Synergies between processing and memory in children's reading span.

Previous research has established the relevance of working memory for cognitive development. Yet the factors responsible for shaping performance in the complex span tasks used to assess working memory capacity are not fully understood. We report a study of reading span in 7- to 11-year old children that addresses several contemporary theoretical issues. We demonstrate that both the timing and the accuracy of recall are affected by the presence or absence of a semantic connection between the processing requirement and the memoranda. Evidence that there can be synergies between processing and memory argues against the view that complex span simply measures the competition between these activities. We also demonstrate a consistent relationship between the rate of completing processing operations (sentence reading) and recall accuracy. At the same time, the shape and strength of this function varies with the task configuration. Taken together, these results demonstrate the potential for reconstructive influences to shape working memory performance among children

Reforming the cancer drug fund focus on drugs that might be shown to be cost effective

The Cancer Drug Fund was originally conceived as a temporary measure, until value based pricing for drugs was introduced, to give NHS cancer patients access to drugs not approved by NICE. Spending on these drugs rose from less than the £50m (€63m; $79m) budgeted for the first year in 2010-11 to well over £200m in 2013-14, and the budget for the scheme—now extended for a further two years—will reach £280m by 2016.1 The recent changes to the fund recognise the impossibility, within any sensible budget limit, of providing all the new cancer drugs that offer possible benefit to patients. More radical changes are needed to the working of the fund, given the failure to introduce value based pricing, so that it deals with the underlying problem of inadequate information on the effectiveness and cost effectiveness of new cancer drugs when used in the NHS

Dealing with digital: the economic organisation of streamed music

© The Author(s) 2020. The intervention of digital service providers (DSPs) or platforms, such as Spotify Apple Music and Tidal, that supply streamed music has fundamentally altered the operation of copyright management organisations (CMOs) and the way song-writers and recording artists are paid. Platform economics has emerged from the economic analysis of two- and multi-sided markets, offering new insights into the way business is conducted in the digital sphere and is applied here to music streaming services. The business model for music streaming differs from previous arrangements by which the royalty paid to song-writers and performers was a percentage of sales. In the case of streamed music, payment is based on revenues from both subscriptions and ad-based free services. The DSP agrees a rate per stream with the various rights holders that varies according to the deal made with each of the major record labels, with CMOs, with representatives of independent labels and with unsigned artists and song-writers with consequences for artists’ earnings. The article discusses these various strands with a view to understanding royalty payments for streamed music in terms of platform economics, offering some data and information from the Norwegian music industry to give empirical support to the analysis

With development, list recall includes more chunks, not just larger ones.

The nature of the childhood development of immediate recall has been difficult to determine. There could be a developmental increase in either the number of chunks held in working memory or the use of grouping to make the most of a constant capacity. In 3 experiments with children in the early elementary school years and adults, we show that improvements in the immediate recall of word and picture lists come partly from increases in the number of chunks of items retained in memory. This finding was based on a distinction between access to a studied group of items (i.e., recall of at least 1 item from the group) and completion of the accessed group (i.e., the proportion of the items recalled from the group). Access rates increased with age, even with statistical controls for completion rates, implicating development of capacity in chunks. (PsycINFO Database Record (c) 2010 APA, all rights reserved

On the interpretation of working memory span in adults.

Experimental research into children’s working memory span has shown that retention duration contributes substantially to span performance, while processing efficiency need not be related to concurrent memory load (Towse, Hitch, & Hutton, 1998). These findings have been used to argue for a model of working memory span that emphasizes time-based forgetting rather than the popular resource-sharing or tradeoff framework. The present paper considers whether adults perform working memory span tasks in a qualitatively different way. Data from reading span and operation span tasks show that adults’ performance can be distinguished from that of children, but also that a task-switching model of working memory span can explain some important aspects of performance

On the nature of the relationship between processing activity and item retention in children.

The concept of working memory emphasizes the interrelationship between the transient retention of information and concurrent processing activity. Three experiments address this relationship in children between 8 and 17 years of age by examining forgetting when a processing task is interpolated between presentation and recall of the memory items. Unlike previous studies, delivery of interpolated stimuli was under computer control and responses to these stimuli were timed. There were consistent effects of the duration of the interpolated task, but no effects of either its difficulty or similarity to memory material and no qualitative developmental differences in task performance. The absence of an effect of difficulty provides no support for models of working memory in which limited capacity is shared between the dual functions of processing and storage, but is compatible with an alternative “task switching” account. However, task switching did not explain developmental differences in recall. Other aspects of the results suggest that there can be interactions between processing and storage but it is argued that these cannot be straightforwardly explained in terms of either task switching or resource sharing

Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare

Background Advanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them. Objectives To identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology—specifically economic evaluation methods—in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges. Methods An Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs. Results Three key topics were identified and prioritised for discussion—uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making. Conclusions ATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access. Classification code I

Characterizing active and inactive brown adipose tissue in adult humans using PET-CT and MR imaging

Activated brown adipose tissue (BAT) plays an important role in thermogenesis and whole body metabolism in mammals. Positron emission tomography (PET)-computed tomography (CT) imaging has identified depots of BAT in adult humans, igniting scientific interest. The purpose of this study is to characterize both active and inactive supraclavicular BAT in adults and compare the values to those of subcutaneous white adipose tissue (WAT). We obtained [18F]fluorodeoxyglucose ([18F]FDG) PET-CT and magnetic resonance imaging (MRI) scans of 25 healthy adults. Unlike [18F]FDG PET, which can detect only active BAT, MRI is capable of detecting both active and inactive BAT. The MRI-derived fat signal fraction (FSF) of active BAT was significantly lower than that of inactive BAT (means ± SD; 60.2 ± 7.6 vs. 62.4 ± 6.8%, respectively). This change in tissue morphology was also reflected as a significant increase in Hounsfield units (HU; −69.4 ± 11.5 vs. −74.5 ± 9.7 HU, respectively). Additionally, the CT HU, MRI FSF, and MRI R2* values are significantly different between BAT and WAT, regardless of the activation status of BAT. To the best of our knowledge, this is the first study to quantify PET-CT and MRI FSF measurements and utilize a semiautomated algorithm to identify inactive and active BAT in the same adult subjects. Our findings support the use of these metrics to characterize and distinguish between BAT and WAT and lay the foundation for future MRI analysis with the hope that some day MRI-based delineation of BAT can stand on its own

Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand

BACKGROUND: In Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs), 37 private clinics and 37 private hospital OPDs. METHOD: Analysis of the characteristics of 148 taped consultations with simulated patients. RESULTS: The family practices performed better than public hospital OPDs with regard to responsiveness, patient-centredness and cost of technical investigations (M-W U: p < 0.001). Prescribing patterns were similar, but family practices prescribed fewer drugs and were less costly than private clinics and hospitals (M-W U: p < 0.001). The degree of patient-centredness was not significantly different. Private clinics and private hospitals scored better for responsiveness. CONCLUSION: In Thailand self-styled family practices, even without specific training, provide a service that is more responsive and patient-centred than conventional care, with less overmedicalization and at a lower cost. Changes in prescription practices may require deeper changes in the medical culture

Clinical Feasibility of Noninvasive Visualization of Lymphatic Flow with Principles of Spin Labeling MR Imaging: Implications for Lymphedema Assessment

Purpose To extend a commonly used noninvasive arterial spin labeling magnetic resonance (MR) imaging method for measuring blood flow to evaluate lymphatic flow. Materials and Methods All volunteers (n = 12) provided informed consent in accordance with institutional review board and HIPAA regulations. Quantitative relaxation time (T1 and T2) measurements were made in extracted human lymphatic fluid at 3.0 T. Guided by these parameters, an arterial spin labeling MR imaging approach was adapted to measure lymphatic flow (flow-alternating inversion-recovery lymphatic water labeling, 3 × 3 × 5 mm) in healthy subjects (n = 6; mean age, 30 years ± 1 [standard deviation]; recruitment duration, 2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of postlabeling delay time and by measuring time to peak signal intensity in axillary lymph nodes. Clinical feasibility was evaluated in patients with stage II lymphedema (three women; age range, 43–64 years) and in control subjects with unilateral cuff-induced lymphatic stenosis (one woman, two men; age range, 31–35 years). Results Mean T1 and T2 relaxation times of lymphatic fluid at 3.0 T were 3100 msec ± 160 (range, 2930–3210 msec; median, 3200 msec) and 610 msec ± 12 (range, 598–618 msec; median, 610 msec), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was 0.61 cm/min ± 0.13 (n = 6). A reduction (P \u3c .005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24 ± 0.18) was significantly (P \u3c .005) higher than the left-to-right ratio in healthy subjects (0.91 ± 0.18). Conclusion This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment