Pain, depression and anxiety in people with haemophilia from three Nordic countries : Cross-sectional survey data from the MIND study

Introduction People with haemophilia (PwH) may experience symptoms of haemophilia-related pain, depression or anxiety, which can negatively impact health-related quality of life. Aim To obtain the perspective of PwH and treaters from Sweden, Finland and Denmark on the management of haemophilia-related pain, depression and anxiety using cross-sectional survey data from the MIND study (NCT03276130). Methods PwH or their caregivers completed a survey about experiences of pain, depression and anxiety related to haemophilia, and the standard EQ-5D-5L instrument. Five investigators at haemophilia treatment centres (HTC) were sent a complementary survey containing questions about the management of pain and depression/anxiety. Results There were 343 PwH (mild: 103; moderate: 53; severe: 180; seven lacking severity information) and 71 caregiver responses. Experience of pain in the last 6 months was reported by 50% of PwH respondents and 46% of caregiver respondents. Anxiety/depression was reported by 28% of PwH respondents. Reporting of pain and anxiety/depression was associated with disease severity. Whilst 62% of PwH who had experienced pain at any time point (n = 242) felt this was adequately addressed and treated at their HTC, only 24% of those who had experienced depression/anxiety (n = 127) felt this was adequately addressed. Disease severity was negatively associated with EQ-5D-5L utility value (p < .001). In the HTC survey, 4/5 and 2/5 agreed that pain and depression/anxiety, respectively, are adequately addressed. Conclusions Pain and depression/anxiety occur more frequently with increasing haemophilia severity, with negative impacts on health-related quality of life. PwH with depression/anxiety or unaddressed pain could benefit from improved management strategies.Peer reviewe

Collateral, Liquidity and Debt Sustainability

We study Markov‐perfect optimal fiscal policy in an economy with financial frictions and sovereign default in the form endogenously determined haircuts on outstanding debt. Government bonds facilitate tax smoothing but also provide collateral and liquidity services that mitigate financial frictions. A debt Laffer curve exists, which induces the government to issue bonds to a point where marginal debt has negative welfare effects. Debt positions in the order of magnitude of annual output remain sustainable despite the option to default. When default happens, liquidity on the bond market is impaired, which can trigger extended periods of recurrent haircuts

Initiating private-collective innovation: The fragility of knowledge sharing

Incentives to innovate are a central element of innovation theory. In the private-investment model, innovators privately fund innovation and then use intellectual property protection mechanisms to appropriate returns from these investments. In the collective-action model, public subsidy funds public goods innovations, characterized by non-rivalry and non-exclusivity in using these innovations. Recently, these models have been compounded in the private-collective innovation model where innovators privately fund public goods innovations. Private-collective innovation is illustrated in the case of open source software development. This paper contributes to the work on this model by investigating incentives that motivate innovators to share their knowledge in an initial situation, before there is a community to support the innovation process. We use game theory to predict knowledge sharing behavior in private-collective innovation, and test these predictions in a laboratory setting. The results show that knowledge sharing is a coordination game with multiple equilibria, reflecting the fragility of knowledge sharing between innovators with conflicting interests. The experimental results demonstrate important asymmetries in the fragility of knowledge sharing and, in some situations, more knowledge sharing than theoretically predicted. A behavioral analysis suggests that knowledge sharing in private-collective innovation is not only affected by material incentives, but also by social preferences such as fairness. The results offer general insights into the relationship between incentives and knowledge sharing and contribute to a better understanding of the initiation of private-collective innovation

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Implicit beliefs of ability, approach-avoidance goals and cognitive anxiety among team sport athletes.

People’s implicit beliefs of ability have been suggested as an antecedent of achievement goal adoption, which has in turn been associated with behavioural, cognitive and affective outcomes. This study examined a conditional process model with team sport athletes’ approach-avoidance achievement goals as mediators between their implicit beliefs of sport ability and sport-related cognitive anxiety. We expected gender to moderate the paths from implicit beliefs of ability to approachavoidance goals and from approach-avoidance goals to cognitive anxiety. Team sport athletes with a mean age of 20 years (163 females and 152 males) responded to questionnaires about their implicit beliefs of sport ability, approach-avoidance goals and sport-related cognitive anxiety. Incremental beliefs, gender and the interaction between them predicted masteryapproach goals. Gender also predicted mastery-avoidance goals, with females reporting higher levels than males. Masteryavoidance goals, gender and the interaction between them predicted cognitive anxiety, with females reporting higher levels of anxiety than males. Entity beliefs positively predicted performance-avoidance goals and the interaction between performance-approach and gender predicted anxiety. The indirect effects also showed gender differences in relation to performance-approach goals. Taken together, our results suggest that coaches trying to create a facilitating climate for their male and female athletes may be wise to consider their athletes’ anxiety and achievement goal patterns as these may affect both the athletes’ well-being and performance

On the determination of the ductile to brittle transition temperature from small punch tests on Grade 91 ferritic-martensitic steel

The exposure of structural materials to the environment in nuclear power plants leads to aging through thermal and/or irradiation effects. One of the consequences of this aging is the shift of the ductile to brittle transition temperature (DBTT) towards higher temperatures. Characterising the aging of structural materials is therefore a safety relevant topic especially in the context of long term operation of nuclear plants. For testing in service materials and to reduce the health risks and costs associated with handling of irradiated materials miniature testing techniques are being developed. The small punch (SP) technique is one of these methods. In a tensile/fracture SP test, a punch with a hemispherical tip is pushed with a constant displacement rate through the center of a small cylindrical disk specimen. A series of tensile SP tests on the ferritic/martensitic steel Gr. 91 at two different displacement rates show no impact of the displacement rate on the DBTT. A new method using fracture energies normalized to the maximum force for deriving the DBTT from force-deflection data is presented. Post-test analysis by means of X-ray computed tomography is used for deriving the DBTT from fracture strains. Both methods give consistent values for the transition temperature. However, the DBTT determined in this study is higher than what can be found in the literature. Supplementary tests indicate that the punch diameter has an effect on the SP defined DBTT.JRC.G.I.4-Nuclear Reactor Safety and Emergency Preparednes