Where’s WALY? : A proof of concept study of the ‘wellbeing adjusted life year’ using secondary analysis of cross-sectional survey data

Background The Quality-Adjusted Life Year (QALY) is a measure that combines life extension and health improvement in a single score, reflecting preferences around different types of health gain. It can therefore be used to inform decision-making around allocation of health care resources to mutually exclusive options that would produce qualitatively different health benefits. A number of quality-of-life instruments can be used to calculate QALYs. The EQ-5D is one of the most commonly used, and is the preferred option for submissions to NICE (https://www.nice.org.uk/process/pmg9/). However, it has limitations that might make it unsuitable for use in areas such as public and mental health where interventions may aim to improve well-being. One alternative to the QALY is a Wellbeing-Adjusted Life Year. In this study we explore the need for a Wellbeing-Adjusted Life Year measure by examining the extent to which a measure of wellbeing (the Warwick-Edinburgh Mental Well-being Scale) maps onto the EQ-5D-3L. Methods Secondary analyses were conducted on data from the Coventry Household Survey in which 7469 participants completed the EQ-5D-3L, Warwick-Edinburgh Mental Well-being Scale, and a measure of self-rated health. Data were analysed using descriptive statistics, Pearson’s and Spearman’s correlations, linear regression, and receiver operating characteristic curves. Results Approximately 75 % of participants scored the maximum on the EQ-5D-3L. Those with maximum EQ-5D-3L scores reported a wide range of levels of mental wellbeing. Both the Warwick-Edinburgh Mental Well-being Scale and the EQ-5D-3L were able to detect differences between those with higher and lower levels of self-reported health. Linear regression indicated that scores on the Warwick-Edinburgh Mental Well-being Scale and the EQ-5D-3L were weakly, positively correlated (with R2 being 0.104 for the index and 0.141 for the visual analogue scale). Conclusion The Warwick-Edinburgh Mental Well-being Scale maps onto the EQ-5D-3L to only a limited extent. Levels of mental wellbeing varied greatly amongst participants who had the maximum score on the EQ-5D-3L. To evaluate the relative effectiveness of interventions that impact on mental wellbeing, a new measure – a Wellbeing Adjusted Life Year – is needed

Les strategies de neutralisation de la pression normative par les consommateurs : le cas du telechargement illegal

International audienceLes techniques de neutralisation, qui permettent aux consommateurs d’accomplir des pratiques déviantes tout en restant attachés à la norme de référence, sont mal connues. Nous montrons, dans le cas du téléchargement illégal, qu’il s’agit d’un assemblage discursif autonome, articulé autour de trois stratégies défensives (déresponsabilisation neutralisatrice, neutralisation pragmatique, neutralisation idéologique), et supportant la contradiction interne

First observation of molecular and volume relaxation in glassy crystal cyanoadamantane

The effect of annealing in the glassy crystal phase of cyanoadamantane has been investigated by X-ray scattering. As is usually observed in glasses, we find a spontaneous volume contraction. At the same time we notice that slow molecular orientational relaxations take place which are connected to the growth of an antiparallel local order: we observe a large amplitude relaxation of the scattering at the X points of the Brillouin zone with characteristic times of several tens of hours.Par diffusion des rayons X, nous avons étudié l'influence d'un recuit dans la phase vitreuse du cyanoadamantane obtenue par trempe de la phase plastique. Nous avons observé la contraction volumique spontanée, typique de l'état vitreux et nous montrons que des mouvements lents de réorientation moléculaire ont lieu alors qu'un ordre local antiparallèle se développe; nous observons des relaxations de grande amplitude de la diffusion aux points X de la zone de Brillouin avec des constantes de temps de plusieurs dizaines d'heures

LOCAL ORDER AND NON EQUILIBRIUM BEHAVIOUR IN GLASSY CRYSTAL CYANOADAMANTANE

Lors de recuits isothermes en phase plastique trempée, le cyanoadamantane évolue vers une phase métastable dont la structure est différente de celle de la phase stable à la même température. Cette microstructure est décrite. La cinétique de mise en ordre qui est corrélée à une contraction volumique est analysée en terme de relaxation moléculaire.During isothermal annealing in the glassy crystal phase, cyanoadamantane relaxes towards a metastable state. The microstructure of the latter is described. It is different from that of the stable phase at the same temperature. The kinetics of ordering which are coupled to a volume contraction are analyzed in terms of molecular relaxation

Local molecular order in the glassy crystalline phase of cyanoadamantane : diffuse X-ray scattering analysis

This Letter presents the results of X-ray scattering experiments performed on cyanoadamantane in its plastic phase (I) and its « glassy crystal » state (Ig) obtained by the quenching of phase (I). The patterns associated with this latter phase are more structured and are characterized by the presence of narrow spots at the X boundary points. An interpretation is proposed in terms of geared antiferroelectric domains. The coherence length is ξ ≃ 20 A.Dans cette Lettre nous présentons les résultats d'expériences de diffusion de rayons X effectuées sur le cyanoadamantane en phase plastique (I) et en phase « cristal vitreux » (Ig) obtenue par trempe de la phase (I). L'aspect général des figures de diffusion est dans ce dernier cas plus structuré. De plus, il apparait en phase vitreuse, des taches diffuses fines aux points X des zones de Brillouin. Nous proposons une interprétation en termes de domaines antiferroélectriques engrainés. La longueur de corrélation correspondante serait alors d'environ 20 A

The implication of the lattice in the non-equilibrium behaviour of a glassy crystal

Time resolved X-ray measurements on single crystals of the mixed system (cyanoadamantane)$_{1-x}$ (chloroadamantane)$_x$, for $x\cong 0.25$, have been made. Special attention has been paid to the underlying lattice in the glassy state. The rotational glass transition is signalled by a jump of the expansivity at $T_{\rm g}$ as in conventional glasses. There is no signature of the freezing on the peak profiles after a deep quench below $T_{\rm g}$. In the neighbourhood of $T_{\rm g}$, there is evidence of a slow correlated amplification of antiferroelectric and ferroelastic fluctuations respectively observed at the X and $\Gamma$ points of the Brillouin zone. In this quasi static ordering process the average underlying lattice is preserved but the mean square displacements are considerably increased

Influence of the growth method upon the phase transition of RbCdCl

Structural properties of two RbCdCl3 samples grown either from the melt or from aqueous solution are studied via X-ray diffraction over a closed temperature cycle between 20 °C and 300 °C. During cooling step (300 $^\circ{\rm C}\to 20$ °C), the crystal grown from the melt undergoes a phase transition at 110 °C that drives it from the cubic structure into a tetragonal structure that still persists at 20 °C. It undergoes exactly the reverse phase transition at the same temperature during the heating ($20~^\circ{\rm C}\to 300~^\circ$C) step that immediately follows. The other crystal grows from aqueous solution at 20 °C in an orthorhombic structure (i.e. not tetragonal as that of the crystal grown from the melt and cooled down to this temperature). During the heating ($20~^\circ{\rm C}\to 300~^\circ$C) step, it undergoes a direct orthorhombic-cubic phase transition at 240 °C (without passing through the tetragonal phase) whereas, during subsequent cooling (300 $^\circ{\rm C}\to 20$ °C), it does not exhibit the corresponding reverse phase transition but rather exhibits exactly the same cubic-tetragonal phase transition at 110 °C as the crystal grown from the melt. However, for both crystals, this tetragonal phase observed at room temperature is unstable and slowly converts into an orthorhombic phase over the course of time. Complementary Differential Scanning Calorimetry (D.S.C.) and Thermo Gravimetric Analysis (T.G.A.) measurements have been carried out over the range ($20\to 300$) °C in order to interpret diffraction experiments

Neuroleptic monitoring: relation between antipsychotic efficiency and radioreceptor assay of serum haloperidol.

International audienceOBJECTIVE: We report preliminary results from use of a radioreceptor assay (RRA) to measure serum haloperidol levels and their relation to clinical response and adverse effects in 19 psychotic patients with positive symptoms treated with haloperidol. METHODS: Blood samples were taken on Days 7, 14 and 21. Clinical evaluation was based on the PANSS, and UKU scales. The D2 antidopaminergic RRA was used to measure haloperidol serum levels. RESULTS: Our results show a correlation between psychosis with positive symptoms assessed by positive scores in the PANSS and the serum drug level measured by RRA concentrations. The observed relationship made it possible to establish a therapeutic serum range of haloperidol equivalents 15-30 ng/ml-1. This range contained no "non-responders". Analysis of the correlation between each item on the positive subscale of the PANSS and the RRA concentration suggested that there was no specific symptom of psychosis closely related to RRA concentration during the first 15 days of treatment. In the third week, however, certain specific symptoms were closely connected to the RRA concentration. CONCLUSION: From these results, it can be concluded that antipsychotic activity can be related to blockade of serum D2 dopamine receptors. In future would be desirable to monitor neuroleptic treatment in this way. The study also showed that the antipsychotic treatment did not correct any specific component of the psychosis during the first stage of the treatment but that it did so at later times

Perception, knowledge, and handling practice regarding the risk of exposure to antineoplastic drugs in oncology day hospitalization units and compounding unit staff.

International audienceBackgroundAntineoplastic drug exposure is a major problem in regard to caregivers’ health. The aim of the present study was to assess the perception, knowledge, and handling practices of all occupation level categories of two oncology day hospitalization units and two compounding units regarding the risk of exposure to antineoplastic drugs.MethodsThis descriptive study, performed through face-to-face interviews, concurrently assessed the perception, knowledge, and handling practices of antineoplastic drugs in five different job categories in four different settings. This work was part of a larger comprehensive project examining surface and blood contamination. Different scores were assigned to evaluate responses to a questionnaire about the perception, knowledge, and handling practices of healthcare workers, a risk global score including a risk perception score, and education/knowledge and handling practices scores.ResultsIn the survey, continuous training was associated with the global risk score (p = 0.03), particularly with the handling practices risk score (p = 0.01). Job category was also significantly associated with the global risk score (p < 0.001), particularly with the handling practices risk score (p < 0.001) and the education/knowledge score (p < 0.001). Pharmacy technicians had the highest score regarding risk perception (71.4%), indicating a higher perception of risk, and had a lower score regarding handling practices (25.0%) as well as a lower score (15.7%) regarding risk knowledge. Nurses and physicians had a high score (50%) regarding the risk of handling practices and a score of 57.1% regarding risk perception, indicating an increased perception of safety. Auxiliary caregivers had the highest global score (43.5%) and a score of 30.0% regarding handling practices.ConclusionsThis study identified significant differences among healthcare workers depending on job categories in the antineoplastic drug handling practices and in the knowledge of the risks associated with occupational exposure to antineoplastic drugs. These differences were particularly important between trained and untrained participants, revealing the importance of implementing a continuous training program