4,100 research outputs found
Fair processes for priority setting: Putting theory into practice: Comment on âexpanded HTA: Enhancing fairness and legitimacyâ
Embedding health technology assessment (HTA) in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we provide further practical lead ways on how these processes can be implemented. We first present the misconception about the relation between facts and values that is since long misleading the conduct of HTA and underlies the current assessment-appraisal split. We then argue that HTA should instead be explicitly organized as an ongoing evidence-informed deliberative process, that facilitates learning among stakeholders. This has important consequences for whose values to consider, how to deal with vested interests, how to consider all values in the decision-making process, and how to communicate decisions. This is in stark contrast to how HTA processes are implemented now. It is time to set the stage for HTA as learning
Boolean Models of Bistable Biological Systems
This paper presents an algorithm for approximating certain types of dynamical
systems given by a system of ordinary delay differential equations by a Boolean
network model. Often Boolean models are much simpler to understand than complex
differential equations models. The motivation for this work comes from
mathematical systems biology. While Boolean mechanisms do not provide
information about exact concentration rates or time scales, they are often
sufficient to capture steady states and other key dynamics. Due to their
intuitive nature, such models are very appealing to researchers in the life
sciences. This paper is focused on dynamical systems that exhibit bistability
and are desc ribedby delay equations. It is shown that if a certain motif
including a feedback loop is present in the wiring diagram of the system, the
Boolean model captures the bistability of molecular switches. The method is
appl ied to two examples from biology, the lac operon and the phage lambda
lysis/lysogeny switch
Childhood Characteristics of Adolescent Inpatients with Early-Onset and Adolescent-Onset Disruptive Behavior
Childhood characteristics are associated with life-course-persistent antisocial behavior in epidemiological studies in general population samples. The present study examines this association in an inpatient sample. The purpose is to identify easily measurable childhood characteristics that may guide choice of treatment for adolescent psychiatric inpatients with severe disruptive behavior. Patients (Nâ=â203) were divided into two groups with either early-onset (EO) or adolescent-onset (AO) disruptive behavior, based on ages at which professional care was used for disruptive behavior, referral to special education, and criminal offences. Both groups differed on several childhood characteristics. No gender differences in these characteristics were found. Logistic regression analysis indicated that individuals with grade retention in primary school, childhood impulsive behavior, and a history of physical abuse, had the highest probability of being member of the EO group. These characteristics are reasonably easy to identify, likely apply to other clinical samples as well, and may help clinicians to target their treatment
High-Resolution Native Mass Spectrometry
Native mass spectrometry (MS) involves the analysis and characterization of macromolecules, predominantly intact proteins and protein complexes, whereby as much as possible the native structural features of the analytes are retained. As such, native MS enables the study of secondary, tertiary, and even quaternary structure of proteins and other biomolecules. Native MS represents a relatively recent addition to the analytical toolbox of mass spectrometry and has over the past decade experienced immense growth, especially in enhancing sensitivity and resolving power but also in ease of use. With the advent of dedicated mass analyzers, sample preparation and separation approaches, targeted fragmentation techniques, and software solutions, the number of practitioners and novel applications has risen in both academia and industry. This review focuses on recent developments, particularly in high-resolution native MS, describing applications in the structural analysis of protein assemblies, proteoform profiling of-among others-biopharmaceuticals and plasma proteins, and quantitative and qualitative analysis of protein-ligand interactions, with the latter covering lipid, drug, and carbohydrate molecules, to name a few
Around the Tables â Contextual Factors in Healthcare Coverage Decisions Across Western Europe
Background: Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion
in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which
display the justification of, the rationale for, these decisions, national healthcare institutes may employ âcontextual
factors,â defined here as situation-specific considerations. Little is known about how the use of such contextual factors
compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4
decision documents specifically in Belgium, England, Germany, and the Netherlands.
Methods: Four group interviews with 3 experts from the national healthcare institute of each country, document and
web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the
documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and
decision outcome.
Results: From the available decision documents, we conclude that in every country studied, contextual factors are
established âaround the table,â ie, in deliberation. All documents examined feature contextual factors, with similar
contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest
variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium,
England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no
documentation was retrievable for 2 decisions.
Conclusion: First, we conclude that in these countries, contextual factors are actively integrated in the decision
document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and
actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange
between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly acc
Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis
STUDY OBJECTIVES: To calculate cost-effectiveness of scenarios concerning lung transplantation in The Netherlands.
DESIGN: Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995.
SETTING: Netherlands, University Hospital Groningen.
PATIENTS: Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation.
INTERVENTION: Lung transplantation.
RESULTS: For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1 =US $0.6, based on exchange rate at the time of the study).
CONCLUSIONS: Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation. The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cost-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program
Do economic evaluations of TAVI deal with learning effects, innovation, and context dependency? A review
Introduction: Most collectively funded healthcare systems set limits to their benefit package. Doing so require
Supersonic water masers in 30 Doradus
We report on extremely high velocity molecular gas, up to -80 km/s relative
to the ambient medium, in the giant star-formation complex 30 Doradus in the
Large Magellanic Cloud (LMC), as observed in new 22 GHz H2O maser emission
spectra obtained with the Mopra radio telescope. The masers may trace the
velocities of protostars, and the observed morphology and kinematics indicate
that current star formation occurs near the interfaces of colliding
stellar-wind blown bubbles. The large space velocities of the protostars and
associated gas could result in efficient mixing of the LMC. A similar mechanism
in the Milky Way could seed the galactic halo with relatively young stars and
gas.Comment: 11 pages plus 1 PS and 1 EPS figure, uses AASTeX preprint style;
accepted for publication in Astrophysical Journal Letter
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