Does responsibility affect the public valuation of health care interventions? A relative valuation approach to health care safety

This article is available open access through the publisher’s website at the link below. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Objective - Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. Method - An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or “matching” method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Results - Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Conclusion - Our results suggest that people do not attach a simple fixed premium to “safety-related” interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.Brunel University

Spectroscopy of drums and quantum billiards: perturbative and non-perturbative results

We develop powerful numerical and analytical techniques for the solution of the Helmholtz equation on general domains. We prove two theorems: the first theorem provides an exact formula for the ground state of an arbirtrary membrane, while the second theorem generalizes this result to any excited state of the membrane. We also develop a systematic perturbative scheme which can be used to study the small deformations of a membrane of circular or square shapes. We discuss several applications, obtaining numerical and analytical results.Comment: 29 pages, 12 figures, 7 tabl

Quantum Reciprocity Conjecture for the Non-Equilibrium Steady State

By considering the lack of history dependence in the non-equilibrium steady state of a quantum system we are led to conjecture that in such a system, there is a set of quantum mechanical observables whose retarded response functions are insensitive to the arrow of time, and which consequently satisfy a quantum analog of the Onsager reciprocity relations. Systems which satisfy this conjecture can be described by an effective Free energy functional. We demonstrate that the conjecture holds in a resonant level model of a multi-lead quantum dot.Comment: References revised to take account of related work on Onsager reciprocity in mesoscopics by Christen, and in hydrodynamics by Mclennan, Dufty and Rub

Density functional theory study of the nematic-isotropic transition in an hybrid cell

We have employed the Density Functional Theory formalism to investigate the nematic-isotropic capillary transitions of a nematogen confined by walls that favor antagonist orientations to the liquid crystal molecules (hybrid cell). We analyse the behavior of the capillary transition as a function of the fluid-substrate interactions and the pore width. In addition to the usual capillary transition between isotropic-like to nematic-like states, we find that this transition can be suppressed when one substrate is wet by the isotropic phase and the other by the nematic phase. Under this condition the system presents interface-like states which allow to continuously transform the nematic-like phase to the isotropic-like phase without undergoing a phase transition. Two different mechanisms for the disappearance of the capillary transition are identified. When the director of the nematic-like state is homogeneously planar-anchored with respect to the substrates, the capillary transition ends up in a critical point. This scenario is analogous to the observed in Ising models when confined in slit pores with opposing surface fields which have critical wetting transitions. When the nematic-like state has a linearly distorted director field, the capillary transition continuously transforms in a transition between two nematic-like states.Comment: 31 pages, 10 figures, submitted to J. Chem. Phy

Retrograde transport pathways utilised by viruses and protein toxins

A model has been presented for retrograde transport of certain toxins and viruses from the cell surface to the ER that suggests an obligatory interaction with a glycolipid receptor at the cell surface. Here we review studies on the ER trafficking cholera toxin, Shiga and Shiga-like toxins, Pseudomonas exotoxin A and ricin, and compare the retrograde routes followed by these protein toxins to those of the ER trafficking SV40 and polyoma viruses. We conclude that there is in fact no obligatory requirement for a glycolipid receptor, nor even with a protein receptor in a lipid-rich environment. Emerging data suggests instead that there is no common pathway utilised for retrograde transport by all of these pathogens, the choice of route being determined by the particular receptor utilised

Protocol for an HTA report: Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic modelling

This article is made available through the Brunel Open Access Publishing Fund. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/Introduction: Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis. Methods: Included are any comparative study of therapeutic writing compared with no writing, waiting list, attention control or placebo writing in patients with any diagnosed LTCs that report at least one of the following: relevant clinical outcomes; quality of life; health service use; psychological, behavioural or social functioning; adherence or adverse events. Searches will be conducted in the main medical databases including MEDLINE, EMBASE, PsycINFO, The Cochrane Library and Science Citation Index. For the realist review, further purposive and iterative searches through snowballing techniques will be undertaken. Inclusions, data extraction and quality assessment will be in duplicate with disagreements resolved through discussion. Quality assessment will include using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data synthesis will be narrative and tabular with meta-analysis where appropriate. De novo economic modelling will be attempted in one clinical area if sufficient evidence is available and performed according to the National Institute for Health and Care Excellence (NICE) reference case.National Institute for Health Research Health Technology Assessment (NIHR HTA) Programm