An evaluation of the Amblyopia and Strabismus Questionnaire using Rasch analysis

noPURPOSE. To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS. The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS. Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS. The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus

The Welfare Impacts of Commodity Price Fluctuations: Evidence from Rural Ethiopia

Many governments try to stabilize commodity prices based on the widespread belief that households value price stability and that the poor especially benefit from food price stabilization. We derive an exact measure of multivariate price risk aversion and of associated household willingness to pay for price stabilization across multiple commodities. Using data from a panel of Ethiopian households, we estimate that the average household would be willing to pay 6-32 percent of its income to eliminate fluctuations in the prices of the seven primary food commodities. But not everyone benefits from price stabilization. Contrary to conventional wisdom, the welfare gains from eliminating price fluctuations would be concentrated in the upper 40 percent of the income distribution, making food price stabilization a distributionally regressive policy in this context.Price Fluctuations; Price Stabilization; Price Risk; Risk and Uncertainty

Development of the Motivational Interviewing Supervision and Training Scale

The movement to use empirically supported treatments has increased the need for researchers and supervisors to evaluate therapists’ adherence to and the quality with which they implement those interventions. Few empirically supported approaches exist for providing these types of evaluations. This is also true for motivational interviewing, an empirically supported intervention important in the addictions field. This study describes the development and psychometric evaluation of the Motivational Interviewing Supervision and Training Scale (MISTS), a measure intended for use in training and supervising therapists implementing motivational interviewing. Satisfactory interrater reliability was found (generalizability coefficient p2 = .79), and evidence was found supporting the convergent and discriminant validity of the MISTS. Recommendations for refinement of the measure and future research are discussed

Radio Astronomy

Contains reports on four research projects.National Aeronautics and Space Administration (Grant NsG-419

A novel hypothesis of dinosaur relationships and early dinosaur evolution

For nearly 130 years dinosaurs have been divided into two distinct clades Ornithischia and Saurischia. Here, we present a radical new hypothesis for the phylogenetic relationships of the major dinosaurian groups, one that challenges the current consensus concerning early dinosaur evolution and highlights problematic aspects of current cladistic definitions. Our study recovers, for the first time, a sister-group relationship between Ornithischia and Theropoda (Ornithoscelida), with Sauropodomorpha + Herrerasauridae forming its monophyletic outgroup. This new tree topology requires redefinition and rediagnosis of Dinosauria and the subsidiary dinosaurian clades. In addition, it forces re-evaluations of early dinosaur cladogenesis and character evolution, suggests the independent acquisition of hypercarnivory in herrerasaurids and theropods, and offers an explanation for many of the anatomical features previously regarded as striking convergences between theropods and early ornithischians

Theta-burst transcranial magnetic stimulation to the prefrontal or parietal cortex does not impair metacognitive visual awareness

Neuroimaging studies commonly associate dorsolateral prefrontal cortex (DLPFC) and pos- terior parietal cortex with conscious perception. However, such studies only investigate cor- relation, rather than causation. In addition, many studies conflate objective performance with subjective awareness. In an influential recent paper, Rounis and colleagues addressed these issues by showing that continuous theta burst transcranial magnetic stimulation (cTBS) applied to the DLPFC impaired metacognitive (subjective) awareness for a percep- tual task, while objective performance was kept constant. We attempted to replicate this finding, with minor modifications, including an active cTBS control site. Using a between- subjects design for both DLPFC and posterior parietal cortices, we found no evidence of a cTBS-induced metacognitive impairment. In a second experiment, we devised a highly rig- orous within-subjects cTBS design for DLPFC, but again failed to find any evidence of meta- cognitive impairment. One crucial difference between our results and the Rounis study is our strict exclusion of data deemed unsuitable for a signal detection theory analysis. Indeed, when we included this unstable data, a significant, though invalid, metacognitive impairment was found. These results cast doubt on previous findings relating metacognitive awareness to DLPFC, and inform the current debate concerning whether or not prefrontal regions are preferentially implicated in conscious perception

Understanding value in a healthcare setting: An application of the business model canvas

The business model canvas is a popular tool used to develop value-driven business models. Specific emphasis is placed on understanding what customers value and providing users with steps on how to design and deliver value for their customers. In health care, creating and delivering value for patients is an often-discussed topic, with the provision of patient-centered care becoming a standard for many health care organizations. While patients play a key role in determining value, providers are the key to delivering value. Therefore, effective health care management relies on integrating multiple perspectives from key stakeholders. This process requires consideration of the key needs that must be addressed, the resources and capabilities necessary to meet these needs, and the interests and values specific to each set of stakeholders. The business model canvas lends itself well to health care service planning as it incorporates the factors described above into the business model’s conceptualization and subsequent realization. This article outlines how the business model canvas was applied to assess the needs of physician stakeholders to help guide the expansion of a pharmacogenomic-based precision medicine clinic that conducts genetic testing for patients at risk of experiencing adverse drug reactions. The article provides a detailed description of how the business model canvas was used and adapted to understand physician’s responsibilities and challenges related to drug prescription and dosing, and how the clinic could address physician needs and create value by mapping clinic services onto physician needs and wants. Interviews were conducted with physicians and the data were analyzed following the recommendations of the developers of the business model canvas. The article examines the strengths and limitations of the business model canvas and discusses its applicability to a health care setting

Pharmacogenomic-based personalized medicine: Multistakeholder perspectives on implementational drivers and barriers in the Canadian healthcare system

Pharmacogenomics (PGx)-based personalized medicine (PM) is increasingly utilized to guide treatment decisions for many drug-disease combinations. Notably, London Health Sciences Centre (LHSC) has pioneered a PGx program that has become a staple for London-based specialists. Although implementational studies have been conducted in other jurisdictions, the Canadian healthcare system is understudied. Herein, the multistakeholder perspectives on implementational drivers and barriers are elucidated. Using a mixed-method qualitative model, key stakeholders, and patients from LHSC’s PGx-based PM clinic were interviewed and surveyed, respectively. Interview transcripts were thematically analyzed in a stepwise process of customer profiling, value mapping, and business model canvasing. Value for LHSC located specialist users of PGx was driven by the quick turnaround time, independence of the PGx clinic, and the quality of information. Engagement of external specialists was only limited by access and awareness, whereas other healthcare nonusers were limited by education and applicability. The major determinant of successful adoption at novel sites were institutional champions. Patients valued and approved of the service, expressed a general willingness to pay, but often traveled far to receive genotyping. This paper discusses the critical pillars of education, awareness, advocacy, and efficiency required to address implementation barriers to healthcare service innovation in Canada. Further adoption of PGx practices into Canadian hospitals is an important factor for advancing system-level changes in care delivery, patient experiences, and outcomes. The findings in this paper can help inform efforts to advance clinical PGx practices, but also the potential adoption and implementation of other innovative healthcare service solutions