THE LEAD TIME TRADE-OFF: THE CASE OF HEALTH STATES BETTER THAN DEATH

The Lead Time Trade-Off (L-TTO) is a variant of the TTO method that tries to overcome some of the problems of the most widely used method (Torrance, 1986) for health states worse than death (SWD). Theoretically, the new method reduces the problems that have been detected when researchers have elicited preferences for SWD. However, several questions remain to be clarified. One of them is the influence of this new method for states better than death (SBD). In this paper we try to shed some light on this issue using a split sample design (n=500). One subsample (n=188) was interviewed using L-TTO and the rest using the traditional TTO (T-TTO). Our results show that the L-TTO produces utilities that are consistently higher than the T-TTO for SBD. Furthermore, the higher the severity the higher the difference between both methods. Another finding is that the L-TTO seems to produce a lower number of SWD. This effect seems to be concentrated in the most severe health states. This implies a violation of additive separability, one of the cornerstones of the QALY model. Our data show that the L-TTO may be different from the T-TTO in more respects than those that were originally intended.Lead Time Trade-Off, QALYs, Discounting, Additive Independece

THE LEAD TIME TRADE-OFF: THE CASE OF HEALTH STATES BETTER THAN DEATH

The Lead Time Trade-Off (L-TTO) is a variant of the TTO method that tries to overcome some of the problems of the most widely used method (Torrance, 1986) for health states worse than death (SWD). Theoretically, the new method reduces the problems that have been detected when researchers have elicited preferences for SWD. However, several questions remain to be clarified. One of them is the influence of this new method for states better than death (SBD). In this paper we try to shed some light on this issue using a split sample design (n=500). One subsample (n=188) was interviewed using L-TTO and the rest using the traditional TTO (T-TTO). Our results show that the L-TTO produces utilities that are consistently higher than the T-TTO for SBD. Furthermore, the higher the severity the higher the difference between both methods. Another finding is that the L-TTO seems to produce a lower number of SWD. This effect seems to be concentrated in the most severe health states. This implies a violation of additive separability, one of the cornerstones of the QALY model. Our data show that the L-TTO may be different from the T-TTO in more respects than those that were originally intended.Lead Time Trade-Off, QALYs, Discounting, Additive Independece

USING A POINT SYSTEM IN THE MANAGEMENT OF WAITING LISTS: THE CASE OF CATARACTS

The objective of this study is to explore the possibility of applying a point system as a guide to the management of waiting lists in National Health Systems. Following recent contributions in the axiomatic theory of justice, the ethical properties of a point system are illustrated. In addition, we present the results of an experiment whose objective was to develop a point system for cataract extraction, based on social preferences. The results of the experiment have shown that the analytic methods used here, of focus groups, interview-administered questionnaires, conjoint analysis, and rank-ordered logit, can be usefully combined to determine the total priority score for each patient.Point System; Priority Criteria; Waiting Lists; Cataract.

The significance of distributive effects in social assessment of health care

In this paper we address the importance of distributive effects in the social valuation of QALY's. We propose a social welfare function that generalises the functions traditionally used in the health economic literature. The novelty is that, depending on the individual health gains, our function can represent either preferences for concentrating or preferences for spreading total gain or both together, an issue which has not been addressed until now. Based on an experiment, we observe that this generalisation provides a suitable approximation to the sampled social preferences.QALY, distributive effects, social welfare function, inequality aversion

Modelling Noise and Imprecision in Individual Decisions

When individuals take part in decision experiments, their answers are typically subject to some degree of noise / error / imprecision. There are different ways of modelling this stochastic element in the data, and the interpretation of the data can be altered radically, depending on the assumptions made about the stochastic specification. This paper presents the results of an experiment which gathered data of a kind that has until now been in short supply. These data strongly suggest that the 'usual' (Fechnerian) assumptions about errors are inappropriate for individual decision experiments. Moreover, they provide striking evidence that core preferences display systematic departures from transitivity which cannot be attributed to any 'error' story.Error Imprecision Preferences Transitivity

General process for the formative assessment of learning

La evaluación formativa se acepta como idónea para mejorar los procesos de enseñanza y aprendizaje. Sin embargo, poco se practica de forma sistemática y aún persiste un enfoque tradicional en muchas escuelas venezolanas al reducirla a una etapa del proceso de aprendizaje necesariamente terminal, enfatizando el producto. En consecuencia, el objetivo de este estudio consistió en configurar un proceso general para la evaluación formativa del aprendizaje a partir de las actividades evaluativas que realizan los docentes en el aula. Metodológicamente se inscribe en el paradigma cualitativo mediante el método etnográfico, el cual se aplicó siguiendo las fases sugeridas por Rodríguez, Gil y García (1999): preparatoria, de campo, analítica e informativa. Para recabar la información se utilizó la observación participante y el diario de campo como instrumento para registrar la información. La información recabada se transcribió, organizó, categorizó y se validó por medio de la triangulación de fuentes. Como resultado se obtuvo un conjunto de actividades de evaluación formativa subyacentes en la práctica pedagógica del docente, las cuales se integraron en una secuencia para conformar un proceso general de evaluación formativa del aprendizaje incluido en los procesos de enseñanza aprendizaje. El proceso es útil para realizar una evaluación formativa consciente y sistemáticaThe formative assessment accepted as suitable for improving teaching and learning processes. However, little practiced in a systematic way and still remains a traditional approach in many Venezuelan schools by reducing it to a stage of the learning process necessarily terminal, emphasizing the product. Consequently, the objective of this study consisted of setting up a general process for the formative evaluation of the learning from the evaluative activities carried out by teachers in the classroom. Methodologically, circumscribed to the qualitative paradigm using the ethnographic method, which applied following the stages suggested by Rodriguez, Gil and García (1999): preparatory, field, analytical e informative. To gather the information used participant observation and field as a tool journal to record what the information. The information collected is transcribed, organized, categorized and validated by means of triangulation of sources. As a result obtained a set of underlying activities of formative evaluation in teaching practice of teachers, which integrated into a sequence to form a general process of formative evaluation of learning included in the processes of teaching and learning. The process is useful to perform a conscious and systematic formative evaluatio

Climate readiness indicators for agriculture

Countries vary in their institutional technical and financial abilities to prepare for climate change in agriculture and to balance food security, adaptation, and mitigation goals.Indicators for climate readiness provide guidance to countries and enable monitoring progress. Readiness assessments can enable donors, investors and national decision-makers to identify where investments are needed or likely to be successful. Examples of climate readiness indicators are provided for five work areas: 1. governance and stakeholder engagement, 2. knowledge and information services, 3. climate-smart agricultural strategy and implementation frameworks, 4. national and subnational capabilities and 5. national information and accounting systems

Ovarian steroids regulate tachykinin and tachykinin receptor gene expression in the mouse uterus

<p>Abstract</p> <p>Background</p> <p>In the mouse uterus, pregnancy is accompanied by changes in tachykinin and tachykinin receptor gene expression and in the uterotonic effects of endogenous tachykinins. In this study we have investigated whether changes in tachykinin expression and responses are a result of changes in ovarian steroid levels.</p> <p>Methods</p> <p>We quantified the mRNAs of tachykinins and tachykinin receptors in uteri from ovariectomized mice and studied their regulation in response to estrogen and progesterone using real-time quantitative RT-PCR. Early (3 h) and late (24 h) responses to estrogen were evaluated and the participation of the estrogen receptors (ER), ERalpha and ERbeta, was analyzed by treating mice with propylpyrazole triol, a selective ERalpha agonist, or diarylpropionitrile, a selective agonist of ERbeta.</p> <p>Results</p> <p>All genes encoding tachykinins (Tac1, Tac2 and Tac4) and tachykinin receptors (Tacr1, Tacr2 and Tacr3) were expressed in uteri from ovariectomized mice. Estrogen increased Tac1 and Tacr1 mRNA after 3 h and decreased Tac1 and Tac4 expression after 24 h. Tac2 and Tacr3 mRNA levels were decreased by estrogen at both 3 and 24 h. Most effects of estrogen were also observed in animals treated with propylpyrazole triol. Progesterone treatment increased the levels of Tac2.</p> <p>Conclusion</p> <p>These results show that the expression of tachykinins and their receptors in the mouse uterus is tightly and differentially regulated by ovarian steroids. Estrogen effects are mainly mediated by ERalpha supporting an essential role for this estrogen receptor in the regulation of the tachykinergic system in the mouse uterus.</p