Are Some Deaths Worse Than Others? The Effect of 'Labelling' on People's Perceptions

This paper sets out to explore the extent to which perceptions regarding the 'badness' of different types of deaths differ according to how those deaths are 'labelled' in the elicitation procedure. In particular, we are interested in whether responses to 'contextual' questions - where the specific context in which the deaths occur is known - differ from 'generic' questions - where the context is unknown. Further, we set out to test whether sensitivity to the numbers of deaths differs across the 'generic' and 'contextual' versions of the questions. We uncover evidence to suggest that both the perceived 'badness' of different types of deaths and sensitivity to the numbers of deaths may differ according to whether 'generic' or 'contextual' descriptions are used. Qualitative data suggested two reasons why responses to 'generic' and 'contextual' questions differed: firstly, some influential variables were omitted from the 'generic' descriptions and secondly, certain variables were interpreted somewhat differently once the context had been identified. The implications of our findings for 'generic' questions, such as those commonly used in health economics (for example, the EQ 5D), are discussed.Preferences, Context effects, Affect heuristic

Tests of Utility Independence When Health Varies over Time

In the conventional QALY model, people's preferences are assumed to satisfy utility independence. When health varies over time, utility independence implies that the value attached to a health state is independent of the health state that arise before or after it. In this paper we set out to test the extent to which utility independence is undermined by sequence and duration effects. Two separate studies were conducted involving a total of 155 respondents. In study one, we conducted 5 tests of utility independence using a standard gamble question. Three of the tests of utility independence were repeated in study two after randomisation was introduced in order to take account of possible ordering effects. Utility independence holds in the majority of cases examined here and so our work generally supports the use of utility independence to derive more tractable models.Utility independence, QALY

Makerspaces: The library as the the change agent in public schools

Makerspaces are the trend in public education. What is a Makerspace, is a makerspace right for our school, how do you set up a Makerspace, and how will it drive change in your school are all questions we will help answer

Molecular and in vitro characterization of a Babesia divergens-like agent from eastern cottontail rabbits (Sylvilagus floridanus) on Nantucket Island

A Babesia sp. isolated from eastern cottontail rabbits (Sylvilagus floridanus) is morphologically similar and genetically identical, based on SSU rRNA gene comparisons, to two agents responsible for human babesiosis in North America and is closely related to the European parasite, Babesia divergens. The ribosomal RNA (rRNA) internal transcribed spacer regions (ITS1 and ITS2) and the 5.8S rRNA genes of Babesia isolates were sequenced and analyzed. The rRNA ITS region sequences of three isolates, one each from Kentucky, Massachusetts and Great Britain, considered Babesia divergens-like organisms, were compared to two Babesia microti isolates, two Babesia odocoilei isolates and a well defined Babesia divergens isolate. The two B. divergenslike isolates from North America shared identical rRNA ITS1-5.8S-ITS2 region sequences, and the clones of these isolates clustered into one clade in three phylogenetic analyses, suggesting that these isolates are conspecific. In vitro comparison of host erythrocyte specificity between the rabbit Babesia sp. and B. divergens was employed to discriminate between the two organisms and to determine the usefulness of in vitro techniques for Babesia sp. characterization. In vitro growth of the rabbit Babesia sp. was supported in human and cottontail rabbit erythrocytes, but not in bovine cells. Babesia divergens in vitro growth was supported in human and bovine erythrocytes, but not in cottontail rabbit cells. Morphological characteristics and size differences also distinguished the two parasites from one another. The erythrocyte specificity and parasite size differences reported in this study agree with previous in vivo results and validate the use of in vitro methods for characterization of Babesia species

The Long-Term Performance Consequences Of Strategic Partnerships In High Tech Industries

In this paper, we examine how inter-firm partnerships impact long-term operating performance. With a global economy, rapid product cycles, capital constraints and advances in technology, firms seldom possess all the capabilities necessary to maintain and grow market share. Consequently, firms rely on a variety of partnerships. Theory suggests that firms enter such relationships to improve performance through access to new products, new markets, or new capabilities. Yet, relatively little is known about the long-term impact of collaborative arrangements such as alliances and established major customer relationships, although such dual partnership arrangements can have a major impact on the firm’s performance success. Our empirical results indicate that inter-firm partnerships affect operating performance, but the impact often depends on the industry, the nature of the firm, and the type of partnership

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically

Are Some Deaths Worse Than Others? Results from a Discrete Choice Experiment

Previous research has shown that people wish a premium to be placed on the prevention of certain types of deaths as they perceive those deaths as 'worse' than others. The research reported in this paper is an attempt to quantify such a 'bad death' premium via a discrete choice experiment (DCE). The four underlying attributes included were: the age of the victim, who was most to blame for the death, the severity of the victim's pain and suffering in the period leading up to death, and the duration of the victim's pain and suffering in the period leading up to death. In addition, a fifth attribute - number of deaths - was included in order to provide a quantitative scale against which to measure the "bad death premium". The results show that each of the 4 underlying attributes did matter to respondents in determining whether deaths were worse than others, but also uncovered marked insensitivity to variations in the number of those deaths. The implication of our findings for the use of quantitative variables in DCEs is discussed.Discrete choice experiment, Value of preventing a fatality, Relative weights, Insensitivity

Cost-effectiveness of Identification and Referral to Improve Safety (IRIS), a domestic violence training and support programme for primary care: a modelling study based on a randomised controlled trial

OBJECTIVE: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention. DESIGN: Markov model-based cost-effectiveness analysis. SETTING: General practices in two urban areas in the UK. PARTICIPANTS: Simulated female individuals from the general UK population who were registered at general practices, aged 16 years and older. INTERVENTION: General practices received staff training, prompts to ask women about DV embedded in the electronic medical record, a care pathway including referral to a specialist DV agency and continuing contact from that agency. The trial compared the rate of referrals of women with specialist DV agencies from 24 general practices that received the IRIS programme with 24 general practices not receiving the programme. The trial did not measure outcomes for women beyond the intermediate outcome of referral to specialist agencies. The Markov model extrapolated the trial results to estimate the long-term healthcare and societal costs and benefits using data from other trials and epidemiological studies. RESULTS: The intervention would produce societal cost savings per woman registered in the general practice of UK£37 (95% CI £178 saved to a cost of £136) over 1 year. The incremental quality-adjusted life-year was estimated to be 0.0010 (95% CI -0.0157 to 0.0101) per woman. Probabilistic sensitivity analysis found 78% of model replications under a willingness to pay threshold of £20 000 per quality-adjusted life-year. CONCLUSIONS: The IRIS programme is likely to be cost-effective and possibly cost saving from a societal perspective. Better data on the trajectory of abuse and the effect of advocacy are needed for a more robust model. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN74012786