Handling protest responses in contingent valuation surveys

OBJECTIVES: Protest responses, whereby respondents refuse to state the value they place on the health gain, are commonly encountered in contingent valuation (CV) studies, and they tend to be excluded from analyses. Such an approach will be biased if protesters differ from non-protesters on characteristics that predict their responses. The Heckman selection model has been commonly used to adjust for protesters, but its underlying assumptions may be implausible in this context. We present a multiple imputation (MI) approach to appropriately address protest responses in CV studies, and compare it with the Heckman selection model. METHODS: This study exploits data from the multinational EuroVaQ study, which surveyed respondents' willingness-to-pay (WTP) for a Quality Adjusted Life Year (QALY). Here, our simulation study assesses the relative performance of MI and Heckman selection models across different realistic settings grounded in the EuroVaQ study, including scenarios with different proportions of missing data and non-response mechanisms. We then illustrate the methods in the EuroVaQ study for estimating mean WTP for a QALY gain. RESULTS: We find that MI provides lower bias and mean squared error compared with the Heckman approach across all considered scenarios. The simulations suggest that the Heckman approach can lead to considerable underestimation or overestimation of mean WTP due to violations in the normality assumption, even after log-transforming the WTP responses. The case study illustrates that protesters are associated with a lower mean WTP for a QALY gain compared with non-protesters, but that the results differ according to method for handling protesters. CONCLUSIONS: MI is an appropriate method for addressing protest responses in CV studies

Old concepts, new challenges: adapting landscape-scale conservation to the twenty-first century

This is the final version of the article. Available from Springer Verlag via the DOI in this record.Landscape-scale approaches to conservation stem largely from the classic ideas of reserve design: encouraging bigger and more sites, enhancing connectivity among sites, and improving habitat quality. Trade-offs are imposed between these four strategies by the limited resources and opportunities available for conservation programmes, including the establishment and management of protected areas, and wildlife-friendly farming and forestry. Although debate regarding trade-offs between the size, number, connectivity and quality of protected areas was prevalent in the 1970–1990s, the implications of the same trade-offs for ongoing conservation responses to threats from accelerating environmental change have rarely been addressed. Here, we reassess the implications of reserve design theory for landscape-scale conservation, and present a blueprint to help practitioners to prioritise among the four strategies. We consider the new perspectives placed on landscape-scale conservation programmes by twenty-first century pressures including climate change, invasive species and the need to marry food security with biodiversity conservation. A framework of the situations under which available theory and evidence recommend that each of the four strategies be prioritized is provided, seeking to increase the clarity required for urgent conservation decision-making.L. Donaldson was supported by a Natural Environment Research Council (NERC) CASE studentship (Grant Number NE/L501669/1) in partnership with the Royal Society for the Protection of Birds (RSPB)

Fulminant necrotizing fasciitis following the use of herbal concoction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer.</p> <p>Case presentation</p> <p>A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation.</p> <p>Conclusion</p> <p>The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.</p

Kahler-Einstein metrics emerging from free fermions and statistical mechanics

We propose a statistical mechanical derivation of Kahler-Einstein metrics, i.e. solutions to Einstein's vacuum field equations in Euclidean signature (with a cosmological constant) on a compact Kahler manifold X. The microscopic theory is given by a canonical free fermion gas on X whose one-particle states are pluricanonical holomorphic sections on X (coinciding with higher spin states in the case of a Riemann surface). A heuristic, but hopefully physically illuminating, argument for the convergence in the thermodynamical (large N) limit is given, based on a recent mathematically rigorous result about exponentially small fluctuations of Slater determinants. Relations to effective bosonization and the Yau-Tian-Donaldson program in Kahler geometry are pointed out. The precise mathematical details will be investigated elsewhere.Comment: v1: 22 pages v2: 25 pages. The relation to quantum gravity has been further developed by working over the moduli space of all complex structures. Relations to Donaldson's program pointed out. References adde

The FDA guidance for industry on PROs: the point of view of a pharmaceutical company

The importance of the patients point of view on their health status is widely recognised. Patient-reported outcomes is a broad term encompassing a large variety of different health data reported by patients, as symptoms, functional status, Quality of Life and Health-Related Quality of Life. Measurements of Health-Related Quality of Life have been developed during many years of researches, and a lot of validated questionnaires exist. However, few attempts have been made to standardise the evaluation of instruments characteristics, no recommendations are made about interpretation on Health-Related Quality of Life results, especially regarding the clinical significance of a change leading a therapeutic approach. Moreover, the true value of Health-Related Quality of Life evaluations in clinical trials has not yet been completely defined. An important step towards a more structured and frequent use of Patient-Reported Outcomes in drug development is represented by the FDA Guidance, issued on February 2006. In our paper we aim to report some considerations on this Guidance. Our comments focus especially on the characteristics of instruments to use, the Minimal Important Difference, and the methods to calculate it. Furthermore, we present the advantages and opportunities of using the Patient-Reported Outcomes in drug development, as seen by a pharmaceutical company. The Patient-Reported Outcomes can provide additional data to make a drug more competitive than others of the same pharmacological class, and a well demonstrated positive impact on the patient' health status and daily life might allow a higher price and/or the inclusion in a reimbursement list. Applying extensively the FDA Guidance in the next trials could lead to a wider culture of subjective measurement, and to a greater consideration for the patient's opinions on his/her care. Moreover, prescribing doctors and payers could benefit from subjective information to better define the value of drugs

Identification of the REST regulon reveals extensive transposable element-mediated binding site duplication

The genome-wide mapping of gene-regulatory motifs remains a major goal that will facilitate the modelling of gene-regulatory networks and their evolution. The repressor element 1 is a long, conserved transcription factor-binding site which recruits the transcriptional repressor REST to numerous neuron-specific target genes. REST plays important roles in multiple biological processes and disease states. To map RE1 sites and target genes, we created a position specific scoring matrix representing the RE1 and used it to search the human and mouse genomes. We identified 1301 and 997 RE1s inhuman and mouse genomes, respectively, of which >40% are novel. By employing an ontological analysis we show that REST target genes are significantly enriched in a number of functional classes. Taking the novel REST target gene CACNA1A as an experimental model, we show that it can be regulated by multiple RE1s of different binding affinities, which are only partially conserved between human and mouse. A novel BLAST methodology indicated that many RE1s belong to closely related families. Most of these sequences are associated with transposable elements, leading us to propose that transposon-mediated duplication and insertion of RE1s has led to the acquisition of novel target genes by REST during evolution

Pediculosis and the Pediatrician

Head lice commonly evoke feelings of disgust, revulsion, anger, and shame among parents and patients. There should, however, be no great cause for such alarm if a physician suspects pediculosis capitis. The recent introduction of several new pediculicidal drugs now allows a choice among four distinct therapeutic agents, which should substantially improve control of isolated cases and epidemics. Physicians must be aware that consumer groups are pressing public health authorities and drug manufacturers to establish proper treatment standards and safety warnings for the use of these agents. In addition, some controversy surrounds the use of lindane in children. This paper reviews the epidemiology and clinical appearance of pediculosis capitis in children, with emphasis on these recent developments. Pubic lice ( Phthirus pubis ) and body lice ( Pedicutus humanus corporis ), both of which are much less common pediatric infestations, are mentioned only briefly.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72607/1/j.1525-1470.1984.tb00447.x.pd

Non-opaque soft tissue foreign body: sonographic findings

<p>Abstract</p> <p>Background</p> <p>Soft tissue foreign bodies are a common cause of orthopedic consultation in emergency departments. It is difficult to confirm their existence because conventional radiology only detects radio-opaque foreign bodies. Sonography can be a useful diagnostic method. The aim of this study is to evaluate diagnostic accuracy of sonography in detection and localization of non-opaque foreign bodies.</p> <p>Methods</p> <p>We evaluated 47 patients with suspected foreign body retention in soft tissues by 10 MHz linear array transducer. A single radiologist performed all examinations with 6 years' experience in musculoskeletal Sonography. We detected and localized the presence of the foreign body in the soft tissue as guidance for facilitating the surgery.</p> <p>Results</p> <p>We detected soft tissue foreign body in 45 cases as hyperechoic foci. Posterior acoustic shadowing was seen in 36 cases and halo sign was seen in 5 cases due to abscess or granulation tissue formation. Surgery was performed in 39 patients and 44 foreign bodies were removed.</p> <p>Conclusion</p> <p>Sonography is a useful modality in detection and localization of radiolucent foreign bodies in soft tissue which can avoid misdiagnosis during primary emergency evaluation.</p