Hospital managers' need for information in decision-making--An interview study in nine European countries.

Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments

On the normativity of evidence:Lessons from philosophy of science and the “VALIDATE” project

“Evidence” is a key term in medicine and health services research, including Health Technology Assessment (HTA). Randomized clinical trials (RCTs) have undoubtedly nominated the scene of generating evidence for a long period of time, becoming the hallmark of evidence-based medicine (EBM). However, due to a number of misunderstandings, the lay audience and some researchers have sometimes placed too much trust in RCTs compared to other methods of investigation.One of the principal misunderstandings is to consider RCTs findings as isolated and self-apparent pieces of information. In other words, what has been essentially lacking was the awareness of the value-context of the evidence and, in particular, the value- and theory-ladenness (normativity) of scientific knowledge.This paper aims to emphasize the normativity that exists in the production of scientific knowledge, and in particular in the conduct of RCTs as well as in the performance of HTA. The work is based on some lessons learned from Philosophy of Science and the European project “VALIDATE” (VALues In Doing Assessments of healthcare TEchnologies”). VALIDATE was a three-year EUErasmus+ strategic partnerships project (2018-2021), in which training in the field of HTA was further optimized by using insights from political science and ethics (in accordance with the recent definition of HTA). Our analysis may reveal useful insights for addressing some challenges that HTA is going to face in the future

Las variaciones de superficie cortical en la corteza dorsolateral prefrontal predicen mejor el futuro desempeño cognitivo que la inteligencia fluida y la memoria operativa

Are cognitive and biological variables useful for predicting future behavioral outcomes? Method: In two independent groups, we measured a set of cognitive (fluid and crystallized intelligence, working memory, and attention control) and biological (cortical thickness and cortical surface area) variables on two occasions separated by six months, to predict behavioral outcomes of interest (performance on an adaptive version of the n-back task) measured twelve and eighteen months later. We followed three stages: discovery, validation, and generalization. In the discovery stage, cognitive/biological variables and the behavioral outcome of interest were assessed in a group of individuals (in-sample). In the validation stage, the cognitive and biological variables were related with a parallel version of the behavioral outcome assessed several months later. In the generalization stage, the validation findings were tested in an independent group of individuals (out-of-sample). Results: The key fi nding revealed that cortical surface area variations within the right dorsolateral prefrontal cortex predict the behavioral outcome of interest in both groups, whereas the cognitive variables failed to show reliable predictive validity. Conclusions: Individual differences in biological variables might predict future behavioral outcomes better than cognitive variables concurrently correlated with these behavioral outcomesAntecedentes: ¿Predicen las variables cognitivas y biológicas el futuro desempeño cognitivo? Método: en dos grupos independientes de participantes se miden variables cognitivas (inteligencia fluida y cristalizada, memoria operativa y control atencional) y biológicas (grosor y superficie cortical) en dos ocasiones separadas por seis meses, para predecir el desempeño en la tarea n-back valorado doce y dieciocho meses después. Se completan tres etapas: descubrimiento, validación y generalización. En la de descubrimiento se valoran en un grupo de individuos las variables cognitivas/biológicas y el desempeño a predecir. En la de validación, se relacionan las mismas variables con una versión paralela de la n-back completada meses después. En la de generalización, los resultados de la validación se replican en un grupo independiente de individuos. Resultados: las variaciones de superficie cortical en la corteza dorsolateral prefrontal derecha predicen el desempeño cognitivo en los dos grupos independientes de individuos, mientras que las variables cognitivas no contribuyen a la predicción del desempeño futuro. Conclusiones: las diferencias individuales en determinadas variables biológicas predicen el desempeño cognitivo mejor que las variables cognitivas que correlacionan concurrentemente con ese desempeñoThis project was supported by PSI2017-82218-P (Ministerio de Economía, Industria y Competitividad, Spain

The collision of comet Shoemaker‐Levy 9 with Jupiter: Detection and evolution of HCN in the stratosphere of the planet

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95000/1/grl8282.pd

Prioritisation of patients on waiting lists for hip and knee arthroplasties and cataract surgery: Instruments validation

<p>Abstract</p> <p>Background</p> <p>Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability.</p> <p>Methods</p> <p>Multicentre validation study which included orthopaedic surgeons and ophthalmologists from 10 hospitals. Participating doctors were asked to include all eligible patients placed in the waiting list for the procedures under study during the medical visit. Doctors assessed patients' priority through a visual analogue scale (VAS) and administered the prioritisation instrument. Information on socio-demographic data and health-related quality of life (HRQOL) (HUI3, EQ-5D, WOMAC and VF-14) was obtained through a telephone interview with patients. The correlation coefficients between the prioritisation instrument score and VAS and HRQOL were calculated. For the reliability study a self-administered questionnaire, which included hypothetic patients' scenarios, was sent via postal mail to the doctors. The priority of these scenarios was assessed through the prioritisation instrument. The intraclass correlation coefficient (ICC) between doctors was calculated.</p> <p>Results</p> <p>Correlations with VAS were strong for the AI (0.64, CI95%: 0.59–0.68) and for the CI (0.65, CI95%: 0.62–0.69), and moderate between the WOMAC and the AI (0.39, CI95%: 0.33–0.45) and the VF-14 and the CI (0.38, IC95%: 0.33–0.43). The results of the discriminant analysis were in general as expected. Inter-observer reliability was 0.79 (CI95%: 0.64–0.94) for the AI, and 0.79 (CI95%: 0.63–0.95) for the CI.</p> <p>Conclusion</p> <p>The results show acceptable validity and reliability of the prioritisation instruments in establishing priority for surgery.</p

Spatial and temporal facies evolution of a Lower Jurassic carbonate platform, NW Tethyan margin (Mallorca, Spain)

The variety of depositional facies of a Lower Jurassic carbonate platform has been investigated on the island of Mallorca along a transect comprising six stratigraphic profiles. Twenty-nine facies and sub-facies have been recognized, grouped into seven facies associations, ranging in depositional environment from supratidal/terrestrial and peritidal to outer platform. Spatial and temporal (2D) facies distribution along the transect reflects the evolution of the carbonate platform with time showing different facies associations, from a broad peritidal platform (stage 1) to a muddy open platform (stage 2), and finally to a peritidal to outer carbonate platform (stage 3). Stage 1 (early Sinemurian to earliest late Sinemurian) corresponds to a nearly-flat peritidal-shallow subtidal epicontinental platform with facies belts that shifted far and fast over the whole study area. The evolution from stage 1 to stage 2 (late Sinemurian) represents a rapid flooding of the epicontinental shallow platform, with more open-marine conditions, and the onset of differential subsidence. During stage 3 (latest Sinemurian), peritidal and shallow-platform environments preferentially developed to the northeast (Llevant Mountains domain) with a rapid transition to middle-outer platform environments toward the northwest (Tramuntana Range domain). Stages 1 and 3 present facies associations typical of Bahamian-type carbonates, whereas stage 2 represents the demise of the Bahamian-type carbonate factory and proliferation of muddy substrates with suspension-feeders. The described platform evolution responded to the interplay between the initial extensional tectonic phases related to Early Jurassic Tethyan rifting, contemporaneous environmental perturbations, and progressive platform flooding related to the Late Triassic–Early Jurassic worldwide marine transgression and associated accommodation changes

Immediate effects of dasatinib on the migration and redistribution of naïve and memory lymphocytes associated with lymphocytosis in chronic myeloid leukemia patients

Introduction: Dasatinib is a dual SRC/ABL tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML) that is known to have unique immunomodulatory effects. In particular, dasatinib intake typically causes lymphocytosis, which has been linked to better clinical response. Since the underlying mechanisms are unknown and SRC family kinases are involved in many cell motility processes, we hypothesized that the movement and migration of lymphocytes is modulated by dasatinib. Patients, Materials and Methods: Peripheral blood samples from CML patients treated with second-line dasatinib were collected before and 2 h after the first dasatinib intake, and follow-up samples from the same patients 3 and 6 months after the start of therapy. The migratory capacity and phenotype of lymphocytes and differential blood counts before and after drug intake were compared for all study time-points. Results: We report here for the first time that dasatinib intake is associated with inhibition of peripheral blood T-cell migration toward the homeostatic chemokines CCL19 and CCL21, which control the trafficking toward secondary lymphoid organs, mainly the lymph nodes. Accordingly, the proportion of lymphocytes in blood expressing CCR7, the chemokine receptor for both CCL19 and CCL21, decreased after the intake including both naïve CD45RA+ and central memory CD45RO+ T-cells. Similarly, naïve B-cells diminished with dasatinib. Finally, such changes in the migratory patterns did not occur in those patients whose lymphocyte counts remained unchanged after taking the drug. Discussion: We, therefore, conclude that lymphocytosis induced by dasatinib reflects a pronounced redistribution of naïve and memory populations of all lymphocyte subsets including CD4+ and CD8+ T-cells and B-cells

Estrategias de estudio y trabajo en estudiantes universitarios de la UIB

El estudio se centra en el conocimiento de los procesos de aprendizaje que se desarrollan en la enseñanza superior, siendo su objetivo principal la evaluación de las estrategias de aprendizaje utilizadas por estudiantes universitarios a lo largo de su formación inicial. Responde a un diseño descriptivo-exploratorio, dirigido a las estrategias de estudio y trabajo de la población universitaria de la Universidad de las Islas Baleares (UIB). Para ello, se procedió a la elaboración de un cuestionario como instrumento de recogida de datos1 sobre estrategias de estudio y trabajo, categorizado en cuatro grupos de estrategias (disposicionales y de apoyo; de búsqueda, recogida y selección de información; de procesamiento y uso de información; metacognitivas, de regulación y control) y sus correspondientes subcategorías. Se trabajó con una muestra de 949 estudiantes de la UIB, clasificados por ámbitos disciplinares y estudios, agrupados en grandes dimensiones (sexo; estudios de ciclo corto y de ciclo largo; rama de estudios; dedicación al estudio y actividad laboral), aportando, para cada una de ellas los datos estadísticos en los que se constata una diferencia significativa.L’estudi està centrat en el coneixement dels processos d’aprenentatge que es desenvolupen a l’ensenyament superior, i el l’objectiu principal és l’avaluació de les estratègies d’aprenentatge utilitzades per estudiants universitaris al llarg de la seva formació inicial. Respon a un disseny descriptiu-exploratori, dirigit a les estratègies d’estudi i treball de la població universitària de la Universitat de les Illes Balears (UIB). En aquest sentit, es va confeccionar un qüestionari com a instrument de recollida de dades sobre estratègies d’estudi i treball, categoritzat en quatre grups d’estratègies (disposicionals i de suport; de cerca, recollida i selecció d’informació; de processament i ús d’informació; metacognitives, de regulació i control) i les subcategories corresponents. Es va treballar amb una mostra de 949 estudiants de la UIB, classificats per àmbits disciplinaris i estudis, agrupats en grans dimensions (sexe; estudis de cicle curt i de cicle llarg; branca d’estudis; dedicació a l’estudi i activitat laboral), que varen aportar, per a cadascuna, dades estadístiques en els quals es constata una diferència significativa.The study is focused on the knowledge of learning processes developed in Higher Education and the main objective is to assess the learning strategies of university students along their initial training. This is a response to a descriptive-exploratory design addressed to the learning and working strategies among the students of the University of the Balearic Islands (UIB). Regarding to this, a question paper was designed as a tool for the collection of data on the studying and working strategies sorted by four strategy groups (dispositional and backup groups; research, collection and selection of information; processing and use of information; metacognitive, regulation and control groups) with their respective subcategories. We took a sample of 949 students from the UIB, sorted by study and disciplinary areas, and we gathered them in larger-dimension groups (gender, shorter and longer degrees, field of study and commitment to studies and work). These groups provided, for each of the samples, statistical information in which an important difference is stated