Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer : eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment

Acknowledgements We thank all the patients and volunteers who agreed to participate in this study and the study contributors.Peer reviewe

Regulating E-Cigarettes: Why Policies Diverge

This paper, part of a festschrift in honor of Professor Malcolm Feeley, explores the landscape of e-cigarette policy globally by looking at three jurisdictions that have taken starkly different approaches to regulating e-cigarettes—the US, Japan, and China. Each of those countries has a robust tobacco industry, government agencies entrusted with protecting public health, an active and sophisticated scientific and medical community, and a regulatory structure for managing new pharmaceutical, tobacco, and consumer products. All three are signatories of the World Health Organization’s Framework Convention on Tobacco Control, all are signatories of the Agreement on Trade-Related Aspects of Intellectual Property Rights, and all are members of the World Trade Organization. Which legal, economic, social and political differences between the three countries explain their diverse approaches to regulating e-cigarettes? Why have they embraced such dramatically different postures toward e-cigarettes? In seeking to answer those questions, the paper builds on Feeley\u27s legacy of comparative scholarship, policy analysis, and focus on law in action

Understanding Riverine Habitat Inundation Patterns: Remote Sensing Tools and Techniques

Regulated flow releases are key components in the ecological restoration of river ecosystems. Understanding relationships among hydrology, habitat inundation, and ecological processes at appropriate spatial scales is required to optimise ecological outcomes. This study used high resolution remotely sensed data to develop a three dimensional (3D) channel and floodplain riverine habitat inundation model. High-resolution LiDAR and digital imagery data were used to develop 3D digital-elevation models. Data segmentation techniques were used to map channel and non-channel areas, while in-channel habitats were identified through topographic characteristics. Object Oriented analysis was used to separate overbank vegetated and non-vegetated areas. Field surveys were undertaken to record the location and diameter of large woody debris (LWD), and canopy foliar density in addition to general landscape description. A qualitative evaluation of the accuracy of the habitat map showed that LiDAR-based discrimination of topographic features and the derivation of a canopy foliar density layer was successful. Mapping of LWD was unsuccessful due to size relative to the LiDAR point cloud density and vertical resolution. The high resolution remotely sensed data used in this study provide a useful tool for understanding river processes at reach scales by linking inundation patterns to geomorphic features, providing a framework for predicting ecological outcomes from river flow regimes

Destitution in the UK 2023

There has been a shameful increase in the level of destitution in the UK, with a growing number of people struggling to afford to meet their most basic physical needs to stay warm, dry, clean and fed. This has deep and profound impacts on people’s health, mental health and prospects; it also puts strain on already overstretched services. This study, the fourth in the Destitution in the UK series, reveals that approximately 3.8 million people experienced destitution in 2022, including around one million children. This is almost two-and-a-half times the number of people in 2017 and nearly triple the number of children. Such high and increasing levels of destitution have no place in a country like ours. Nearly three-quarters of people experiencing destitution are in receipt of social security payments – further evidence of benefit inadequacy. Ad-hoc support from the Government, first during the Covid-19 pandemic and now to help with the cost of living, has not halted the rising level of destitution. There is an urgent need for action to tackle destitution in the UK

Destitution in the UK 2023

There has been a shameful increase in the level of destitution in the UK, with a growing number of people struggling to afford to meet their most basic physical needs to stay warm, dry, clean and fed. This has deep and profound impacts on people’s health, mental health and prospects; it also puts strain on already overstretched services. This study, the fourth in the Destitution in the UK series, reveals that approximately 3.8 million people experienced destitution in 2022, including around one million children. This is almost two-and-a-half times the number of people in 2017 and nearly triple the number of children. Such high and increasing levels of destitution have no place in a country like ours. Nearly three-quarters of people experiencing destitution are in receipt of social security payments – further evidence of benefit inadequacy. Ad-hoc support from the Government, first during the Covid-19 pandemic and now to help with the cost of living, has not halted the rising level of destitution. There is an urgent need for action to tackle destitution in the UK

Destitution in the UK 2020

No abstract available

InfoBC Discrete Choice Experiment Data

The data describes the responses of 113 self identified patient respondents for a discrete choice experiment investigating trade-offs between hypothetical treatments. A pending abstract for the paper is included below. Background: There has been a recent proliferation in treatment options for patients with metastatic breast cancer. Discussions surrounding treatment often involve trade-offs between overall survival and side-effects. Understanding patient preferences for such trade-offs can support shared decision-making. Methods: We designed a discrete choice experiment (DCE) to look at patient trade-offs between overall survival and side-effects which impact quality of life when choosing between treatments for metastatic breast cancer. Treatment attributes were fatigue, nausea, diarrhoea, other side-effects (peripheral neuropathy, hand foot syndrome, and mucositis), urgent hospital admission and overall survival (annual probability of survival). Responses were analysed using a multinomial logit model and willingness to trade overall survival for improvements in side-effects was estimated. Results: 113 respondents participated, including 72 metastatic breast cancer patients and 33 primary breast cancer patients. Whilst overall survival was highly important respondents demonstrated a willingness to trade overall survival for reductions in Grade 2 side-effects. Respondents were willing to give up the greatest survival to avoid Grade 2 side-effects relative to no side-effects: firstly, hand foot syndrome (10.66%), then mucositis (9.80%), peripheral neuropathy (9.20%), and finally diarrhoea (6.14%). Grade 1 side-effects were not significant, suggesting respondents were willing to tolerate them and unwilling to forgo any survival benefits to avoid them. Risk of urgent hospital admission was not significant. Conclusion: Patient trade-offs can form a baseline for discussion in the doctor-patient consultation, helping to move towards a process of shared decision-making.Hall, Peter; Bullen, Alistair; Ennis, Holly; Loria Rebolldo, Luis; McIntyre, Morag. (2022). InfoBC Discrete Choice Experiment Data, [dataset]. University of Edinburgh. Edinburgh Medical School. Molecular, Genetic and Population Health Sciences. Usher Institute. https://doi.org/10.7488/ds/3460