190 research outputs found
Sea Bed Sand Waves Studied To Help Pipeline Planners
The article cites a study that offers information on the variability of sand wave characteristics in the North Sea. The sand waves variability includes a statement that pipelines may start vibrating due to turbulence generated under the free span and navigational channels often need to be dredged for ships to pass safely. The study used multi-beam measurement of three fields in the North Sea in which sand waves occur. Moreover, the study concludes that understanding the variability of sand waves can help determine the optimal depth of a pipeline trench
How young people from culturally and linguistically diverse backgrounds experience mental health: some insights for mental health nurses
This article reports on a part of a study which looked at the mental health of
culturally and linguistically diverse (CALD) young people. The research sought to learn
from CALD young people, carers, and service providers experiences relevant to the
mental health of this group of young people. The ultimate goal was to gain insights that
would inform government policy, service providers, ethnic communities and most
importantly the young people themselves. To this end, qualitative interviews were
undertaken with 123 CALD young people, 41 carers and 14 mental health service
providers in Queensland, Western Australia and South Australia.
Only one aspect of the study will be dealt with here, namely the views of the
young CALD participants, which included risk factors, coping strategies and
recommendations about how they could be supported in their struggle to maintain
mental health. One of the most important findings of the study relates to the resilience
of these young people and an insight into the strategies that they used to cope. The
efforts of these young people to assist us in our attempts to understand their situation
deserve to be rewarded by improvements in the care that we provide. To this end this
article sets out to inform mental health nurses of the results of the study so that they will
be in a position to better understand the needs and strengths of their CALD clients and
be in a better position to work effectively with them
Severity-Stratified Discrete Choice Experiment Designs for Health State Evaluations
__Background:__ Discrete choice experiments (DCEs) are increasingly used for health state valuations. However, the values derived from initial DCE studies vary widely. We hypothesize that these findings indicate the presence of unknown sources of bias that must be recognized and minimized. Against this background, we studied whether values derived from a DCE are sensitive to how well the DCE design spans the severity range.
__Methods:__ We constructed an experiment involving three variants of DCE tasks for health state valuation: standard DCE, DCE-death, and DCE-duration. For each type of DCE, an experimental design was generated under two different conditions, enabling a comparison of health state values derived from current best practice Bayesian efficient DCE designs with values derived from âseverity-stratifiedâ designs that control for coverage of the severity range in health state selection. About 3000 respondents participated in the study and were randomly assigned to one of the six study arms.
__Results:__ Imposing the severity-stratified restriction had a large effect on health states sampled for the DCE-duration approach. The unstratified efficient design returned a skewed distribution of selected health states, and this introduced bias. The choice probability of bad health states was underestimated, and time trade-offs to avoid bad states were overestimated, resulting in too low values. Imposing the same restriction had limited effect in the DCE-death approach and standard DCE.
__Conclusion:__ Variation in DCE-derived values can be partially explained by differences in how well selected health states spanned the severity range. Imposing a âseverity stratificationâ on DCE-duration designs is a validity requirement
Quality Control Process for EQ-5D-5L Valuation Studies
Background: The values of the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are elicited using composite time trade-off and discrete choice experiments. Unfortunately, data quality issues and interviewer effects were observed in the first few EQ-5D-5L valuation studies. To prevent these issues from occurring in later studies, the EuroQol Group established a cyclic quality control (QC) process. Objectives: To describe this QC process and show its impact on data quality. Methods: A newly developed QC tool provided information about protocol compliance, interviewer effects, and mean values by health state severity. In a cyclic process, this information is initially used to evaluate whether new interviewers meet minimal quality requirements and later to provide feedback about how their performance may be improved. To investigate the impact of this cyclic process, we compared the quality of the data in Dutch and Spanish valuation studies that did not have this QC process with that in the follow-up studies in the same countries that used the QC process. Data quality was measured using protocol violations, variability between interviewers, the proportion of inconsistent responders, and clustering of composite time trade-off values. Results: In Spain, protocol violations were reduced from 87% in the valuation study to 5% in the follow-up study and in the Netherlands from 20% to 8%. In both countries, interviewers performed more homogeneously in the follow-up studies. The number of inconsistent respondents was reduced by 23.2% in Spain and 23.6% in the Netherlands. Values were less clustered in the follow-up studies. Conclusions: The implementation of a strict QC process in EQ-5D-5L valuation studies increases interviewer protocol compliance and promotes data quality
Exploring the Impact of Adding a Respiratory Dimension to the EQ-5D-5L.
Objectives. To evaluate the impact of adding a respiratory dimension (a bolt-on dimension) to the EQ-5D-5L health
state valuations. Methods. Based on extensive regression and principal component analyses, 2 respiratory bolt-on
candidates were formulated: R1, limitations in physical activities due to shortness of breath, and R2, breathing problems. Valuation interviews for the selected bol
Using Age-Specific Values for Pediatric HRQoL in a Cost-Effectiveness Analysis : Is There a Problem to Be Solved? If So, How?
Value sets for the EQ-5D-Y-3L published to date appear to have distinctive characteristics compared with value sets for corresponding adult instruments: in many cases, the value for the worst health state is higher and there are fewer values < 0. The aim of this paper is to consider how and why values for child and adult health differ; and what the implications of that are for the use of EQ-5D-Y-3L values in economic evaluations to inform healthcare resource allocation decisions. We posit four potential explanations for the differences in values: (a) The wording of severity labels may mean the worst problems on the EQ-5D-Y-3L are descriptively less severe than those on the EQ-5D-5L; (b) Adults may genuinely consider that children are less badly affected than adults by descriptively similar health issues. That is, for any given health problem, adult respondents in valuation studies consider childrenâs overall health-related quality of life (HRQoL) on average to be higher than that for adults; (c) Values are being sought by eliciting adultsâ stated preferences for HRQoL in another person, rather than in themselves (regardless of whether the âother personâ concerned is a child); and (d) The need to elicit preferences for child HRQoL that are anchored at dead = 0 invokes special considerations regarding childrenâs survival. Existing evidence does not rule out the possibility that (c) and (d) exert an upward bias in values. We consider the implications of that for the interpretation and use of values for pediatric HRQoL. Alternative methods for valuing childrenâs HRQoL in a manner that is not âage specificâ are possible and may help to avoid issues of non-comparability. Use of these methods would place the onus on health technology assessment bodies to reflect any special considerations regarding child quality-adjusted life-year gains
Positive & Negative Roles of Innate Effector Cells in Controlling Cancer Progression
Innate immune cells are active at the front line of host defense against pathogens and now appear to play a range of roles under non-infectious conditions as well, most notably in cancer. Establishing the balance of innate immune responses is critical for the âflavorâ of these responses and subsequent adaptive immunity and can be either âgood or badâ in controlling cancer progression. The importance of innate NK cells in tumor immune responses has already been extensively studied over the last few decades, but more recently several relatively mono- or oligo-clonal [i.e., (semi-) invariant] innate T cell subsets received substantial interest in tumor immunology including invariant natural killer T (iNKT), γΎ-T and mucosal associated invariant T (MAIT) cells. These subsets produce high levels of various pro- and/or anti-inflammatory cytokines/chemokines reflecting their capacity to suppress or stimulate immune responses. Survival of patients with cancer has been linked to the frequencies and activation status of NK, iNKT, and γΎ-T cells. It has become clear that NK, iNKT, γΎ-T as well as MAIT cells all have physiological roles in anti-tumor responses, which emphasize their possible relevance for tumor immunotherapy. A variety of clinical trials has focused on manipulating NK, iNKT, and γΎ-T cell functions as a cancer immunotherapeutic approach demonstrating their safety and potential for achieving beneficial therapeutic effects, while the exploration of MAIT cell related therapies is still in its infancy. Current issues limiting the full therapeutic potential of these innate cell subsets appear to be related to defects and suppressive properties of these subsets that, with the right stimulus, might be reversed. In general, how innate lymphocytes are activated appears to control their subsequent abilities and consequent impact on adaptive immunity. Controlling these potent regulators and mediators of the immune system should enable their protective roles to dominate and their deleterious potential (in the specific context of cancer) to be mitigated
Time to tweak the TTO: results from a comparison of alternative specifications of the TTO
Abstract This article examines the effect that different
specifications of the time trade-off (TTO) valuation task
may have on values for EQ-5D-5L health states. The new
variants of the TTO, namely lead-time TTO and lag-time
TTO, along with the classic approach to TTO were compared
using two durations for the health states (15 and
20 years). The study tested whether these methods yield
comparable health-state values. TTO tasks were administered
online. It was found that lag-time TTO produced
lower values than lead-time TTO and that the difference
was larger in the longer time frame. Classic TTO values
most resembled those of the lag-time TTO in a 20-year
time frame in terms of mean absolute difference. The relative
importance of different domains of health was systematically
affected by the duration of the health state. In
the tasks with a 10-year health-state duration, anxiety/
depression had the largest negative impact on health-state
values; in the tasks with a 5-year duration, the pain/discomfort
domain had the largest negative impact
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