vegetable stock 2 tablespoons lemon juice 1/2 teaspoon fennel seeds, crushed 1/4 teaspoon cumin 1/4 teaspoon

  13. Talk or text to tell? How young adults in Canada and South Africa prefer to receive STI results, counseling, and treatment updates in a wireless world.

    Science.gov (United States)

    Labacher, Lukas; Mitchell, Claudia

    2013-01-01

    Young adults often lack access to confidential, long-lasting, and nonjudgmental interactions with sexual health professionals at brick-and-mortar clinics. To ensure that patients return for their STI test results, post-result counseling, and STI-related information, computer-mediated health intervention programming allows them to receive sexual health information through onsite computers, the Internet, and mobile phone calls and text messages. To determine whether young adults (age: M = 21 years) prefer to communicate with health professionals about the status of their sexual health through computer-mediated communication devices, 303 second-year university students (183 from an urban North American university and 120 from a periurban university in South Africa) completed a paper-based survey indicating how they prefer to communicate with doctors and nurses: talking face to face, mobile phone call, text message, Internet chat programs, Facebook, Twitter, or e-mail. Nearly all students, and female students in South Africa in particular, prefer to receive their STI test results, post-results counseling, and STI-related information by talking face to face with doctors and nurses rather than communicating through computers or mobile phones. Results are clarified in relation to gender, availability of various technologies, and prevalence of HIV in Canada and in South Africa.

  14. Long baseline neutrino oscillation experiments

    International Nuclear Information System (INIS)

    Gallagher, H.

    2006-01-01

    In this paper I will review briefly the experimental results which established the existence of neutrino mixing, the current generation of long baseline accelerator experiments, and the prospects for the future. In particular I will focus on the recent analysis of the MINOS experiment. (author)

  15. Baseline Report on HB2320

    Science.gov (United States)

    State Council of Higher Education for Virginia, 2015

    2015-01-01

    Staff provides this baseline report as a summary of its preliminary considerations and initial research in fulfillment of the requirements of HB2320 from the 2015 session of the General Assembly. Codified as § 23-7.4:7, this legislation compels the Education Secretary and the State Council of Higher Education for Virginia (SCHEV) Director, in…

  16. A preference for migration

    OpenAIRE

    Stark, Oded

    2007-01-01

    At least to some extent migration behavior is the outcome of a preference for migration. The pattern of migration as an outcome of a preference for migration depends on two key factors: imitation technology and migration feasibility. We show that these factors jointly determine the outcome of a preference for migration and we provide examples that illustrate how the prevalence and transmission of a migration-forming preference yield distinct migration patterns. In particular, the imitation of...

  17. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences

    Directory of Open Access Journals (Sweden)

    Emily A. Hurley

    2017-12-01

    Full Text Available Effective patient-provider communication (PPC promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART, yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power, and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp. Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2% compared to a biomedical style (22.5% (p<0.001. Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2% compared to a provider-dominated style (35.8%. In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4% and/or “tough” style (40.6%, but significantly fewer preferred the “sharp” style (14.5% (p<0.001. Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately

  18. Preferences, Consumption Smoothing and Risk Premia

    NARCIS (Netherlands)

    Lettau, M.; Uhlig, H.F.H.V.S.

    1997-01-01

    Risk premia in the consumption capital asset pricing model depend on preferences and dividend. We develop a decomposition which allows a separate treatment of both components. We show that preferences alone determine the risk-return tradeoff measured by the Sharpe-ratio. In general, the risk-return

  19. Partner notification of sexually transmitted diseases: practices and preferences.

    Science.gov (United States)

    Gursahaney, Priya R; Jeong, Kwonho; Dixon, Bruce W; Wiesenfeld, Harold C

    2011-09-01

    Timely notification and treatment of sex partners exposed to a sexually transmitted disease (STD) is essential to reduce reinfection and transmission. Our objectives were to determine factors associated with patient-initiated notification of sex partners and preferences regarding standard partner referral versus expedited partner therapy (EPT). Participants diagnosed with gonorrhea, chlamydia, trichomoniasis, or nongonococcal urethritis within the previous year were administered a baseline survey asking about demographics, sexual history, and partner treatment preferences (standard partner referral vs. EPT). They identified up to 4 sex partners within the past 2 months, and answered questions on relationship characteristics, quality, and notification self-efficacy. At follow-up, participants with a current STD were asked whether they notified their partners. Generalized estimating equations were used to evaluate the associations between predictor variables and partner notification. Of the 201 subjects enrolled, 157 had a current STD diagnosis, and 289 sex partners were identified. The rate of successful partner notification was 77.3% (157/203 sex partners). Partner notification was increased if the subject had a long-term relationship with a sex partner (odds ratio: 3.07; 95% confidence interval: 1.43, 6.58), considered the partner to be a main partner (odds ratio: 2.53; 95% confidence interval: 1.43, 6.58), or had increased notification self-efficacy. Overall, participants did not prefer EPT over standard referral; however, females, those with higher education levels, and those with a prior STD preferred EPT. Patient-initiated partner referral is more successful in patients with increased self-efficacy who have stronger interpersonal relationships with their sex partners.

  20. Results of a quantitative survey to explore both perceptions of the purposes of follow-up and preferences for methods of follow-up delivery among service users, primary care practitioners and specialist clinicians after cancer treatment.

    Science.gov (United States)

    Frew, G; Smith, A; Zutshi, B; Young, N; Aggarwal, A; Jones, P; Kockelbergh, R; Richards, M; Maher, E J

    2010-12-01

    To ascertain perceptions of reasons for follow-up after cancer treatment among service users (patients and carers), primary care practitioners and specialist clinicians (doctors and specialist nurses) and to identify levels of preference for different models of follow-up and the effect of an individual's experience on preferred models. A national survey designed to meet the needs of each key respondent group was carried out after a structured literature review, an extensive consultation process and a pilot scheme. Respondents were asked to assess their degree of preference for 10 pre-selected indications for follow-up. Eight models of follow-up were also identified and respondents were asked to state their experience and preference for each type. The questionnaire was distributed nationally via the 34 cancer networks in England and was available both online and in hard copy (postal). The uptake for the electronic format was in the main by primary care practitioners and specialist clinicians. Service users preferred the paper (postal) format. The survey was also publicised through the primary care and patient partnership forums at a Cancer Network Development event. In total, 2928 responses were received, comprising service users (21% of the sample), primary care practitioners (32%) and specialist clinicians (47%). Eighty-six per cent of responses were received from the 10 strategic health authorities in England, with the remaining 14% from Scotland, Wales and The Isle of Man. The responses from Scotland, Wales and the Isle of Man generally occurred where they interfaced with English cancer networks or had been engaged through word of mouth by colleagues. Among all respondents the main aims of cancer follow-up were considered to be: (1) to monitor for early complications after treatment; (2) to detect recurrences early; (3) to detect late effects of treatment. The most commonly experienced method of follow-up among all respondent groups was outpatient review with a

  1. Preferences over Social Risk

    DEFF Research Database (Denmark)

    Harrison, Glenn W.; Lau, Morten; Rutström, E. Elisabet

    2013-01-01

    that subjects systematically reveal different risk attitudes in a social setting with no prior knowledge about the risk preferences of others compared to when they solely bear the consequences of the decision. However, we also find that subjects are significantly more risk averse when they know the risk......We elicit individual preferences over social risk. We identify the extent to which these preferences are correlated with preferences over individual risk and the well-being of others. We examine these preferences in the context of laboratory experiments over small, anonymous groups, although...... the methodological issues extend to larger groups that form endogenously (e.g., families, committees, communities). Preferences over social risk can be closely approximated by individual risk attitudes when subjects have no information about the risk preferences of other group members. We find no evidence...

  2. Baseline budgeting for continuous improvement.

    Science.gov (United States)

    Kilty, G L

    1999-05-01

    This article is designed to introduce the techniques used to convert traditionally maintained department budgets to baseline budgets. This entails identifying key activities, evaluating for value-added, and implementing continuous improvement opportunities. Baseline Budgeting for Continuous Improvement was created as a result of a newly named company president's request to implement zero-based budgeting. The president was frustrated with the mind-set of the organization, namely, "Next year's budget should be 10 to 15 percent more than this year's spending." Zero-based budgeting was not the answer, but combining the principles of activity-based costing and the Just-in-Time philosophy of eliminating waste and continuous improvement did provide a solution to the problem.

  3. TOIB Study. Are topical or oral ibuprofen equally effective for the treatment of chronic knee pain presenting in primary care: a randomised controlled trial with patient preference study. [ISRCTN79353052

    Directory of Open Access Journals (Sweden)

    Parsons Suzanne

    2005-11-01

    Full Text Available Abstract Background Many older people have chronic knee pain. Both topical and oral non- steroidal anti-inflammatory drugs (NSAIDs are commonly used to treat this. Oral NSAIDS are effective, at least in the short term, but can have severe adverse effects. Topical NSAIDs also appear to be effective, at least in the short term. One might expect topical NSAIDs both to be less effective and to have fewer adverse effects than oral NSAIDs. If topical NSAIDs have fewer adverse effects this may outweigh both the reduction in effectiveness and the higher cost of topical compared to oral treatment. Patient preferences may influence the comparative effectiveness of drugs delivered via different routes. Methods TOIB is a randomised trial comparing topical and oral ibuprofen, with a parallel patient preference study. We are recruiting people aged 50 or over with chronic knee pain, from 27 MRC General Practice Research Framework practices across the UK. We are seeking to recruit 283 participants to the RCT and 379 to the PPS. Participants will be followed up for up to two years (with the majority reaching one year. Outcomes will be assessed by postal questionnaire, nurse examination, laboratory tests and medical record searches at one and two years or the end of the study. Discussion This study will provide new evidence on the overall costs and benefits of treating chronic knee pain with either oral or topical ibuprofen. The use of a patient preference design is unusual, but will allow us to explore how preference influences response to a medication. In addition, it will provide more information on adverse events. This study will provide evidence to inform primary care practitioners, and possibly influence practice.

  4. Integrated Baseline Review (IBR) Handbook

    Science.gov (United States)

    Fleming, Jon F.; Terrell, Stefanie M.

    2018-01-01

    The purpose of this handbook is intended to be a how-to guide to prepare for, conduct, and close-out an Integrated Baseline Review (IBR). It discusses the steps that should be considered, describes roles and responsibilities, tips for tailoring the IBR based on risk, cost, and need for management insight, and provides lessons learned from past IBRs. Appendices contain example documentation typically used in connection with an IBR. Note that these appendices are examples only, and should be tailored to meet the needs of individual projects and contracts.

  5. Environmental Baseline File National Transportation

    International Nuclear Information System (INIS)

    Harris, M.

    1999-01-01

    This Environmental Baseline File summarizes and consolidates information related to the national-level transportation of commercial spent nuclear fuel. Topics addressed include: shipments of commercial spent nuclear fuel based on mostly truck and mostly rail shipping scenarios; transportation routing for commercial spent nuclear fuel sites and DOE sites; radionuclide inventories for various shipping container capacities; transportation routing; populations along transportation routes; urbanized area population densities; the impacts of historical, reasonably foreseeable, and general transportation; state-level food transfer factors; Federal Guidance Report No. 11 and 12 radionuclide dose conversion factors; and national average atmospheric conditions

  6. Baseline atmospheric program Australia 1993

    International Nuclear Information System (INIS)

    Francey, R.J.; Dick, A.L.; Derek, N.

    1996-01-01

    This publication reports activities, program summaries and data from the Cape Grim Baseline Air Pollution Station in Tasmania, during the calendar year 1993. These activities represent Australia's main contribution to the Background Air Pollution Monitoring Network (BAPMoN), part of the World Meteorological Organization's Global Atmosphere Watch (GAW). The report includes 5 research reports covering trace gas sampling, ozone and radon interdependence, analysis of atmospheric dimethylsulfide and carbon-disulfide, sampling of trace gas composition of the troposphere, and sulfur aerosol/CCN relationship in marine air. Summaries of program reports for the calendar year 1993 are also included. Tabs., figs., refs

  7. Baseline LAW Glass Formulation Testing

    International Nuclear Information System (INIS)

    Kruger, Albert A.; Mooers, Cavin; Bazemore, Gina; Pegg, Ian L.; Hight, Kenneth; Lai, Shan Tao; Buechele, Andrew; Rielley, Elizabeth; Gan, Hao; Muller, Isabelle S.; Cecil, Richard

    2013-01-01

    The major objective of the baseline glass formulation work was to develop and select glass formulations that are compliant with contractual and processing requirements for each of the LAW waste streams. Other objectives of the work included preparation and characterization of glasses with respect to the properties of interest, optimization of sulfate loading in the glasses, evaluation of ability to achieve waste loading limits, testing to demonstrate compatibility of glass melts with melter materials of construction, development of glass formulations to support ILAW qualification activities, and identification of glass formulation issues with respect to contract specifications and processing requirements

  8. Compatibility of Mating Preferences

    OpenAIRE

    Bingol, Haluk O.; Basar, Omer

    2016-01-01

    Human mating is a complex phenomenon. Although men and women have different preferences in mate selection, there should be compatibility in these preferences since human mating requires agreement of both parties. We investigate how compatible the mating preferences of men and women are in a given property such as age, height, education and income. We use dataset of a large online dating site (N = 44, 255 users). (i) Our findings are based on the "actual behavior" of users trying to find a dat...

  9. FED baseline engineering studies report

    Energy Technology Data Exchange (ETDEWEB)

    Sager, P.H.

    1983-04-01

    Studies were carried out on the FED Baseline to improve design definition, establish feasibility, and reduce cost. Emphasis was placed on cost reduction, but significant feasibility concerns existed in several areas, and better design definition was required to establish feasibility and provide a better basis for cost estimates. Design definition and feasibility studies included the development of a labyrinth shield ring concept to prevent radiation streaming between the torus spool and the TF coil cryostat. The labyrinth shield concept which was developed reduced radiation streaming sufficiently to permit contact maintenance of the inboard EF coils. Various concepts of preventing arcing between adjacent shield sectors were also explored. It was concluded that installation of copper straps with molybdenum thermal radiation shields would provide the most reliable means of preventing arcing. Other design studies included torus spool electrical/structural concepts, test module shielding, torus seismic response, poloidal conditions in the magnets, disruption characteristics, and eddy current effects. These additional studies had no significant impact on cost but did confirm the feasibility of the basic FED Baseline concept.

  10. FED baseline engineering studies report

    International Nuclear Information System (INIS)

    Sager, P.H.

    1983-04-01

    Studies were carried out on the FED Baseline to improve design definition, establish feasibility, and reduce cost. Emphasis was placed on cost reduction, but significant feasibility concerns existed in several areas, and better design definition was required to establish feasibility and provide a better basis for cost estimates. Design definition and feasibility studies included the development of a labyrinth shield ring concept to prevent radiation streaming between the torus spool and the TF coil cryostat. The labyrinth shield concept which was developed reduced radiation streaming sufficiently to permit contact maintenance of the inboard EF coils. Various concepts of preventing arcing between adjacent shield sectors were also explored. It was concluded that installation of copper straps with molybdenum thermal radiation shields would provide the most reliable means of preventing arcing. Other design studies included torus spool electrical/structural concepts, test module shielding, torus seismic response, poloidal conditions in the magnets, disruption characteristics, and eddy current effects. These additional studies had no significant impact on cost but did confirm the feasibility of the basic FED Baseline concept

  11. A prospective, double-blind, randomized, two-period crossover, multicenter study to evaluate tolerability and patient preference between mirabegron and tolterodine in patients with overactive bladder (PREFER study).

    Science.gov (United States)

    Staskin, David; Herschorn, Sender; Fialkov, Jonathan; Tu, Le Mai; Walsh, Terry; Schermer, Carol R

    2018-02-01

    The objective of this study was to assess the tolerability and treatment preference in patients with overactive bladder (OAB) treated with mirabegron or tolterodine. This was a two-period, 8-week crossover, double-blind, phase IV study (PREFER; NCT02138747) in treatment-naive adults with OAB for 3 months or longer randomized to one of four treatment sequences in a 5:5:1:1 ratio (mirabegron/tolterodine, tolterodine/mirabegron, mirabegron/mirabegron, or tolterodine/tolterodine), separated by a washout period of 2 weeks. The primary endpoint was drug tolerability using the Medication Tolerability scale of the OAB Treatment Satisfaction (OAB-S) questionnaire at end of treatment (EoT). Period-by-treatment interactions were analyzed to determine any effect of drug order. Patient preference, change from baseline in OAB symptoms, and treatment-emergent adverse events (TEAEs) were assessed. A total of 358 randomized patients completed the OAB-S Medication Tolerability scale questionnaire at one or more visits after the baseline evaluation. The mean (95% CI) OAB-S Medication Tolerability scores were significantly higher (better tolerability) for mirabegron (86.29 [83.50, 89.08]) than for tolterodine (83.40 [80.59, 86.20]; p = 0.004). The period-by-treatment interaction was not significant (p = 0.955). Improvements in OAB-S Medication Tolerability scores at EoT were more evident in women, patients aged ≥65 years, and in patients without baseline incontinence, and were greater with mirabegron than with tolterodine extended release. There were no significant differences in patient preference or improvements in OAB symptoms. Significant differences in favor of mirabegron were observed for anticholinergic TEAEs (20.4% vs. 27.4%; p = 0.042) and specifically for gastrointestinal disorders (14.7% vs. 22.5%; p = 0.015). Tolerability of mirabegron was significantly higher than that of tolterodine, and patient preference and improvements in OAB symptoms were comparable

  12. Eye tracking social preferences

    NARCIS (Netherlands)

    Jiang, Ting; Potters, Jan; Funaki, Yukihiko

    We hypothesize that if people are motivated by a particular social preference, then choosing in accordance with this preference will lead to an identifiable pattern of eye movements. We track eye movements while subjects make choices in simple three-person distribution experiments. We characterize

  13. von Neumann Morgenstern Preferences

    DEFF Research Database (Denmark)

    Vind, Karl

    von Neumann Morgenstern utility is generalized to von Neumann Morgenstern preferences. The proof is an application of simple hyperplane theorems......von Neumann Morgenstern utility is generalized to von Neumann Morgenstern preferences. The proof is an application of simple hyperplane theorems...

  14. von Neumann Morgenstern Preferences

    DEFF Research Database (Denmark)

    Vind, Karl

    2000-01-01

    von Neumann Morgenstern utility is generalized to von Neumann Morgenstern preferences. The proof is an application of simple hyperplane theorems......von Neumann Morgenstern utility is generalized to von Neumann Morgenstern preferences. The proof is an application of simple hyperplane theorems...

  15. Measuring Normative Risk Preferences

    NARCIS (Netherlands)

    G.A.G. Alserda (Gosse)

    2017-01-01

    textabstractThe results of eliciting risk preferences depend on the elicitation method. Different methods of measuring the same variable tend to produce different results. This raises the question whether normative risk preferences can be elicited at all. Using two types of manipulation, I assess

  16. Pinellas Plant Environmental Baseline Report

    Energy Technology Data Exchange (ETDEWEB)

    1997-06-01

    The Pinellas Plant has been part of the Department of Energy`s (DOE) nuclear weapons complex since the plant opened in 1957. In March 1995, the DOE sold the Pinellas Plant to the Pinellas County Industry Council (PCIC). DOE has leased back a large portion of the plant site to facilitate transition to alternate use and safe shutdown. The current mission is to achieve a safe transition of the facility from defense production and prepare the site for alternative uses as a community resource for economic development. Toward that effort, the Pinellas Plant Environmental Baseline Report (EBR) discusses the current and past environmental conditions of the plant site. Information for the EBR is obtained from plant records. Historical process and chemical usage information for each area is reviewed during area characterizations.

  17. Integrated Baseline Review (IBR) Handbook

    Science.gov (United States)

    Fleming, Jon F.; Kehrer, Kristen C.

    2016-01-01

    The purpose of this handbook is intended to be a how-to guide to prepare for, conduct, and close-out an Integrated Baseline Review (IBR). It discusses the steps that should be considered, describes roles and responsibilities, tips for tailoring the IBR based on risk, cost, and need for management insight, and provides lessons learned from past IBRs. Appendices contain example documentation typically used in connection with an IBR. Note that these appendices are examples only, and should be tailored to meet the needs of individual projects and contracts. Following the guidance in this handbook will help customers and suppliers preparing for an IBR understand the expectations of the IBR, and ensure that the IBR meets the requirements for both in-house and contract efforts.

  18. Dopamine D1 receptor agonist treatment attenuates extinction of morphine conditioned place preference while increasing dendritic complexity in the nucleus accumbens core.

    Science.gov (United States)

    Kobrin, Kendra L; Arena, Danielle T; Heinrichs, Stephen C; Nguyen, Olivia H; Kaplan, Gary B

    2017-03-30

    The dopamine D1 receptor (D1R) has a role in opioid reward and conditioned place preference (CPP), but its role in CPP extinction is undetermined. We examined the effect of D1R agonist SKF81297 on the extinction of opioid CPP and associated dendritic morphology in the nucleus accumbens (NAc), a region involved with reward integration and its extinction. During the acquisition of morphine CPP, mice received morphine and saline on alternate days; injections were given immediately before each of eight daily conditioning sessions. Mice subsequently underwent six days of extinction training designed to diminish the previously learned association. Mice were treated with either 0.5mg/kg SKF81297, 0.8mg/kg SKF81297, or saline immediately after each extinction session. There was a dose-dependent effect, with the highest dose of SKF81297 attenuating extinction, as mice treated with this dose had significantly higher CPP scores than controls. Analysis of medium spiny neuron morphology revealed that in the NAc core, but not in the shell, dendritic arbors were significantly more complex in the morphine conditioned, SKF81297-treated mice compared to controls. In separate experiments using mice conditioned with only saline, SKF81297 administration after extinction sessions had no effect on CPP and produced differing effects on dendritic morphology. At the doses used in our experiments, SKF81297 appears to maintain previously learned opioid conditioned behavior, even in the face of new information. The D1R agonist's differential, rather than unidirectional, effects on dendritic morphology in the NAc core suggests that it may be involved in encoding reward information depending on previously learned behavior. Published by Elsevier B.V.

  19. Effects of ampicillin, cefazolin and cefoperazone treatments on GLT-1 expressions in the mesocorticolimbic system and ethanol intake in alcohol-preferring rats.

    Science.gov (United States)

    Rao, P S S; Goodwani, S; Bell, R L; Wei, Y; Boddu, S H S; Sari, Y

    2015-06-04

    Chronic ethanol consumption is known to downregulate expression of the major glutamate transporter 1 (GLT-1), which increases extracellular glutamate concentrations in subregions of the mesocorticolimbic reward pathway. While β-lactam antibiotics were initially identified as potent upregulators of GLT-1 expression, only ceftriaxone has been extensively studied in various drug addiction models. Therefore, in this study, adult male alcohol-preferring (P) rats exposed chronically to ethanol were treated with other β-lactam antibiotics, ampicillin, cefazolin or cefoperazone (100mg/kg) once daily for five consecutive days to assess their effects on ethanol consumption. The results demonstrated that each compound significantly reduced ethanol intake compared to the saline-treated control group. Importantly, each compound significantly upregulated both GLT-1 and pAKT expressions in the nucleus accumbens and prefrontal cortex compared to saline-treated control group. In addition, only cefoperazone significantly inhibited hepatic aldehyde dehydrogenase-2 enzyme activity. Moreover, these β-lactams exerted only a transient effect on sucrose drinking, suggesting specificity for chronically inhibiting ethanol reward in adult male P rats. Cerebrospinal fluid concentrations of ampicillin, cefazolin or cefoperazone have been confirmed using high-performance liquid chromatography. These findings demonstrate that multiple β-lactam antibiotics demonstrate efficacy in reducing alcohol consumption and appear to be potential therapeutic compounds for treating alcohol abuse and/or dependence. In addition, these results suggest that pAKT may be an important player in this effect, possibly through increased transcription of GLT-1. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

  20. High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes.

    Science.gov (United States)

    Custer, Aimee; Sufrinko, Alicia; Elbin, R J; Covassin, Tracey; Collins, Micky; Kontos, Anthony

    2016-02-01

    Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. Cohort study. High school and collegiate athletic programs. A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68). Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment. The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group. Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their

  1. Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome : preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment

    NARCIS (Netherlands)

    Twisk, Moniek; Haadsma, Maaike L.; van der Veen, Fulco; Repping, Sjoerd; Mastenbroek, Sebastiaan; Heineman, Maas-Jan; Bossuyt, Patrick M. M.; Korevaar, Johanna C.

    2007-01-01

    Objective: Although the primary goal of preimplantation genetic screening (PGS) is to increase pregnancy rates in women undergoing IVF/intracytoplasmic sperm injection treatment, it has been suggested that it may also be used as an alternative to prenatal testing for Down syndrome. Design: Trade-off

  2. Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome: preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment

    NARCIS (Netherlands)

    Twisk, Moniek; Haadsma, Maaike L.; van der Veen, Fulco; Repping, Sjoerd; Mastenbroek, Sebastiaan; Heineman, Maas-Jan; Bossuyt, Patrick M. M.; Korevaar, Johanna C.

    2007-01-01

    Objective: Although the primary goal of preimplantation genetic screening (PGS) is to increase pregnancy rates in women undergoing IVF/intracytoplasmic sperm injection treatment, it has been suggested that it may also be used as an alternative to prenatal testing for Down syndrome. Design: Trade-off

  3. Finger Tapping-Related Activation Differences in Treatment-Naive Pediatric Tourette Syndrome: A Comparison of the Preferred and Nonpreferred Hand

    Science.gov (United States)

    Roessner, Veit; Wittfoth, Matthias; August, Julia M.; Rothenberger, Aribert; Baudewig, Jurgen; Dechent, Peter

    2013-01-01

    Background: Disturbances of motor circuitry are commonly encountered in Tourette syndrome (TS). The aim of this study was to investigate simple motor performance differences between boys with TS and healthy controls. Methods: We attempted to provide insight into motor network alterations by studying a group of treatment-naive patients suffering…

  4. Pre-fermentative cold maceration, saignée, and various thermal treatments as options for modulating volatile aroma and phenol profiles of red wine.

    Science.gov (United States)

    Lukić, Igor; Budić-Leto, Irena; Bubola, Marijan; Damijanić, Kristijan; Staver, Mario

    2017-06-01

    The effects of six maceration treatments on volatile aroma and phenol composition of Teran red wine were studied: standard maceration (control C), cold pre-fermentation maceration (CPM), saignée (S), pre-fermentation heating with extended maceration (PHT) or juice fermentation (PHP), and post-fermentation heating (POH). PHP wine contained the highest amounts of esters, fatty acids and anthocyanins, and the lowest content of other phenols. Alternative treatments decreased higher alcohols in relation to control C. CPM treatment lowered the extraction of seed tannins, exhibited the highest acetaldehyde, ethyl acetate and C 6 -compounds levels, and had increased ester levels in relation to control C. POH wine contained the highest concentration of total phenols, flavonoids, monomeric, oligomeric and polymeric flavanols, and color intensity and hue. S and PHT wines contained lower amount of total phenols, but higher than in C and CPM wines. The calculated Odor Activity Values were used to establish significant differences between the treatments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. "I don't need my patients' opinion to withdraw treatment": patient preferences at the end-of-life and physician attitudes towards advance directives in England and France.

    Science.gov (United States)

    Horn, Ruth

    2014-08-01

    This paper presents the results of a qualitative interview study exploring English and French physicians' moral perspectives and attitudes towards end-of-life decisions when patients lack capacity to make decisions for themselves. The paper aims to examine the importance physicians from different contexts accord to patient preferences and to explore the (potential) role of advance directives (ADs) in each context. The interviews focus on (1) problems that emerge when deciding to withdraw/-hold life-sustaining treatment from both conscious and unconscious patients; (2) decision-making procedures and the participation of proxies/relatives; (3) previous experience with ADs and views on their usefulness; and (4) perspectives on ways in which the decision-making processes in question might be improved. The analysis reveals differences in the way patient preferences are taken into consideration and shows how these differences influence the reasons physicians in each country invoke to justify their reluctance to adhering to ADs. Identifying cultural differences that complicate efforts to develop the practical implementation of ADs can help to inform national policies governing ADs and to better adapt them to practice.

  6. The California Baseline Methane Survey

    Science.gov (United States)

    Duren, R. M.; Thorpe, A. K.; Hopkins, F. M.; Rafiq, T.; Bue, B. D.; Prasad, K.; Mccubbin, I.; Miller, C. E.

    2017-12-01

    The California Baseline Methane Survey is the first systematic, statewide assessment of methane point source emissions. The objectives are to reduce uncertainty in the state's methane budget and to identify emission mitigation priorities for state and local agencies, utilities and facility owners. The project combines remote sensing of large areas with airborne imaging spectroscopy and spatially resolved bottom-up data sets to detect, quantify and attribute emissions from diverse sectors including agriculture, waste management, oil and gas production and the natural gas supply chain. Phase 1 of the project surveyed nearly 180,000 individual facilities and infrastructure components across California in 2016 - achieving completeness rates ranging from 20% to 100% per emission sector at < 5 meters spatial resolution. Additionally, intensive studies of key areas and sectors were performed to assess source persistence and variability at times scales ranging from minutes to months. Phase 2 of the project continues with additional data collection in Spring and Fall 2017. We describe the survey design and measurement, modeling and analysis methods. We present initial findings regarding the spatial, temporal and sectoral distribution of methane point source emissions in California and their estimated contribution to the state's total methane budget. We provide case-studies and lessons learned about key sectors including examples where super-emitters were identified and mitigated. We summarize challenges and recommendations for future methane research, inventories and mitigation guidance within and beyond California.

  7. Hydrogeology baseline study Aurora Mine

    International Nuclear Information System (INIS)

    1996-01-01

    A baseline hydrogeologic study was conducted in the area of Syncrude's proposed Aurora Mine in order to develop a conceptual regional hydrogeologic model for the area that could be used to understand groundwater flow conditions. Geologic information was obtained from over 2,000 coreholes and from data obtained between 1980 and 1996 regarding water level for the basal aquifer. A 3-D numerical groundwater flow model was developed to provide quantitative estimates of the potential environmental impacts of the proposed mining operations on the groundwater flow system. The information was presented in the context of a regional study area which encompassed much of the Athabasca Oil Sands Region, and a local study area which was defined by the lowlands of the Muskeg River Basin. Characteristics of the topography, hydrology, climate, geology, and hydrogeology of the region are described. The conclusion is that groundwater flow in the aquifer occurs mostly in a westerly direction beneath the Aurora Mine towards its inferred discharge location along the Athabasca River. Baseflow in the Muskeg River is mostly related to discharge from shallow surficial aquifers. Water in the river under baseflow conditions was fresh, of calcium-carbonate type, with very little indication of mineralization associated with deeper groundwater in the Aurora Mine area. 44 refs., 5 tabs., 31 figs

  8. 2016 Annual Technology Baseline (ATB)

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley; Kurup, Parthiv; Hand, Maureen; Feldman, David; Sigrin, Benjamin; Lantz, Eric; Stehly, Tyler; Augustine, Chad; Turchi, Craig; O' Connor, Patrick; Waldoch, Connor

    2016-09-01

    Consistent cost and performance data for various electricity generation technologies can be difficult to find and may change frequently for certain technologies. With the Annual Technology Baseline (ATB), National Renewable Energy Laboratory provides an organized and centralized dataset that was reviewed by internal and external experts. It uses the best information from the Department of Energy laboratory's renewable energy analysts and Energy Information Administration information for conventional technologies. The ATB will be updated annually in order to provide an up-to-date repository of current and future cost and performance data. Going forward, we plan to revise and refine the values using best available information. The ATB includes both a presentation with notes (PDF) and an associated Excel Workbook. The ATB includes the following electricity generation technologies: land-based wind; offshore wind; utility-scale solar PV; concentrating solar power; geothermal power; hydropower plants (upgrades to existing facilities, powering non-powered dams, and new stream-reach development); conventional coal; coal with carbon capture and sequestration; integrated gasification combined cycle coal; natural gas combustion turbines; natural gas combined cycle; conventional biopower. Nuclear laboratory's renewable energy analysts and Energy Information Administration information for conventional technologies. The ATB will be updated annually in order to provide an up-to-date repository of current and future cost and performance data. Going forward, we plan to revise and refine the values using best available information.

  9. Contraceptive use and method preference among women in Soweto, South Africa: the influence of expanding access to HIV care and treatment services.

    Directory of Open Access Journals (Sweden)

    Angela Kaida

    2010-11-01

    Full Text Available Preventing unintended pregnancy among HIV-positive women constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV hyper-endemic settings. We sought to investigate whether the prevalence of contraceptive use and method preferences varied by HIV status and receipt of highly active antiretroviral therapy (HAART among women in Soweto, South Africa.We used survey data from 563 sexually active, non-pregnant women (18-44 years recruited from the Perinatal HIV Research Unit in Soweto (May-December, 2007; 171 women were HIV-positive and receiving HAART (median duration of use = 31 months; IQR = 28, 33, 178 were HIV-positive and HAART-naïve, and 214 were HIV-negative. Medical record review was conducted to confirm HIV status and clinical variables. Logistic regression models estimated adjusted associations between HIV status, receipt of HAART, and contraceptive use.Overall, 78% of women reported using contraception, with significant variation by HIV status: 86% of HAART users, 82% of HAART-naïve women, and 69% of HIV-negative women (p<0.0001. In adjusted models, compared with HIV-negative women, women receiving HAART were significantly more likely to use contraception while HAART-naïve women were non-significantly more likely (AOR: 2.40; 95% CI: 1.25, 4.62 and AOR: 1.59; 95% CI: 0.88, 2.85; respectively. Among HIV-positive women, HAART users were non-significantly more likely to use contraception compared with HAART-naïve women (AOR: 1.55; 95% CI: 0.84, 2.88. Similar patterns held for specific use of barrier (primarily male condoms, permanent, and dual protection contraceptive methods.Among HIV-positive women receiving HAART, the observed higher prevalence of contraceptive use overall and condoms in particular promises to yield fewer unintended pregnancies and reduced risks of

  10. Contraceptive use and method preference among women in Soweto, South Africa: the influence of expanding access to HIV care and treatment services.

    Science.gov (United States)

    Kaida, Angela; Laher, Fatima; Strathdee, Steffanie A; Money, Deborah; Janssen, Patricia A; Hogg, Robert S; Gray, Glenda

    2010-11-05

    Preventing unintended pregnancy among HIV-positive women constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV hyper-endemic settings. We sought to investigate whether the prevalence of contraceptive use and method preferences varied by HIV status and receipt of highly active antiretroviral therapy (HAART) among women in Soweto, South Africa. We used survey data from 563 sexually active, non-pregnant women (18-44 years) recruited from the Perinatal HIV Research Unit in Soweto (May-December, 2007); 171 women were HIV-positive and receiving HAART (median duration of use = 31 months; IQR = 28, 33), 178 were HIV-positive and HAART-naïve, and 214 were HIV-negative. Medical record review was conducted to confirm HIV status and clinical variables. Logistic regression models estimated adjusted associations between HIV status, receipt of HAART, and contraceptive use. Overall, 78% of women reported using contraception, with significant variation by HIV status: 86% of HAART users, 82% of HAART-naïve women, and 69% of HIV-negative women (pwomen, women receiving HAART were significantly more likely to use contraception while HAART-naïve women were non-significantly more likely (AOR: 2.40; 95% CI: 1.25, 4.62 and AOR: 1.59; 95% CI: 0.88, 2.85; respectively). Among HIV-positive women, HAART users were non-significantly more likely to use contraception compared with HAART-naïve women (AOR: 1.55; 95% CI: 0.84, 2.88). Similar patterns held for specific use of barrier (primarily male condoms), permanent, and dual protection contraceptive methods. Among HIV-positive women receiving HAART, the observed higher prevalence of contraceptive use overall and condoms in particular promises to yield fewer unintended pregnancies and reduced risks of vertical and sexual HIV transmission. These findings highlight the

  11. Quality of life and patient satisfaction in patients with atrial fibrillation on stable vitamin K antagonist treatment or switched to a non-vitamin K antagonist oral anticoagulant during a 1-year follow-up: A PREFER in AF Registry substudy.

    Science.gov (United States)

    De Caterina, Raffaele; Brüggenjürgen, Bernd; Darius, Harald; Köhler, Sabine; Lucerna, Markus; Pecen, Ladislav; Renda, Giulia; Schilling, Richard John; Schliephacke, Tessa; Zamorano, José Luis; Le Heuzey, Jean-Yves; Kirchhof, Paulus

    2018-02-01

    Non-vitamin K antagonist oral anticoagulants (NOACs) are being introduced for stroke prevention in non-valvular Atrial Fibrillation (AF), and promise to be accepted better than Vitamin K Antagonists (VKAs) by patients, improving their Quality of Life (QoL). To assess to what extent patient-related factors influence decisions to switch from a VKA to a NOAC. The PREFER in AF Registry collected data at baseline in 2012 - at the beginning of NOAC prescriptions - and at 1-year follow-up, in 6412 patients in seven Western European countries. QoL and patient satisfaction questionnaires (EQ-5D-5L and/or PACT-Q2) were completed in 3777 patients at both visits. Data were compared across categories of patients on stable treatment with a VKA (i.e. continuously over the previous 12 months) (n=2102) or recently switched (within 12 months) from a VKA to a NOAC (n=213) during a 1-year follow-up, allowing a snapshot of factors influencing the switch at a time when NOACs were being introduced into the market. Compared to patients on stable treatment with a VKA, switched patients were similar in terms of age, sex, body mass index and other risk factors, but had lower prevalences of hypertension and heart valve dysfunction, and a lower rate of use of concomitant treatment with antiplatelet/anti-inflammatory agents; they also had a lower CHA 2 DS 2 -VASc score. Among 25 features investigated, switched patients more often reported bruising or bleeding, complained about bruising, were dissatisfied with the anticoagulant treatment, and reported mobility problems and anxiety/depressive traits. At the beginning of NOAC prescriptions, European doctors tended to switch from VKAs to NOACs those patients at lower risk than "non-switchers". Complaints about bruising or bleeding, dissatisfaction with treatment, mobility problems and anxiety/depression traits appear to be related to - and may have influenced - the choice to switch from a VKA to a NOAC. Copyright © 2017 Elsevier Masson SAS

  12. Revealed smooth nontransitive preferences

    DEFF Research Database (Denmark)

    Keiding, Hans; Tvede, Mich

    2013-01-01

    In the present paper, we are concerned with the behavioural consequences of consumers having nontransitive preference relations. Data sets consist of finitely many observations of price vectors and consumption bundles. A preference relation rationalizes a data set provided that for every observed...... consumption bundle, all strictly preferred bundles are more expensive than the observed bundle. Our main result is that data sets can be rationalized by a smooth nontransitive preference relation if and only if prices can normalized such that the law of demand is satisfied. Market data sets consist of finitely...... many observations of price vectors, lists of individual incomes and aggregate demands. We apply our main result to characterize market data sets consistent with equilibrium behaviour of pure-exchange economies with smooth nontransitive consumers....

  13. Consumers’ preferences for bread

    DEFF Research Database (Denmark)

    Edenbrandt, Anna Kristina; Gamborg, Christian; Thorsen, Bo Jellesmark

    2017-01-01

    Consumers are apprehensive about transgenic technologies, so cisgenics, which limit gene transfers to sexually compatible organisms, have been suggested to address consumer concerns. We study consumer preferences for rye bread alternatives based on transgenic or cisgenic rye, grown conventionally...

  14. 2016 Annual Technology Baseline (ATB) - Webinar Presentation

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley; Kurup, Parthiv; Hand, Maureen; Feldman, David; Sigrin, Benjamin; Lantz, Eric; Stehly, Tyler; Augustine, Chad; Turchi, Craig; Porro, Gian; O' Connor, Patrick; Waldoch, Connor

    2016-09-13

    This deck was presented for the 2016 Annual Technology Baseline Webinar. The presentation describes the Annual Technology Baseline, which is a compilation of current and future cost and performance data for electricity generation technologies.

  15. 75 FR 66748 - Notice of Baseline Filings

    Science.gov (United States)

    2010-10-29

    ...- 000] Notice of Baseline Filings October 22, 2010. ONEOK Gas Transportation, L.L.C Docket No. PR11-68... above submitted a revised baseline filing of their Statement of Operating Conditions for services...

  16. Teachers' preferences towards textbook

    Directory of Open Access Journals (Sweden)

    Stanojević Darko D.

    2016-01-01

    Full Text Available In this paper, using the method named Conjoint analysis, and with the goal of determining teacher's preferences in the process of textbook selection, and also defining the prototype of quality textbook which will could be used in the classroom. With consideration of criteria defined in the previous researches on this topic, an continuing the work on those results, we will create clear hypothetical prototype of the textbook which will satisfy the teacher's preference.

  17. 324 Building Baseline Radiological Characterization

    International Nuclear Information System (INIS)

    Reeder, R.J.; Cooper, J.C.

    2010-01-01

    This report documents the analysis of radiological data collected as part of the characterization study performed in 1998. The study was performed to create a baseline of the radiological conditions in the 324 Building. A total of 85 technical (100 square centimeter (cm 2 )) smears were collected from the Room 147 hoods, the Shielded Materials Facility (SMF), and the Radiochemical Engineering Cells (REC). Exposure rate readings (window open and window closed) were taken at a distance of 2.5 centimeters (cm) and 30 cm from the surface of each smear. Gross beta-gamma and alpha counts of each smear were also performed. The smear samples were analyzed by gamma energy analysis (GEA). Alpha energy analysis (AEA) and strontium-90 analysis were also performed on selected smears. GEA results for one or more samples reported the presence of manganese-54, cobalt-60, silver-108m antimony-125, cesium-134, cesium-137, europium-154, europium-155, and americium-241. AEA results reported the presence of plutonium-239/240, plutonium-238/ 241 Am, curium-243/244, curium-242, and americium-243. Tables 5 through 9 present a summary by location of the estimated maximum removable and total contamination levels in the Room 147 hoods, the SMF, and the REC. The smear sample survey data and laboratory analytical results are presented in tabular form by sample in Appendix A. The Appendix A tables combine survey data documented in radiological survey reports found in Appendix B and laboratory analytical results reported in the 324 Building Physical and Radiological Characterization Study (Berk, Hill, and Landsman 1998), supplemented by the laboratory analytical results found in Appendix C.

  18. STD patients’ preferences for HIV prevention strategies

    Directory of Open Access Journals (Sweden)

    Castro JG

    2014-12-01

    Full Text Available Jose G Castro,1 Deborah L Jones,2 Stephen M Weiss2 1Infectious Diseases, Department of Medicine, 2Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA Abstract: The objective of this pilot study was to explore the knowledge of and preferences regarding effective biomedical interventions among high risk individuals attending a sexually transmitted diseases clinic, and to examine the effect of a brief information intervention on preference. Participants completed a baseline assessment, attended a presentation on human immunodeficiency virus (HIV prevention methods, and completed a postintervention assessment. Outcome measures included: demographics and sexual risk factors, self-perceived HIV risk, and knowledge and attitudes regarding new biomedical methods of HIV prevention. After the baseline evaluation, participants were provided with information on new biomedical prevention strategies. Participants were given the option to review the information by reading a pamphlet or by viewing a brief video containing the same information. Participants (n=97 were female (n=51 and male (n=46. At baseline, only a small minority of participants were aware of the newer biomedical strategies to prevent HIV infection. Postintervention, 40% endorsed having heard about the use of HIV medications to prevent HIV infection; 72% had heard that male circumcision can decrease the risk of acquiring HIV infection in men; and 73% endorsed knowledge of the potential role of microbicides in decreasing the risk of acquiring HIV. Following the intervention, the most preferred prevention method was male condoms, followed by preexposure prophylaxis, and microbicides. The least preferred methods were male circumcision and female condoms. This study provides preliminary information on knowledge and attitudes regarding newer biomedical interventions to protect against HIV infection. Keywords: STD clinic, biomedical HIV prevention, PrEP, male

  19. Cryotherapy is preferable to ablative CO2 laser for the treatment of isolated actinic keratoses of the face and scalp: a randomized clinical trial.

    Science.gov (United States)

    Zane, C; Facchinetti, E; Rossi, M T; Specchia, C; Ortel, B; Calzavara-Pinton, P

    2014-05-01

    Actinic keratosis (AK) may progress to squamous cell carcinoma. In the case of normal or mildly photodamaged skin, lesion-directed treatments are considered valuable options despite poor published evidence of their therapeutic activity. The aim of this single-centre, open-label, prospective, nonsponsored, randomized, controlled clinical trial was to compare CO2 laser ablation with cryotherapy in the treatment of isolated AKs of the face and scalp. Patients with isolated (≤ 4) AKs of the face and scalp were randomized to receive CO2 laser ablation or cryotherapy. After 90 days, the overall complete remission (CR) rates of patients and lesions were assessed and correlated with thickness grade. Two hundred patients with a total number of 543 AKs were enrolled. The CR rates of lesions after 3 months were 78·2% with cryotherapy and 72·4% with CO2 laser ablation. Thicker lesions were significantly more responsive to cryotherapy (P = 0·034). Seventy-three patients (71·6%) had CR of all lesions 3 months after cryotherapy and 64 (65·3%) after laser ablation. At 12 months after treatment the number of patients with CR was reduced to 53 with cryotherapy and 14 with laser ablation. The rate of patients and lesions with CR is similar after 3 months, but more patients remain in stable remission for 12 months after cryotherapy. Cryotherapy is more effective for thick lesions. The cosmetic outcome was good or excellent in almost all patients. © 2014 British Association of Dermatologists.

  20. The Combination of Marketed Antagonists of α1b-Adrenergic and 5-HT2A Receptors Inhibits Behavioral Sensitization and Preference to Alcohol in Mice: A Promising Approach for the Treatment of Alcohol Dependence.

    Directory of Open Access Journals (Sweden)

    Fabrice Trovero

    Full Text Available Alcohol-dependence is a chronic disease with a dramatic and expensive social impact. Previous studies have indicated that the blockade of two monoaminergic receptors, α1b-adrenergic and 5-HT2A, could inhibit the development of behavioral sensitization to drugs of abuse, a hallmark of drug-seeking and drug-taking behaviors in rodents. Here, in order to develop a potential therapeutic treatment of alcohol dependence in humans, we have blocked these two monoaminergic receptors by a combination of antagonists already approved by Health Agencies. We show that the association of ifenprodil (1 mg/kg and cyproheptadine (1 mg/kg (α1-adrenergic and 5-HT2 receptor antagonists marketed as Vadilex ® and Periactine ® in France, respectively blocks behavioral sensitization to amphetamine in C57Bl6 mice and to alcohol in DBA2 mice. Moreover, this combination of antagonists inhibits alcohol intake in mice habituated to alcohol (10% v/v and reverses their alcohol preference. Finally, in order to verify that the effect of ifenprodil was not due to its anti-NMDA receptors property, we have shown that a combination of prazosin (0.5 mg/kg, an α1b-adrenergic antagonist, Mini-Press ® in France and cyproheptadine (1 mg/kg could also reverse alcohol preference. Altogether these findings strongly suggest that combined prazosin and cyproheptadine could be efficient as a therapy to treat alcoholism in humans. Finally, because α1b-adrenergic and 5-HT2A receptors blockade also inhibits behavioral sensitization to psychostimulants, opioids and tobacco, it cannot be excluded that this combination will exhibit some efficacy in the treatment of addiction to other abused drugs.

  1. Program Baseline Change Control Board charter

    International Nuclear Information System (INIS)

    1993-02-01

    The purpose of this Charter is to establish the Program Baseline Change Control Board (PBCCB) for the Office of Civilian Radioactive Waste Management (OCRWM) Program, and to describe its organization, responsibilities, and basic methods of operation. Guidance for implementing this Charter is provided by the OCRWM Baseline Management Plan (BMP) and OCRWM Program Baseline Change Control Procedure

  2. 40 CFR 1042.825 - Baseline determination.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Baseline determination. 1042.825... Provisions for Remanufactured Marine Engines § 1042.825 Baseline determination. (a) For the purpose of this... not valid. (f) Use good engineering judgment for all aspects of the baseline determination. We may...

  3. Age Preferences for Professional Helpers.

    Science.gov (United States)

    Furchtgott, Ernest; Busemeyer, Jerome R.

    1981-01-01

    For all occupations except clergyman, a relationship between the age of the respondent and preferred age of the professional existed. Older individuals preferred older service providers with one exception, their physician. Highly educated respondents preferred younger physicians. (Author)

  4. Preference Handling for Artificial Intelligence

    OpenAIRE

    Goldsmith, Judy; University of Kentucky; Junker, Ulrich; ILOG

    2009-01-01

    This article explains the benefits of preferences for AI systems and draws a picture of current AI research on preference handling. It thus provides an introduction to the topics covered by this special issue on preference handling.

  5. Overseas Environmental Baseline Guidance Document

    Science.gov (United States)

    2007-05-01

    milligrams per liter (mg/L) determined before or at the first customer, and the corresponding disinfectant contact time, T , in minutes. CT values...for a CWS and NTNCWS that adds a disinfectant (oxidant, such as chlorine, chlorine dioxide, chloramines , or ozone) to any part of its treatment...drinking water. Operators may increase residual disinfectant levels of chlorine or chloramines (but not chlorine dioxide) in the distribution system to a

  6. Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries

    DEFF Research Database (Denmark)

    Shen, Ye; King, Charles H.; Binder, Sue

    2017-01-01

    Background The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because their studies provided an opportunity to evaluate the effects of mass treatment...

  7. Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder : Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions

    NARCIS (Netherlands)

    Vuijk, R.; Arntz, A.

    Background To our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD. Methods/design Twelve adult

  8. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS) : Design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care

    NARCIS (Netherlands)

    Wiegersma, Marian; Panman, Chantal M. C. R.; Kollen, Boudewijn J.; Vermeulen, Karin M.; Schram, Aaltje J.; Messelink, Embert J.; Berger, Marjolein Y.; Lisman-Van Leeuwen, Yvonne; Dekker, Janny H.

    Pelvic floor muscle training (PFMT) and pessaries are commonly used in the conservative treatment of pelvic organ prolapse (POP). Because there is a lack of evidence regarding the optimal choice between these two interventions, we designed the "Pelvic Organ prolapse in primary care: effects of

  9. Considering baseline factors and early response rates to optimize therapy for chronic myeloid leukemia in chronic phase.

    Science.gov (United States)

    Akard, Luke P; Bixby, Dale

    2016-05-01

    Multiple BCR-ABL tyrosine kinase inhibitors (TKIs) are available for the treatment of chronic myeloid leukemia in chronic phase (CML-CP), and several baseline and on-treatment predictive factors have been identified that can be used to help guide TKI selection for individual patients. In particular, early molecular response (EMR; BCR-ABL ≤10% on the International Scale at 3 months) has become an accepted benchmark for evaluating whether patients with CML-CP are responding optimally to frontline TKI therapy. Failure to achieve EMR is considered an inadequate initial response according to the National Comprehensive Cancer Network guidelines and a warning response according to the European LeukemiaNet recommendations. Here we review data supporting the importance of achieving EMR for improving patients' long-term outcomes and discuss key considerations for selecting a frontline TKI in light of these data. Because a higher proportion of patients achieve EMR with second-generation TKIs such as nilotinib and dasatinib than with imatinib, these TKIs may be preferable for many patients, particularly those with known negative prognostic factors at baseline. We also discuss other considerations for frontline TKI choice, including toxicities, cost-effectiveness, and the emerging goals of deep molecular response and treatment-free remission.

  10. Measuring children's food preferences

    DEFF Research Database (Denmark)

    Olsen, Annemarie; Kildegaard, Heidi; Gabrielsen, Gorm

    2012-01-01

    The aim of this study is to investigate if children’s food preferences can be reliable measured by using pictures of foods presented on a computer screen in a conjoint layout.We investigate reproducibility (test–retest) and infer validity by comparison with traditional hedonic evaluations...... juices (tangible products), chosen to span the preference spectrum, were hedonically evaluated for appearance and taste. Finally, an actual product choice was performed by having the children choose between two buns and two juices.Results showed that the computer evaluationswith pictures of foods...... provided reproducible information about the children’s visual food preferences, which were in concordance with both hedonic measures and products choices, and can thus be considered valid....

  11. BMC{trademark}: Baseline report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-31

    Barrier Membrane Containment (BMC){trademark} is a high-density polyethylene membrane (HOPE) groundwater barrier and pass-through system, with applications ranging from plume control and containment to groundwater manipulation coupled with in-site treatment. BMC{trademark} system can function as a permeable or impermeable reaction wall, a cut-off wall, interceptor trenches, a barrier with collection and/or monitoring system and a pass-through in a funnel and gate configuration. BMC{trademark} can be inspected with a down-hole video camera, producing a permanent VHS format tape, insuring the integrity of the wall and the interlocking joints. The joints are sealed with a ``U``-packing elastomeric gasket to prevent the flow of fluids or gases.

  12. Enterprise Mac Managed Preferences

    CERN Document Server

    Marczak, Edward

    2010-01-01

    Many systems administrators on the Mac need a way to manage machine configuration after initial setup and deployment. Apple's Managed Preferences system (also known as MCX) is under-documented, often misunderstood, and sometimes outright unknown by sys admins. MCX is usually deployed in conjunction with an OS X server, but it can also be used in Windows environments or where no dedicated server exists at all. Enterprise Mac Managed Preferences is the definitive guide to Apple's Managed Client technology. With this book, you'll get the following: * An example-driven guide to Mac OS X Managed Pr

  13. 40 CFR 74.20 - Data for baseline and alternative baseline.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Data for baseline and alternative baseline. 74.20 Section 74.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... baseline and alternative baseline. (a) Acceptable data. (1) The designated representative of a combustion...

  14. Predicting the Effectiveness of Work-Focused CBT for Common Mental Disorders: The Influence of Baseline Self-Efficacy, Depression and Anxiety.

    Science.gov (United States)

    Brenninkmeijer, Veerle; Lagerveld, Suzanne E; Blonk, Roland W B; Schaufeli, Wilmar B; Wijngaards-de Meij, Leoniek D N V

    2018-02-15

    Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasi-experimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW.

  15. Integrated planning: A baseline development perspective

    International Nuclear Information System (INIS)

    Clauss, L.; Chang, D.

    1994-01-01

    The FEMP Baseline establishes the basis for integrating environmental activity technical requirements with their cost and schedule elements. The result is a path forward to successfully achieving the FERMCO mission. Specific to cost management, the FEMP Baseline has been incorporate into the FERMCO Project Control System (PCS) to provide a time-phased budget plan against which contractor performance is measured with an earned value management system. The result is the Performance Measurement Baseline (PMB), an important tool for keeping cost under control

  16. Constructive Preference Elicitation

    Directory of Open Access Journals (Sweden)

    Paolo Dragone

    2018-01-01

    Full Text Available When faced with large or complex decision problems, human decision makers (DM can make costly mistakes, due to inherent limitations of their memory, attention, and knowledge. Preference elicitation tools assist the decision maker in overcoming these limitations. They do so by interactively learning the DM’s preferences through appropriately chosen queries and suggesting high-quality outcomes based on the preference estimates. Most state-of-the-art techniques, however, fail in constructive settings, where the goal is to synthesize a custom or entirely novel configuration rather than choosing the best option among a given set of candidates. Many wide-spread problems are constructive in nature: customizing composite goods such as cars and computers, bundling products, recommending touristic travel plans, designing apartments, buildings, or urban layouts, etc. In these settings, the full set of outcomes is humongous and can not be explicitly enumerated, and the solution must be synthesized via constrained optimization. In this article, we describe recent approaches especially designed for constructive problems, outlining the underlying ideas and their differences as well as their limitations. In presenting them, we especially focus on novel issues that the constructive setting brings forth, such as how to deal with sparsity of the DM’s preferences, how to properly frame the interaction, and how to achieve efficient synthesis of custom instances.

  17. Immigrants' location preferences

    DEFF Research Database (Denmark)

    Damm, Anna Piil

    This paper exploits a spatial dispersal policy for refugee immigrants to estimate the importance of local and regional factors for refugees' location preferences. The main results of a mixed proportional hazard competing risks model are that placed refugees react to high regional unemployment...

  18. Hormones and social preferences

    NARCIS (Netherlands)

    Buser, T.

    2011-01-01

    We examine whether social preferences are determined by hormones. We do this by investigating whether markers for the strength of prenatal testosterone exposure (finger length ratios) and current exposure to progesterone and oxytocin (the menstrual cycle) are correlated with choices in social

  19. Preferred Dance Tempo

    DEFF Research Database (Denmark)

    Dahl, Sofia; Huron, David; Brod, Garvin

    2014-01-01

    In two experiments participants tuned a drum machine to their preferred dance tempo. Measurements of height, shoulder width, leg length, and weight were taken for each participant, and their sex recorded. Using a multiple regression analysis, height and leg length combined was found to be the bes...

  20. IPCC Socio-Economic Baseline Dataset

    Data.gov (United States)

    National Aeronautics and Space Administration — The Intergovernmental Panel on Climate Change (IPCC) Socio-Economic Baseline Dataset consists of population, human development, economic, water resources, land...

  1. Can the optimum artificial tear treatment for dry eye disease be predicted from presenting signs and symptoms?

    Science.gov (United States)

    Essa, Laika; Laughton, Deborah; Wolffsohn, James S

    2018-02-01

    To assess dry eye treatment with four preservative-free dry eye artificial tear treatments to facilitate evidence-based prescribing. A randomised, single masked crossover trial of Clinitas Soothe, Hyabak, Tears Again and TheraTears artificial tears was conducted on 50 symptomatic dry eye patients, aged 60.8±14.2years. At baseline and after trialling each treatment for 4 weeks, signs and symptoms were assessed using the Ocular Surface Disease Index (OSDI), non-invasive tear break-up time, fluorescein tear break-up time, tear meniscus height (TMH), Phenol Red test, lid-parallel conjunctival folds (LIPCOF), ocular surface staining, and lipid layer grading and osmolarity (baseline visit only). OSDI (p=0.002), LIPCOF (p=0.014) and conjunctival staining (pdry eye treatment on ocular symptoms and signs was similar. Clinitas Soothe and Hyabak were preferred by 34%/30% of participants, but only subjective comparison with the other drops influenced this choice. TheraTears was preferred (by 24%) by those with a lower baseline tear volume (p=0.01) and Tears Again (by 12%) by those with a thinner baseline lipid layer (p=0.04). The treatment that afforded the greatest improvement in clinical signs did not consistently match each individual's preferred treatment. If prescribed to a general dry eye population, the artificial tears performed similarly, improving symptoms and conjunctival signs. However, osmolarity balanced artificial tears were the preferred treatment in individuals with low baseline tear volume and lipisomal spray for individuals with a baseline lipid layer deficiency. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  2. TAPIR--Finnish national geochemical baseline database.

    Science.gov (United States)

    Jarva, Jaana; Tarvainen, Timo; Reinikainen, Jussi; Eklund, Mikael

    2010-09-15

    In Finland, a Government Decree on the Assessment of Soil Contamination and Remediation Needs has generated a need for reliable and readily accessible data on geochemical baseline concentrations in Finnish soils. According to the Decree, baseline concentrations, referring both to the natural geological background concentrations and the diffuse anthropogenic input of substances, shall be taken into account in the soil contamination assessment process. This baseline information is provided in a national geochemical baseline database, TAPIR, that is publicly available via the Internet. Geochemical provinces with elevated baseline concentrations were delineated to provide regional geochemical baseline values. The nationwide geochemical datasets were used to divide Finland into geochemical provinces. Several metals (Co, Cr, Cu, Ni, V, and Zn) showed anomalous concentrations in seven regions that were defined as metal provinces. Arsenic did not follow a similar distribution to any other elements, and four arsenic provinces were separately determined. Nationwide geochemical datasets were not available for some other important elements such as Cd and Pb. Although these elements are included in the TAPIR system, their distribution does not necessarily follow the ones pre-defined for metal and arsenic provinces. Regional geochemical baseline values, presented as upper limit of geochemical variation within the region, can be used as trigger values to assess potential soil contamination. Baseline values have also been used to determine upper and lower guideline values that must be taken into account as a tool in basic risk assessment. If regional geochemical baseline values are available, the national guideline values prescribed in the Decree based on ecological risks can be modified accordingly. The national geochemical baseline database provides scientifically sound, easily accessible and generally accepted information on the baseline values, and it can be used in various

  3. Arc melter demonstration baseline test results

    International Nuclear Information System (INIS)

    Soelberg, N.R.; Chambers, A.G.; Anderson, G.L.; Oden, L.L.; O'Connor, W.K.; Turner, P.C.

    1994-07-01

    This report describes the test results and evaluation for the Phase 1 (baseline) arc melter vitrification test series conducted for the Buried Waste Integrated Demonstration program (BWID). Phase 1 tests were conducted on surrogate mixtures of as-incinerated wastes and soil. Some buried wastes, soils, and stored wastes at the INEL and other DOE sites, are contaminated with transuranic (TRU) radionuclides and hazardous organics and metals. The high temperature environment in an electric arc furnace may be used to process these wastes to produce materials suitable for final disposal. An electric arc furnace system can treat heterogeneous wastes and contaminated soils by (a) dissolving and retaining TRU elements and selected toxic metals as oxides in the slag phase, (b) destroying organic materials by dissociation, pyrolyzation, and combustion, and (c) capturing separated volatilized metals in the offgas system for further treatment. Structural metals in the waste may be melted and tapped separately for recycle or disposal, or these metals may be oxidized and dissolved into the slag. The molten slag, after cooling, will provide a glass/ceramic final waste form that is homogeneous, highly nonleachable, and extremely durable. These features make this waste form suitable for immobilization of TRU radionuclides and toxic metals for geologic timeframes. Further, the volume of contaminated wastes and soils will be substantially reduced in the process

  4. A typology of preferences for participation in healthcare decision making.

    Science.gov (United States)

    Flynn, Kathryn E; Smith, Maureen A; Vanness, David

    2006-09-01

    Classifying patients as "active" or "passive" with regard to healthcare decision making is misleading, since patients have different desires for different components of the decision-making process. Distinguishing patients' desired roles is an essential step towards promoting care that respects and responds to individual patients' preferences. We included items on the 2004 Wisconsin Longitudinal Study mail survey measuring preferences for four components of the decision-making process: physician knowledge of patient medical history, physician disclosure of treatment choices, discussion of treatment choices, and selection of treatment choice. We characterized preference types for 5199 older adults using cluster analysis. Ninety-six percent of respondents are represented by four preference types, all of which prefer maximal information exchange with physicians. Fifty-seven percent of respondents wanted to retain personal control over important medical decisions ("autonomists"). Among the autonomists, 81% preferred to discuss treatment choices with their physician. Thirty-nine percent of respondents wanted their physician to make important medical decisions ("delegators"). Among the delegators, 41% preferred to discuss treatment choices. Female gender, higher educational attainment, better self-rated health, fewer prescription medications, and having a shorter duration at a usual place of care predicted a significantly higher probability of the most active involvement in discussing and selecting treatment choices. The overwhelming majority of older adults want to be given treatment options and have their physician know everything about their medical history; however, there are substantial differences in how they want to be involved in discussing and selecting treatments.

  5. FAQs about Baseline Testing among Young Athletes

    Science.gov (United States)

    ... a similar exam conducted by a health care professional during the season if an athlete has a suspected concussion. Baseline testing generally takes place during the pre-season—ideally prior to the first practice. It is important to note that some baseline ...

  6. 75 FR 74706 - Notice of Baseline Filings

    Science.gov (United States)

    2010-12-01

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Notice of Baseline Filings November 24, 2010. Centana Intrastate Pipeline, LLC. Docket No. PR10-84-001. Centana Intrastate Pipeline, LLC... applicants listed above submitted a revised baseline filing of their Statement of Operating Conditions for...

  7. 76 FR 8725 - Notice of Baseline Filings

    Science.gov (United States)

    2011-02-15

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Notice of Baseline Filings Enstor Grama Ridge Storage and Docket No. PR10-97-002. Transportation, L.L.C.. EasTrans, LLC Docket No. PR10-30-001... revised baseline filing of their Statement of Operating Conditions for services provided under section 311...

  8. 75 FR 57268 - Notice of Baseline Filings

    Science.gov (United States)

    2010-09-20

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR10-103-000; Docket No. PR10-104-000; Docket No. PR10-105- 000 (Not Consolidated)] Notice of Baseline Filings September 13..., 2010, and September 10, 2010, respectively the applicants listed above submitted their baseline filing...

  9. 75 FR 65010 - Notice of Baseline Filings

    Science.gov (United States)

    2010-10-21

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR11-1-000; Docket No. PR11-2-000; Docket No. PR11-3-000] Notice of Baseline Filings October 14, 2010. Cranberry Pipeline Docket..., 2010, respectively the applicants listed above submitted their baseline filing of its Statement of...

  10. 76 FR 5797 - Notice of Baseline Filings

    Science.gov (United States)

    2011-02-02

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR10-114-001; Docket No. PR10-129-001; Docket No. PR10-131- 001; Docket No. PR10-68-002 Not Consolidated] Notice of Baseline... applicants listed above submitted a revised baseline filing of their Statement of Operating Conditions for...

  11. 75 FR 70732 - Notice of Baseline Filings

    Science.gov (United States)

    2010-11-18

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR11-71-000; Docket No. PR11-72-000; Docket No. PR11-73- 000] Notice of Baseline Filings November 10, 2010. Docket No. PR11-71-000..., 2010, the applicants listed above submitted their baseline filing of their Statement of Operating...

  12. Physicians' preferences for asthma guidelines implementation.

    Science.gov (United States)

    Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

    2010-10-01

    Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

  13. Estimating exponential scheduling preferences

    DEFF Research Database (Denmark)

    Hjorth, Katrine; Börjesson, Maria; Engelson, Leonid

    2015-01-01

    of car drivers' route and mode choice under uncertain travel times. Our analysis exposes some important methodological issues related to complex non-linear scheduling models: One issue is identifying the point in time where the marginal utility of being at the destination becomes larger than the marginal......Different assumptions about travelers' scheduling preferences yield different measures of the cost of travel time variability. Only few forms of scheduling preferences provide non-trivial measures which are additive over links in transport networks where link travel times are arbitrarily...... utility of being at the origin. Another issue is that models with the exponential marginal utility formulation suffer from empirical identification problems. Though our results are not decisive, they partly support the constant-affine specification, in which the value of travel time variability...

  14. PREFERENCE, PRINCIPLE AND PRACTICE

    DEFF Research Database (Denmark)

    Skovsgaard, Morten; Bro, Peter

    2011-01-01

    Legitimacy has become a central issue in journalism, since the understanding of what journalism is and who journalists are has been challenged by developments both within and outside the newsrooms. Nonetheless, little scholarly work has been conducted to aid conceptual clarification as to how jou...... distinct, but interconnected categories*preference, principle, and practice. Through this framework, historical attempts to justify journalism and journalists are described and discussed in the light of the present challenges for the profession....

  15. Emotions and Economic Preference

    OpenAIRE

    Todorova, Tamara; Ramachandran, Bharath

    2005-01-01

    We wish to examine critically the viewpoint that: a) economists take too narrow a view of rationality and do not recognize the role of emotions as a component of rationality and b) do not address the question of whether preferences are rational or not, and instead take them as just given. We trace the relationship between economics and emotions showing some economic dimensions of emotional states. We illustrate them with examples of economic behavior based on emotional reactions.

  16. Patients' preference in migraine

    NARCIS (Netherlands)

    Dekker, François (Frans)

    2014-01-01

    This thesis is about migraine. Three elements are discussed. First element is preventive treatment, second element is attack treatment and the third part focuses on medication overuse headache. The preventive treatment of migraine is a valuable intervention in primary care. If preventive treatment

  17. Reinforcement Magnitude: An Evaluation of Preference and Reinforcer Efficacy

    OpenAIRE

    Trosclair-Lasserre, Nicole M; Lerman, Dorothea C; Call, Nathan A; Addison, Laura R; Kodak, Tiffany

    2008-01-01

    Consideration of reinforcer magnitude may be important for maximizing the efficacy of treatment for problem behavior. Nonetheless, relatively little is known about children's preferences for different magnitudes of social reinforcement or the extent to which preference is related to differences in reinforcer efficacy. The purpose of the current study was to evaluate the relations among reinforcer magnitude, preference, and efficacy by drawing on the procedures and results of basic experimenta...

  18. What is the preferred number of consecutive night shifts? results from a crossover intervention study among police officers in Denmark.

    Science.gov (United States)

    Nabe-Nielsen, Kirsten; Jensen, Marie Aarrebo; Hansen, Åse Marie; Kristiansen, Jesper; Garde, Anne Helene

    2016-10-01

    Among police officers in Denmark, we studied (i) how many consecutive night shifts participants preferred at baseline; (ii) preferences regarding three intervention conditions (two, four, and seven consecutive night shifts followed by the same number of days off/day shifts: '2 + 2', '4 + 4', '7 + 7') at follow-up; (iii) characteristics of participants preferring each of these intervention conditions. Questionnaire data from a crossover intervention study were used (baseline: n = 73; follow-up: n = 68). At baseline, 49% preferred four consecutive night shifts. At follow-up, 57% preferred '4 + 4', 26% preferred '2 + 2' and 26% preferred '7 + 7'. Participants, who preferred longer spells of night work experienced that night work was less demanding, found it easier to sleep at different times of the day, and were more frequently evening types compared with participants who preferred shorter spells of night work. The participants' preferences are likely to be influenced by their previous shift work experience. Practitioner Summary: We investigated police officers' preferences regarding the number of consecutive night shifts. The majority preferred four consecutive night shifts. Those who preferred the longer spells of night work found night work less demanding, found it easier to sleep at different times of the day, and were more frequently evening types.

  19. Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer’s Quality of Life Questionnaire C30: a confirmatory versus exploratory approach

    Science.gov (United States)

    Costa, Daniel SJ; Aaronson, Neil K; Fayers, Peter M; Grimison, Peter S; Janda, Monika; Pallant, Julie F; Rowen, Donna; Velikova, Galina; Viney, Rosalie; Young, Tracey A; King, Madeleine T

    2014-01-01

    Background Multi attribute utility instruments (MAUIs) are preference-based measures that comprise a health state classification system (HSCS) and a scoring algorithm that assigns a utility value to each health state in the HSCS. When developing a MAUI from a health-related quality of life (HRQOL) questionnaire, first a HSCS must be derived. This typically involves selecting a subset of domains and items because HRQOL questionnaires typically have too many items to be amendable to the valuation task required to develop the scoring algorithm for a MAUI. Currently, exploratory factor analysis (EFA) followed by Rasch analysis is recommended for deriving a MAUI from a HRQOL measure. Aim To determine whether confirmatory factor analysis (CFA) is more appropriate and efficient than EFA to derive a HSCS from the European Organisation for the Research and Treatment of Cancer’s core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30), given its well-established domain structure. Methods QLQ-C30 (Version 3) data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQ-C30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis. Results CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04). EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA. Conclusion CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest

  20. The Vocational Preference Inventory Scores and Environmental Preferences

    Science.gov (United States)

    Kunce, Joseph T.; Kappes, Bruno Maurice

    1976-01-01

    This study investigated the relationship between vocational interest measured by the Vocational Preference Inventory (VPI) and preferences of 175 undergraduates for structured or unstructured environments. Males having clear-cut preferences for structured situations had significantly higher Realistic-Conventional scores than those without…

  1. TWRS technical baseline database manager definition document

    International Nuclear Information System (INIS)

    Acree, C.D.

    1997-01-01

    This document serves as a guide for using the TWRS Technical Baseline Database Management Systems Engineering (SE) support tool in performing SE activities for the Tank Waste Remediation System (TWRS). This document will provide a consistent interpretation of the relationships between the TWRS Technical Baseline Database Management software and the present TWRS SE practices. The Database Manager currently utilized is the RDD-1000 System manufactured by the Ascent Logic Corporation. In other documents, the term RDD-1000 may be used interchangeably with TWRS Technical Baseline Database Manager

  2. Life Support Baseline Values and Assumptions Document

    Science.gov (United States)

    Anderson, Molly S.; Ewert, Michael K.; Keener, John F.

    2018-01-01

    The Baseline Values and Assumptions Document (BVAD) provides analysts, modelers, and other life support researchers with a common set of values and assumptions which can be used as a baseline in their studies. This baseline, in turn, provides a common point of origin from which many studies in the community may depart, making research results easier to compare and providing researchers with reasonable values to assume for areas outside their experience. This document identifies many specific physical quantities that define life support systems, serving as a general reference for spacecraft life support system technology developers.

  3. The Causes of Preference Reversal.

    OpenAIRE

    Tversky, Amos; Slovic, Paul; Kahneman, Daniel

    1990-01-01

    Observed preference reversal cannot be adequately explained by violations of independence, the reduction axiom, or transitivity. The primary cause of preference reversal is the failure of procedure invariance, especially the overpricing of low-probability, high-payoff bets. This result violates regret theory and generalized (nonindependent) utility models. Preference reversal and a new reversal involving time preferences are explained by scale compatibility, which implies that payoffs are wei...

  4. Human preference for air movement

    DEFF Research Database (Denmark)

    Toftum, Jørn; Melikov, Arsen Krikor; Tynel, A.

    2002-01-01

    Human preference for air movement was studied at slightly cool, neutral, and slightly warm overall thermal sensations and at temperatures ranging from 18 deg.C to 28 deg.C. Air movement preference depended on both thermal sensation and temperature, but large inter-individual differences existed...... between subjects. Preference for less air movement was linearly correlated with draught discomfort, but the percentage of subjects who felt draught was lower than the percentage who preferred less air movement....

  5. Technical baseline description for in situ vitrification laboratory test equipment

    International Nuclear Information System (INIS)

    Beard, K.V.; Bonnenberg, R.W.; Watson, L.R.

    1991-09-01

    IN situ vitrification (ISV) has been identified as possible waste treatment technology. ISV was developed by Pacific Northwest Laboratory (PNL), Richland, Washington, as a thermal treatment process to treat contaminated soils in place. The process, which electrically melts and dissolves soils and associated inorganic materials, simultaneously destroys and/or removes organic contaminants while incorporating inorganic contaminants into a stable, glass-like residual product. This Technical Baseline Description has been prepared to provide high level descriptions of the design of the Laboratory Test model, including all design modifications and safety improvements made to data. Furthermore, the Technical Baseline Description provides a basic overview of the interface documents for configuration management, program management interfaces, safety, quality, and security requirements. 8 figs

  6. Hanford Site technical baseline database. Revision 1

    International Nuclear Information System (INIS)

    Porter, P.E.

    1995-01-01

    This report lists the Hanford specific files (Table 1) that make up the Hanford Site Technical Baseline Database. Table 2 includes the delta files that delineate the differences between this revision and revision 0 of the Hanford Site Technical Baseline Database. This information is being managed and maintained on the Hanford RDD-100 System, which uses the capabilities of RDD-100, a systems engineering software system of Ascent Logic Corporation (ALC). This revision of the Hanford Site Technical Baseline Database uses RDD-100 version 3.0.2.2 (see Table 3). Directories reflect those controlled by the Hanford RDD-100 System Administrator. Table 4 provides information regarding the platform. A cassette tape containing the Hanford Site Technical Baseline Database is available

  7. Reinforcement Magnitude: An Evaluation of Preference and Reinforcer Efficacy

    Science.gov (United States)

    Trosclair-Lasserre, Nicole M.; Lerman, Dorothea C.; Call, Nathan A.; Addison, Laura R.; Kodak, Tiffany

    2008-01-01

    Consideration of reinforcer magnitude may be important for maximizing the efficacy of treatment for problem behavior. Nonetheless, relatively little is known about children's preferences for different magnitudes of social reinforcement or the extent to which preference is related to differences in reinforcer efficacy. The purpose of the current…

  8. THE US LONG BASELINE NEUTRINO EXPERIMENT STUDY.

    Energy Technology Data Exchange (ETDEWEB)

    BISHAI,M.

    2007-08-06

    The US Long Baseline Neutrino Experiment Study was commissioned jointly by Brookhaven National Laboratory (BNL)and Fermi National Accelerator Laboratory (FNAL) to investigate the potential for future U.S. based long baseline neutrino oscillation experiments using MW class conventional neutrino beams that can be produced at FNAL. The experimental baselines are based on two possible detector locations: (1) off-axis to the existing FNAL NuMI beamline at baselines of 700 to 810 km and (2) NSF's proposed future Deep Underground Science and Engineering Laboratory (DUSEL) at baselines greater than 1000km. Two detector technologies are considered: a megaton class Water Cherenkov detector deployed deep underground at a DUSEL site, or a 100kT Liquid Argon Time-Projection Chamber (TPC) deployed on the surface at any of the proposed sites. The physics sensitivities of the proposed experiments are summarized. We find that conventional horn focused wide-band neutrino beam options from FNAL aimed at a massive detector with a baseline of > 1000km have the best sensitivity to CP violation and the neutrino mass hierarchy for values of the mixing angle {theta}{sub 13} down to 2{sup o}.

  9. Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer's Quality of Life Questionnaire C30: a confirmatory versus exploratory approach

    Directory of Open Access Journals (Sweden)

    Costa DSJ

    2014-11-01

    from the European Organisation for the Research and Treatment of Cancer's core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30, given its well-established domain structure.Methods: QLQ-C30 (Version 3 data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites. The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQ-C30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis.Results: CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04. EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA.Conclusion: CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest that CFA should be recommended generally when deriving a preference-based measure from a HRQOL measure that has an established domain structure.Keywords: multi attribute utility instrument, health state classification system, confirmatory factor analysis, exploratory factor analysis, European Organisation for the Research and Treatment of Cancer QLQ-C30

  10. Estimating exponential scheduling preferences

    DEFF Research Database (Denmark)

    Hjorth, Katrine; Börjesson, Maria; Engelson, Leonid

    Extended abstract Choice of departure time is a travel choice dimension that transportation planners often need to forecast in appraisal. A traveller may shift departure time in response to changes in expected travel time or travel time variability (TTV) or in response to time-differentiated cong......Extended abstract Choice of departure time is a travel choice dimension that transportation planners often need to forecast in appraisal. A traveller may shift departure time in response to changes in expected travel time or travel time variability (TTV) or in response to time...... from the underlying scheduling preferences (Noland and Small, 1995, Bates et al., 2001, Fosgerau and Karlström, 2010). The scheduling preferences can be formally represented as time-dependent rates of utility derived at different locations. Assuming that the travellers are rational and choose departure......’ departure time choice. The assumption underlying the scheduling approach is that the traveller rationally maximises her total utility obtained during a period of time. The total utility depends on time of departure from the origin and time of arrival to the destination. The total utility is usually assumed...

  11. Nonintrusive methodology for wellness baseline profiling

    Science.gov (United States)

    Chung, Danny Wen-Yaw; Tsai, Yuh-Show; Miaou, Shaou-Gang; Chang, Walter H.; Chang, Yaw-Jen; Chen, Shia-Chung; Hong, Y. Y.; Chyang, C. S.; Chang, Quan-Shong; Hsu, Hon-Yen; Hsu, James; Yao, Wei-Cheng; Hsu, Ming-Sin; Chen, Ming-Chung; Lee, Shi-Chen; Hsu, Charles; Miao, Lidan; Byrd, Kenny; Chouikha, Mohamed F.; Gu, Xin-Bin; Wang, Paul C.; Szu, Harold

    2007-04-01

    We develop an accumulatively effective and affordable set of smart pair devices to save the exuberant expenditure for the healthcare of aging population, which will not be sustainable when all the post-war baby boomers retire (78 millions will cost 1/5~1/4 GDP in US alone). To design an accessible test-bed for distributed points of homecare, we choose two exemplars of the set to demonstrate the possibility of translation of modern military and clinical know-how, because two exemplars share identically the noninvasive algorithm adapted to the Smart Sensor-pairs for the real world persistent surveillance. Currently, the standard diagnoses for malignant tumors and diabetes disorders are blood serum tests, X-ray CAT scan, and biopsy used sometime in the physical checkup by physicians as cohort-average wellness baselines. The loss of the quality of life in making second careers productive may be caused by the missing of timeliness for correct diagnoses and easier treatments, which contributes to the one quarter of human errors generating the lawsuits against physicians and hospitals, which further escalates the insurance cost and wasteful healthcare expenditure. Such a vicious cycle should be entirely eliminated by building an "individual diagnostic aids (IDA)," similar to the trend of personalized drug, developed from daily noninvasive intelligent databases of the "wellness baseline profiling (WBP)". Since our physiology state undulates diurnally, the Nyquist anti-aliasing theory dictates a minimum twice-a-day sampling of the WBP for the IDA, which must be made affordable by means of noninvasive, unsupervised and unbiased methodology at the convenience of homes. Thus, a pair of military infrared (IR) spectral cameras has been demonstrated for the noninvasive spectrogram ratio test of the spontaneously emitted thermal radiation from a normal human body at 37°C temperature. This invisible self-emission spreads from 3 microns to 12 microns of the radiation wavelengths

  12. A long baseline global stereo matching based upon short baseline estimation

    Science.gov (United States)

    Li, Jing; Zhao, Hong; Li, Zigang; Gu, Feifei; Zhao, Zixin; Ma, Yueyang; Fang, Meiqi

    2018-05-01

    In global stereo vision, balancing the matching efficiency and computing accuracy seems to be impossible because they contradict each other. In the case of a long baseline, this contradiction becomes more prominent. In order to solve this difficult problem, this paper proposes a novel idea to improve both the efficiency and accuracy in global stereo matching for a long baseline. In this way, the reference images located between the long baseline image pairs are firstly chosen to form the new image pairs with short baselines. The relationship between the disparities of pixels in the image pairs with different baselines is revealed by considering the quantized error so that the disparity search range under the long baseline can be reduced by guidance of the short baseline to gain matching efficiency. Then, the novel idea is integrated into the graph cuts (GCs) to form a multi-step GC algorithm based on the short baseline estimation, by which the disparity map under the long baseline can be calculated iteratively on the basis of the previous matching. Furthermore, the image information from the pixels that are non-occluded under the short baseline but are occluded for the long baseline can be employed to improve the matching accuracy. Although the time complexity of the proposed method depends on the locations of the chosen reference images, it is usually much lower for a long baseline stereo matching than when using the traditional GC algorithm. Finally, the validity of the proposed method is examined by experiments based on benchmark datasets. The results show that the proposed method is superior to the traditional GC method in terms of efficiency and accuracy, and thus it is suitable for long baseline stereo matching.

  13. Associations between baseline allergens and polysensitization

    DEFF Research Database (Denmark)

    Carlsen, B.C.; Menne, T.; Johansen, J.D.

    2008-01-01

    Background: Identification of patients at risk of developing polysensitization is not possible at present. An association between weak sensitizers and polysensitization has been hypothesized. Objectives: To examine associations of 21 allergens in the European baseline series to polysensitization....... Patients/Methods: From a database-based study with 14 998 patients patch tested with the European baseline series between 1985 and 2005, a group of 759 (5.1%) patients were polysensitized. Odds ratios were calculated to determine the relative contribution of each allergen to polysensitization. Results...... denominator for the association between the allergens and the polysensitization was apparent, and any association, whether positive or negative, was relatively low. Based on these results, sensitization to specific baseline allergens cannot be used as risk indicators for polysensitization Udgivelsesdato: 2008...

  14. Associations between baseline allergens and polysensitization

    DEFF Research Database (Denmark)

    Carlsen, Berit Christina; Menné, Torkil; Johansen, Jeanne Duus

    2008-01-01

    BACKGROUND: Identification of patients at risk of developing polysensitization is not possible at present. An association between weak sensitizers and polysensitization has been hypothesized. OBJECTIVES: To examine associations of 21 allergens in the European baseline series to polysensitization....... PATIENTS/METHODS: From a database-based study with 14 998 patients patch tested with the European baseline series between 1985 and 2005, a group of 759 (5.1%) patients were polysensitized. Odds ratios were calculated to determine the relative contribution of each allergen to polysensitization. RESULTS...... denominator for the association between the allergens and the polysensitization was apparent, and any association, whether positive or negative, was relatively low. Based on these results, sensitization to specific baseline allergens cannot be used as risk indicators for polysensitization....

  15. Color preferences are not universal.

    Science.gov (United States)

    Taylor, Chloe; Clifford, Alexandra; Franklin, Anna

    2013-11-01

    Claims of universality pervade color preference research. It has been argued that there are universal preferences for some colors over others (e.g., Eysenck, 1941), universal sex differences (e.g., Hurlbert & Ling, 2007), and universal mechanisms or dimensions that govern these preferences (e.g., Palmer & Schloss, 2010). However, there have been surprisingly few cross-cultural investigations of color preference and none from nonindustrialized societies that are relatively free from the common influence of global consumer culture. Here, we compare the color preferences of British adults to those of Himba adults who belong to a nonindustrialized culture in rural Namibia. British and Himba color preferences are found to share few characteristics, and Himba color preferences display none of the so-called "universal" patterns or sex differences. Several significant predictors of color preference are identified, such as cone-contrast between stimulus and background (Hurlbert & Ling, 2007), the valence of color-associated objects (Palmer & Schloss, 2010), and the colorfulness of the color. However, the relationship of these predictors to color preference was strikingly different for the two cultures. No one model of color preference is able to account for both British and Himba color preferences. We suggest that not only do patterns of color preference vary across individuals and groups but the underlying mechanisms and dimensions of color preference vary as well. The findings have implications for broader debate on the extent to which our perception and experience of color is culturally relative or universally constrained. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  16. Baseline methodologies for clean development mechanism projects

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M.K. (ed.); Shrestha, R.M.; Sharma, S.; Timilsina, G.R.; Kumar, S.

    2005-11-15

    The Kyoto Protocol and the Clean Development Mechanism (CDM) came into force on 16th February 2005 with its ratification by Russia. The increasing momentum of this process is reflected in more than 100 projects having been submitted to the CDM Executive Board (CDM-EB) for approval of the baselines and monitoring methodologies, which is the first step in developing and implementing CDM projects. A CDM project should result in a net decrease of GHG emissions below any level that would have resulted from other activities implemented in the absence of that CDM project. The 'baseline' defines the GHG emissions of activities that would have been implemented in the absence of a CDM project. The baseline methodology is the process/algorithm for establishing that baseline. The baseline, along with the baseline methodology, are thus the most critical element of any CDM project towards meeting the important criteria of CDM, which are that a CDM should result in 'real, measurable, and long term benefits related to the mitigation of climate change'. This guidebook is produced within the frame work of the United Nations Environment Programme (UNEP) facilitated 'Capacity Development for the Clean Development Mechanism (CD4CDM)' Project. This document is published as part of the projects effort to develop guidebooks that cover important issues such as project finance, sustainability impacts, legal framework and institutional framework. These materials are aimed to help stakeholders better understand the CDM and are believed to eventually contribute to maximize the effect of the CDM in achieving the ultimate goal of UNFCCC and its Kyoto Protocol. This Guidebook should be read in conjunction with the information provided in the two other guidebooks entitled, 'Clean Development Mechanism: Introduction to the CDM' and 'CDM Information and Guidebook' developed under the CD4CDM project. (BA)

  17. Geochemical baseline studies of soil in Finland

    Science.gov (United States)

    Pihlaja, Jouni

    2017-04-01

    The soil element concentrations regionally vary a lot in Finland. Mostly this is caused by the different bedrock types, which are reflected in the soil qualities. Geological Survey of Finland (GTK) is carrying out geochemical baseline studies in Finland. In the previous phase, the research is focusing on urban areas and mine environments. The information can, for example, be used to determine the need for soil remediation, to assess environmental impacts or to measure the natural state of soil in industrial areas or mine districts. The field work is done by taking soil samples, typically at depth between 0-10 cm. Sampling sites are chosen to represent the most vulnerable areas when thinking of human impacts by possible toxic soil element contents: playgrounds, day-care centers, schools, parks and residential areas. In the mine districts the samples are taken from the areas locating outside the airborne dust effected areas. Element contents of the soil samples are then analyzed with ICP-AES and ICP-MS, Hg with CV-AAS. The results of the geochemical baseline studies are published in the Finnish national geochemical baseline database (TAPIR). The geochemical baseline map service is free for all users via internet browser. Through this map service it is possible to calculate regional soil baseline values using geochemical data stored in the map service database. Baseline data for 17 elements in total is provided in the map service and it can be viewed on the GTK's web pages (http://gtkdata.gtk.fi/Tapir/indexEN.html).

  18. Baseline methodologies for clean development mechanism projects

    International Nuclear Information System (INIS)

    Lee, M.K.; Shrestha, R.M.; Sharma, S.; Timilsina, G.R.; Kumar, S.

    2005-11-01

    The Kyoto Protocol and the Clean Development Mechanism (CDM) came into force on 16th February 2005 with its ratification by Russia. The increasing momentum of this process is reflected in more than 100 projects having been submitted to the CDM Executive Board (CDM-EB) for approval of the baselines and monitoring methodologies, which is the first step in developing and implementing CDM projects. A CDM project should result in a net decrease of GHG emissions below any level that would have resulted from other activities implemented in the absence of that CDM project. The 'baseline' defines the GHG emissions of activities that would have been implemented in the absence of a CDM project. The baseline methodology is the process/algorithm for establishing that baseline. The baseline, along with the baseline methodology, are thus the most critical element of any CDM project towards meeting the important criteria of CDM, which are that a CDM should result in 'real, measurable, and long term benefits related to the mitigation of climate change'. This guidebook is produced within the frame work of the United Nations Environment Programme (UNEP) facilitated 'Capacity Development for the Clean Development Mechanism (CD4CDM)' Project. This document is published as part of the projects effort to develop guidebooks that cover important issues such as project finance, sustainability impacts, legal framework and institutional framework. These materials are aimed to help stakeholders better understand the CDM and are believed to eventually contribute to maximize the effect of the CDM in achieving the ultimate goal of UNFCCC and its Kyoto Protocol. This Guidebook should be read in conjunction with the information provided in the two other guidebooks entitled, 'Clean Development Mechanism: Introduction to the CDM' and 'CDM Information and Guidebook' developed under the CD4CDM project. (BA)

  19. Are preference and resistance to change convergent expressions of stimulus value?

    Science.gov (United States)

    Podlesnik, Christopher A; Jimenez-Gomez, Corina; Shahan, Timothy A

    2013-07-01

    Behavioral momentum theory asserts that preference and relative resistance to disruption depend on reinforcement rates and provide converging expressions of the conditioned value of discriminative stimuli. However, preference and resistance to disruption diverge when assessing preference during brief extinction probes. We expanded upon this opposing relation by arranging target stimuli signaling equal variable-interval schedules across components of a multiple schedule. We paired one target stimulus with a richer reinforced alternative and the other with a leaner alternative. Furthermore, we varied reinforcement rates for the paired alternatives to assess the effects of manipulating relative conditioned value on preference and resistance to disruption by presession feeding, intercomponent food, and extinction. We replicated the opposing relation between preference and resistance to disruption but varying reinforcement rates for the paired alternatives did not systematically affect preference or resistance to disruption beyond levels observed in our initial condition. Importantly, we found that only preference between the target stimuli was related to relative baseline response rates in the presence of those stimuli. These findings suggest that preference during extinction probes might reveal more about baseline response rates between concurrently available alternatives than relative conditioned value. Resistance to disruption, conversely, appears to better reflect conditioned value because it is less confounded with baseline response rates and is a function of all sources of reinforcement obtained in the presence of a stimulus context. © Society for the Experimental Analysis of Behavior.

  20. Waste management project technical baseline description

    International Nuclear Information System (INIS)

    Sederburg, J.P.

    1997-01-01

    A systems engineering approach has been taken to describe the technical baseline under which the Waste Management Project is currently operating. The document contains a mission analysis, function analysis, requirement analysis, interface definitions, alternative analysis, system definition, documentation requirements, implementation definitions, and discussion of uncertainties facing the Project

  1. Baseline and Multimodal UAV GCS Interface Design

    Science.gov (United States)

    2013-07-01

    complete a computerized version of the NASA - TLX assessment of perceived mental workload. 2.3 Results The baseline condition ran smoothly and with...System MALE Medium-altitude, Long-endurance NASA - TLX NASA Task Load Index SA Situation Awareness TDT Tucker Davis Technologies UAV Uninhabited Aerial

  2. National Cyberethics, Cybersafety, Cybersecurity Baseline Study

    Science.gov (United States)

    Education Digest: Essential Readings Condensed for Quick Review, 2009

    2009-01-01

    This article presents findings from a study that explores the nature of the Cyberethics, Cybersafety, and Cybersecurity (C3) educational awareness policies, initiatives, curriculum, and practices currently taking place in the U.S. public and private K-12 educational settings. The study establishes baseline data on C3 awareness, which can be used…

  3. Guidance on Port Biological Baseline Surveys (PBBS)

    Digital Repository Service at National Institute of Oceanography (India)

    Awad, A.; Haag, F.; Anil, A.C.; Abdulla, A.

    This publication has been prepared by GBP, IOI, CSIR-NIO and IUCN in order to serve as guidance to those who are planning to carry out a port biological baseline survey, in particular in the context of Ballast Water Management. It has been drafted...

  4. Solid Waste Program technical baseline description

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, A.B.

    1994-07-01

    The system engineering approach has been taken to describe the technical baseline under which the Solid Waste Program is currently operating. The document contains a mission analysis, function analysis, system definition, documentation requirements, facility and project bases, and uncertainties facing the program.

  5. Toward Baseline Software Anomalies in NASA Missions

    Science.gov (United States)

    Layman, Lucas; Zelkowitz, Marvin; Basili, Victor; Nikora, Allen P.

    2012-01-01

    In this fast abstract, we provide preliminary findings an analysis of 14,500 spacecraft anomalies from unmanned NASA missions. We provide some baselines for the distributions of software vs. non-software anomalies in spaceflight systems, the risk ratings of software anomalies, and the corrective actions associated with software anomalies.

  6. Physics Potential of Long-Baseline Experiments

    Directory of Open Access Journals (Sweden)

    Sanjib Kumar Agarwalla

    2014-01-01

    Full Text Available The discovery of neutrino mixing and oscillations over the past decade provides firm evidence for new physics beyond the Standard Model. Recently, θ13 has been determined to be moderately large, quite close to its previous upper bound. This represents a significant milestone in establishing the three-flavor oscillation picture of neutrinos. It has opened up exciting prospects for current and future long-baseline neutrino oscillation experiments towards addressing the remaining fundamental questions, in particular the type of the neutrino mass hierarchy and the possible presence of a CP-violating phase. Another recent and crucial development is the indication of non-maximal 2-3 mixing angle, causing the octant ambiguity of θ23. In this paper, I will review the phenomenology of long-baseline neutrino oscillations with a special emphasis on sub-leading three-flavor effects, which will play a crucial role in resolving these unknowns. First, I will give a brief description of neutrino oscillation phenomenon. Then, I will discuss our present global understanding of the neutrino mass-mixing parameters and will identify the major unknowns in this sector. After that, I will present the physics reach of current generation long-baseline experiments. Finally, I will conclude with a discussion on the physics capabilities of accelerator-driven possible future long-baseline precision oscillation facilities.

  7. Patient Preferences for Managing Insomnia: A Discrete Choice Experiment.

    Science.gov (United States)

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Saini, Bandana; Laba, Tracey-Lea

    2018-03-03

    Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments. An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences. Treatments were preferentially viewed if they conferred long-term sleep benefits (p managing insomnia.

  8. Accelerated Best Basis Inventory Baselining Task

    International Nuclear Information System (INIS)

    SASAKI, L.M.

    2001-01-01

    The baselining effort was recently proposed to bring the Best-Basis Inventory (BBI) and Question No.8 of the Tank Interpretive Report (TIR) for all 177 tanks to the current standards and protocols and to prepare a TIR Question No.8 if one is not already available. This plan outlines the objectives and methodology of the accelerated BBI baselining task. BBI baselining meetings held during December 2000 resulted in a revised BBI methodology and an initial set of BBI creation rules to be used in the baselining effort. The objectives of the BBI baselining effort are to: (1) Provide inventories that are consistent with the revised BBI methodology and new BBI creation rules. (2) Split the total tank waste in each tank into six waste phases, as appropriate (Supernatant, saltcake solids, saltcake liquid, sludge solids, sludge liquid, and retained gas). In some tanks, the solids and liquid portions of the sludge and/or saltcake may be combined into a single sludge or saltcake phase. (3) Identify sampling events that are to be used for calculating the BBIs. (4) Update waste volumes for subsequent reconciliation with the Hanlon (2001) waste tank summary. (5) Implement new waste type templates. (6) Include any sample data that might have been unintentionally omitted in the previous BBI and remove any sample data that should not have been included. Sample data to be used in the BBI must be available on TWINS. (7) Ensure that an inventory value for each standard BBI analyte is provided for each waste component. Sample based inventories for supplemental BBI analytes will be included when available. (8) Provide new means and confidence interval reports if one is not already available and include uncertainties in reporting inventory values

  9. Mercury baseline levels in Flemish soils (Belgium)

    International Nuclear Information System (INIS)

    Tack, Filip M.G.; Vanhaesebroeck, Thomas; Verloo, Marc G.; Van Rompaey, Kurt; Ranst, Eric van

    2005-01-01

    It is important to establish contaminant levels that are normally present in soils to provide baseline data for pollution studies. Mercury is a toxic element of concern. This study was aimed at assessing baseline mercury levels in soils in Flanders. In a previous study, mercury contents in soils in Oost-Vlaanderen were found to be significantly above levels reported elsewhere. For the current study, observations were extended over two more provinces, West-Vlaanderen and Antwerpen. Ranges of soil Hg contents were distinctly higher in the province Oost-Vlaanderen (interquartile range from 0.09 to 0.43 mg/kg) than in the other provinces (interquartile ranges from 0.7 to 0.13 and 0.7 to 0.15 mg/kg for West-Vlaanderen and Antwerpen, respectively). The standard threshold method was applied to separate soils containing baseline levels of Hg from the data. Baseline concentrations for Hg were characterised by a median of 0.10 mg Hg/kg dry soil, an interquartile range from 0.07 to 0.14 mg/kg and a 90% percentile value of 0.30 mg/kg. The influence of soil properties such as clay and organic carbon contents, and pH on baseline Hg concentrations was not important. Maps of the spatial distribution of Hg levels showed that the province Oost-Vlaanderen exhibited zones with systematically higher Hg soil contents. This may be related to the former presence of many small-scale industries employing mercury in that region. - Increased mercury levels may reflect human activity

  10. Children Reason about Shared Preferences

    Science.gov (United States)

    Fawcett, Christine A.; Markson, Lori

    2010-01-01

    Two-year-old children's reasoning about the relation between their own and others' preferences was investigated across two studies. In Experiment 1, children first observed 2 actors display their individual preferences for various toys. Children were then asked to make inferences about new, visually inaccessible toys and books that were described…

  11. Intelligence and musical mode preference

    DEFF Research Database (Denmark)

    Bonetti, Leonardo; Costa, Marco

    2016-01-01

    The relationship between fluid intelligence and preference for major–minor musical mode was investigated in a sample of 80 university students. Intelligence was assessed by the Raven’s Advanced Progressive Matrices. Musical mode preference was assessed by presenting 14 pairs of musical stimuli...... differences at the cognitive and personality level related to the enjoyment of sad music....

  12. Assessing Preference for Social Interactions

    Science.gov (United States)

    Clay, Casey J.; Samaha, Andrew L.; Bloom, Sarah E.; Bogoev, Bistra K.; Boyle, Megan A.

    2013-01-01

    We examined a procedure to assess preference for social interactions in individuals with intellectual and developmental disabilities. Preferences were identified in five individuals using a paired-choice procedure in which participants approached therapists who provided different forms of social interactions. A subsequent tracking test showed that…

  13. Job satisfaction and preference drift.

    NARCIS (Netherlands)

    Maassen van den Brink, H.; Groot, W.J.N.

    1999-01-01

    Most empirical studies do not find that higher wages lead to more job satisfaction. In this paper we argue that the insignificant effect of wages on job satisfaction is due to preference drift. We adapt the standard ordered response model to allow for preference shifts. The empirical results support

  14. Great apes prefer cooked food.

    Science.gov (United States)

    Wobber, Victoria; Hare, Brian; Wrangham, Richard

    2008-08-01

    The cooking hypothesis proposes that a diet of cooked food was responsible for diverse morphological and behavioral changes in human evolution. However, it does not predict whether a preference for cooked food evolved before or after the control of fire. This question is important because the greater the preference shown by a raw-food-eating hominid for the properties present in cooked food, the more easily cooking should have been adopted following the control of fire. Here we use great apes to model food preferences by Paleolithic hominids. We conducted preference tests with various plant and animal foods to determine whether great apes prefer food items raw or cooked. We found that several populations of captive apes tended to prefer their food cooked, though with important exceptions. These results suggest that Paleolithic hominids would likewise have spontaneously preferred cooked food to raw, exapting a pre-existing preference for high-quality, easily chewed foods onto these cooked items. The results, therefore, challenge the hypothesis that the control of fire preceded cooking by a significant period.

  15. Predicting Baseline for Analysis of Electricity Pricing

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T. [Ulsan National Inst. of Science and Technology (Korea, Republic of); Lee, D. [Ulsan National Inst. of Science and Technology (Korea, Republic of); Choi, J. [Ulsan National Inst. of Science and Technology (Korea, Republic of); Spurlock, A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sim, A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Todd, A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wu, K. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-05-03

    To understand the impact of new pricing structure on residential electricity demands, we need a baseline model that captures every factor other than the new price. The standard baseline is a randomized control group, however, a good control group is hard to design. This motivates us to devlop data-driven approaches. We explored many techniques and designed a strategy, named LTAP, that could predict the hourly usage years ahead. The key challenge in this process is that the daily cycle of electricity demand peaks a few hours after the temperature reaching its peak. Existing methods rely on the lagged variables of recent past usages to enforce this daily cycle. These methods have trouble making predictions years ahead. LTAP avoids this trouble by assuming the daily usage profile is determined by temperature and other factors. In a comparison against a well-designed control group, LTAP is found to produce accurate predictions.

  16. CASA Uno GPS orbit and baseline experiments

    Science.gov (United States)

    Schutz, B. E.; Ho, C. S.; Abusali, P. A. M.; Tapley, B. D.

    1990-01-01

    CASA Uno data from sites distributed in longitude from Australia to Europe have been used to determine orbits of the GPS satellites. The characteristics of the orbits determined from double difference phase have been evaluated through comparisons of two-week solutions with one-week solutions and by comparisons of predicted and estimated orbits. Evidence of unmodeled effects is demonstrated, particularly associated with the orbit planes that experience solar eclipse. The orbit accuracy has been assessed through the repeatability of unconstrained estimated baseline vectors ranging from 245 km to 5400 km. Both the baseline repeatability and the comparison with independent space geodetic methods give results at the level of 1-2 parts in 100,000,000. In addition, the Mojave/Owens Valley (245 km) and Kokee Park/Ft. Davis (5409 km) estimates agree with VLBI and SLR to better than 1 part in 100,000,000.

  17. Baseline composition of solar energetic particles

    International Nuclear Information System (INIS)

    Meyer, J.

    1985-01-01

    We analyze all existing spacecraft observations of the highly variable heavy element composition of solar energetic particles (SEP) during non- 3 He-rich events. All data show the imprint of an ever-present basic composition pattern (dubbed ''mass-unbiased baseline'' SEP composition) that differs from the photospheric composition by a simple bias related to first ionization potential (FIP). In each particular observation, this mass-unbiased baseline composition is being distorted by an additional bias, which is always a monotonic function of mass (or Z). This latter bias varies in amplitude and even sign from observation to observation. To first order, it seems related to differences in the A/Z* ratio between elements (Z* = mean effective charge)

  18. Parents' preferences strongly influence their decisions to withhold prescribed opioids when faced with analgesic trade-off dilemmas for children: a prospective observational study.

    Science.gov (United States)

    Voepel-Lewis, Terri; Zikmund-Fisher, Brian J; Smith, Ellen Lavoie; Zyzanski, Sarah; Tait, Alan R

    2015-08-01

    Despite parents' stated desire to treat pain in their children, recent studies have critiqued their underuse of prescribed analgesics to treat pain in their children after painful procedures. Parents' analgesic preferences, including their perceived importance of providing pain relief or avoiding adverse drug effects may have important implications for their analgesic decisions, yet no studies have evaluated the influence of preferences on decisions to withhold prescribed opioids for children. We prospectively explored how parents' preferences influenced decisions to withhold prescribed opioids when faced with hypothetical dilemmas and after hospital discharge. Prospective Observational Study Design: Phase 1 included hypothetical analgesic decisions and Phase 2, real analgesic decisions after hospital discharge. Large tertiary care pediatric hospital in the Midwest of the United States. Five-hundred seven parents whose children underwent a painful surgical procedure requiring an opioid prescription were included. At baseline, parents completed surveys assessing their pain relief preference (i.e., their rated importance of pain relief relative to adverse drug event avoidance), preferred treatment thresholds (i.e., pain level at which they would give an opioid), adverse drug event understanding, and hypothetical trade-off decisions (i.e., scenarios presenting variable pain and adverse drug event symptoms in a child). After discharge, parents recorded all analgesics they gave their child as well as pain scores at the time of administration. Higher preference to provide pain relief (over avoid analgesic risk) lessened the likelihood that parents would withhold the prescribed opioid when adverse drug event symptoms were present together with high pain scores in the hypothetical scenarios. Additionally, higher preferred treatment thresholds increased the likelihood of parents withholding opioids during their hypothetical decision-making as well as at home. The strong

  19. Baseline risk and marginal willingness to pay for health risk reduction.

    Science.gov (United States)

    Gerking, Shelby; Adamowicz, Wiktor; Dickie, Mark; Veronesi, Marcella

    2017-01-01

    Empirical results presented in this paper suggest that parents' marginal willingness to pay (MWTP) for a reduction in morbidity risk from heart disease is inversely related to baseline risk (i.e., the amount of risk initially faced) both for themselves and for their children. For instance, a 40% reduction from the mean of baseline risk results in an increase in MWTP by 70% or more. Thus, estimates of monetary benefits of public programs to reduce heart disease risk would be understated if the standard practice is followed of evaluating MWTP at initial risk levels and then multiplying this value by the number of cases avoided. Estimates are supported by: (1) unique quantitative information on perceptions of the risk of getting heart disease that allow baseline risk to be defined at an individual level and (2) improved econometric procedures to control for well-known difficulties associated with stated preference data.

  20. OCRWM baseline management procedure for document identifiers

    International Nuclear Information System (INIS)

    1993-03-01

    This procedure establishes a uniform numbering system (document identifier) for all Program and project technical, cost, and schedule baselines, and selected management and procurement documents developed for and controlled by the Office of Civilian Radioactive Waste Management (OCRWM) for the Civilian Radioactive Waste Management System (CRWMS). The document identifier defined in this procedure is structured to ensure that the relational integrity between configuration items (CIs) and their associated documentation and software is maintained, traceable, categorical, and retrievable for the life of the program

  1. Information Technology Sector Baseline Risk Assessment

    Science.gov (United States)

    2009-08-01

    alternative root be economically advantageous , an actor’s ability to exploit market forces and create an alternative root would be significantly improved...conduct their operations. Therefore, a loss or disruption to Internet services would not be advantageous for the desired outcomes of these syndicates.26... eCommerce Service loss or disruption [C] Traffic Redirection [C] = Undesired consequence Information Technology Sector Baseline Risk Assessment

  2. Preference or fat? Revisiting opioid effects on food intake.

    Science.gov (United States)

    Taha, Sharif A

    2010-07-14

    It is well established that opioid signaling in the central nervous system constitutes a powerful stimulus for food intake. The role of opioids in determining food preference, however, is less well defined. Opioids have been proposed to promote intake of preferred foods, or, alternatively, to preferentially increase consumption of fat. In the present manuscript, I comprehensively review results from previous studies investigating this issue. Data from these studies suggests a mechanism for opioid action that may reconcile the previously proposed hypotheses: opioid effects on food intake do appear to be largely specific for fat consumption, but individual animals' sensitivity to this effect may be dependent on baseline food preferences. In addition, I highlight the possibility that the selectivity of endogenous opioid effects may importantly differ from that of exogenous agonists in the degree to which baseline preferences, rather than macronutrient intake, are altered. The paper represents an invited review by a symposium, award winner or keynote speaker at the Society for the Study of Ingestive Behavior [SSIB] Annual Meeting in Portland, July 2009. 2010 Elsevier Inc. All rights reserved.

  3. TWRS phase I privatization site environmental baseline and characterization plan

    International Nuclear Information System (INIS)

    Shade, J.W.

    1997-01-01

    This document provides a plan to characterize and develop an environmental baseline for the TWRS Phase I Privatization Site before construction begins. A site evaluation study selected the former Grout Disposal Area of the Grout Treatment Facility in the 200 East Area as the TWRS Phase I Demonstration Site. The site is generally clean and has not been used for previous activities other than the GTF. A DQO process was used to develop a Sampling and Analysis Plan that would allow comparison of site conditions during operations and after Phase I ends to the presently existing conditions and provide data for the development of a preoperational monitoring plan

  4. An Improved Rank Correlation Effect Size Statistic for Single-Case Designs: Baseline Corrected Tau.

    Science.gov (United States)

    Tarlow, Kevin R

    2017-07-01

    Measuring treatment effects when an individual's pretreatment performance is improving poses a challenge for single-case experimental designs. It may be difficult to determine whether improvement is due to the treatment or due to the preexisting baseline trend. Tau- U is a popular single-case effect size statistic that purports to control for baseline trend. However, despite its strengths, Tau- U has substantial limitations: Its values are inflated and not bound between -1 and +1, it cannot be visually graphed, and its relatively weak method of trend control leads to unacceptable levels of Type I error wherein ineffective treatments appear effective. An improved effect size statistic based on rank correlation and robust regression, Baseline Corrected Tau, is proposed and field-tested with both published and simulated single-case time series. A web-based calculator for Baseline Corrected Tau is also introduced for use by single-case investigators.

  5. Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control.

    Science.gov (United States)

    Beddhu, Srinivasan; Chertow, Glenn M; Cheung, Alfred K; Cushman, William C; Rahman, Mahboob; Greene, Tom; Wei, Guo; Campbell, Ruth C; Conroy, Margaret; Freedman, Barry I; Haley, William; Horwitz, Edward; Kitzman, Dalane; Lash, James; Papademetriou, Vasilios; Pisoni, Roberto; Riessen, Erik; Rosendorff, Clive; Watnick, Suzanne G; Whittle, Jeffrey; Whelton, Paul K

    2018-01-09

    In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear. SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target baseline DBP. Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level ( P for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction P value of 0.78. Results were similar for all-cause death and kidney events. Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP. UR