What Drives Responses to Willingness-to-pay Questions? A Methodological Inquiry in the Context of Hypertension Self-management

Background: The use of economic evaluation to determine the cost-effectiveness of health interventions is recommended by decision-making bodies internationally. Understanding factors that explain variations in costs and benefits is important for policy makers. Objective: This work aimed to test a priori hypotheses defining the relationship between benefits of using self-management equipment (measured using the willingness-to-pay (WTP) approach) and a number of demographic and other patient factors. Methods: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Results: 393 hypertensive patients (204 in the intervention and 189 in the control) were willing to pay for self-management equipment and 85% of these (335) provided positive WTP values. Three hypotheses were accepted: higher WTP values were associated with being male, higher household incomes and satisfaction with the equipment. Prior experiences of using this equipment, age and changes in blood pressure were not significantly related to WTP. Conclusion: The majority of hypertensive patients who had taken part in a self-management study were prepared to purchase the self-monitoring equipment using their own funds, more so for men, those with higher incomes and those with greater satisfaction. Further research based on bigger and more diverse populations is recommended

Gender differences in the Force Concept Inventory for different educational levels in the United Kingdom

The Force Concept Inventory (FCI) is widely used to investigate the effect of education level on conceptual understanding of Newtonian mechanics but has only recently been scrutinized for gender effects and retention. This study examines both the gender gap in first year physics undergraduates compared to the gap for nonphysicists and the FCI retention after three months. All participants were either studying or working at the University of Sheffield in the UK and had completed a similar compulsory level of secondary education. As expected the results show that a greater level of education in physics is associated with a larger average FCI score. However, further analysis shows that there exists a gender gap at all levels of education. The size of the effect of gender is quantified using Cohen’s d and ranges from 0.84 to 1.17 which indicates a large effect due to gender for all levels of education. Despite the FCI having been used as a tool to measure learning gains immediately following instruction in Newtonian mechanics there has been little work to investigate whether this increase in FCI score remains after some time has elapsed. Here the increase in FCI scores is found to remain increased after a three month absence of mechanics-related teaching, and that this retention of FCI scores is independent of gender. Despite this, the gender gap still remains large and statistically significant after the three month delay

The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review

OBJECTIVES: To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN: A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING: Community-based interventions. PARTICIPANTS: Patients with multimorbidity. MAIN OUTCOME MEASURES: Unplanned healthcare usage. RESULTS: Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS: Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics

Geometry and Joint Systems for Lattice-Based Reconfigurable Space Structures

We describe analytical methods for the design of the discrete elements of ultralight lattice structures. This modular, building block strategy allows for relatively simple element manufacturing, as well as relatively simple robotic assembly of low mass density structures on orbit, with potential for disassembly and reassembly into highly varying and large structures. This method also results in a structure that is easily navigable by relatively small mobile robots. The geometry of the cell can allow for high packing efficiency to minimize wasted payload volume while maximizing structural performance and constructability. We describe the effect of geometry choices on the final system mechanical properties, manufacturability of the components, and automated robotic constructability of a final system. Geometry choices considered include building block complexity, symmetry of the unit cell, and effects of vertex, edge, and face connectivity of the unit cell. Mechanical properties considered include strength scaling, modulus scaling, and structural performance of the joint, including proof load, shear load, mass, and loading area; as well as validation and verification opportunities. Manufacturability metrics include cost and time, manufacturing method (COTS versus custom), and tolerances required. Automated constructability metrics include local effects of loads imparted to the structure by the robot and assembly complexity, encompassing the ability of the robot to clamp and number of placement motions needed for assembly

What’s Worth Talking About? Information Theory Reveals How Children Balance Informativeness and Ease of Production

Of all the things we could say, what determines what is worth saying? Greenfield’s principle of informativeness states that, right from the onset of language, humans selectively comment on whatever they find unexpected. We quantify this tendency using information theoretic measures, and test the counterintuitive prediction that children will produce words that are low frequency given the context because these will be most informative. Using corpora of child directed speech, we identified adjectives that varied in how informative (i.e., unexpected) they were given the noun they modified. Three-year-olds (N=31, replication N=13) heard an experimenter use these adjectives to describe pictures. The children’s task was then to describe the pictures to another person. As the information content of the experimenter’s adjective increased, so did children’s tendency to comment on the feature that adjective had encoded. Furthermore, our analyses suggest that children balance this informativeness with a competing drive to ease production

Visual art inspired by the collective feeding behavior of sand-bubbler crabs

Sand--bubblers are crabs of the genera Dotilla and Scopimera which are known to produce remarkable patterns and structures at tropical beaches. From these pattern-making abilities, we may draw inspiration for digital visual art. A simple mathematical model is proposed and an algorithm is designed that may create such sand-bubbler patterns artificially. In addition, design parameters to modify the patterns are identified and analyzed by computational aesthetic measures. Finally, an extension of the algorithm is discussed that may enable controlling and guiding generative evolution of the art-making process

Exploring invisibility and epistemic injustice in Long Covid - a citizen science qualitative analysis of patient stories from an online Covid community

Background In 2020, the long-lasting effects of the Covid-19 virus were not included in public messages of risks to public health. Long Covid emerged as a novel and enigmatic illness with a serious and life-changing impact. Long Covid is poorly explained by objective medical tests, leading to widespread disbelief and stigma associated with the condition. The aim of this organic research is to explore the physical and epistemic challenges of living with Long Covid. Methods Unlike any previous pandemic in history, online Covid communities and ‘citizen science’ have played a leading role in advancing our understanding of Long Covid. As patient-led research of this grassroots Covid community, a team approach to thematic analysis was undertaken of 66 patient stories submitted online to covid19-recovery.org at the beginning of the Covid-19 pandemic between April and September 2020. Results The overriding theme of the analysis highlights the complexities and challenges of living with Long Covid. Our distinct themes were identified: the life-changing impact of the condition, the importance of validation and how, for many, seeking alternatives was felt to be their only option. Conclusions Long Covid does not easily fit into the dominant evidence-based practice and the biomedical model of health, which rely on objective indicators of the disease process. Patient testimonies are vital to understanding and treating Long Covid, yet patients are frequently disbelieved, and their testimonies are not taken seriously leading to stigma and epistemic injustice, which introduces a lack of trust into the therapeutic relationship. Patient Contribution The research was undertaken in partnership with our consumer representative(s) and all findings and subsequent recommendations have been coproduced

Structural analysis of the starfish SALMFamide neuropeptides S1 and S2: The N-terminal region of S2 facilitates self-association

The neuropeptides S1 (GFNSALMFamide) and S2 (SGPYSFNSGLTFamide), which share sequence similarity, were discovered in the starfish Asterias rubens and are prototypical members of the SALMFamide family of neuropeptides in echinoderms. SALMFamide neuropeptides act as muscle relaxants and both S1 and S2 cause relaxation of cardiac stomach and tube foot preparations in vitro but S2 is an order of magnitude more potent than S1. Here we investigated a structural basis for this difference in potency using spectroscopic techniques. Circular dichroism spectroscopy showed that S1 does not have a defined structure in aqueous solution and this was supported by 2D nuclear magnetic resonance experiments. In contrast, we found that S2 has a well-defined conformation in aqueous solution. However, the conformation of S2 was concentration dependent, with increasing concentration inducing a transition from an unstructured to a structured conformation. Interestingly, this property of S2 was not observed in an N-terminally truncated analogue of S2 (short S2 or SS2; SFNSGLTFamide). Collectively, the data obtained indicate that the N-terminal region of S2 facilitates peptide self-association at high concentrations, which may have relevance to the biosynthesis and/or bioactivity of S2 in vivo