Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies

Purpose: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct, comprehensible, and data-driven. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states. Methods: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort domain from the EuroQol-5D was incorporated at the final stage. Results: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair. Conclusions: Overall, the combined use of Rasch and cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states

Combining Rasch and cluster analysis: a novel method for developing rheumatoid arthritis states for use in valuation studies

Purpose: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct, comprehensible, and data-driven. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states. Methods: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort domain from the EuroQol-5D was incorporated at the final stage. Results: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair. Conclusions: Overall, the combined use of Rasch and cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states.health state; Rasch analysis; cluster analysis; quality of life; rheumatoid arthritis

A qualitative study exploring the general population's perception of rheumatoid arthritis after being informed about disease adaptation

Purpose: This study aimed to gain an understanding of what factors induce individuals to alter their opinions about a health condition after being informed about disease adaptation and being given time to reflect and deliberate on this information. Rheumatoid arthritis (RA) states are used as an illustration. Methods: Semi-structured interviews were conducted with 12 members of the general population. They completed two time trade-off exercises for three RA states and underwent an adaptation exercise (AE) which consisted of listening to recordings of patients discussing how they adapted to RA. Also included was a structured discussion to encourage the participant to reflect on how the patients have adapted. Participants were shown their own health state values, as well as patient values. Findings: After being informed about disease adaptation and reflecting on the information, participants were more likely to consider adaptation and alter their opinions of RA if they were able to empathise with the patients in the AE. This enabled individuals to feel that they could cope by reflecting on their experience of RA in family and friends, by drawing on others for support if they had RA, and by having a positive attitude towards life. Conclusions: The results demonstrate that there is a range of reasons for which people change their perceptions about RA; this requires further exploration

A qualitative study exploring the general population's perception of rheumatoid arthritis after being informed about disease adaptation

Purpose: This study aimed to gain an understanding of what factors induce individuals to alter their opinions about a health condition after being informed about disease adaptation and being given time to reflect and deliberate on this information. Rheumatoid arthritis (RA) states are used as an illustration. Methods: Semi-structured interviews were conducted with 12 members of the general population. They completed two time trade-off exercises for three RA states and underwent an adaptation exercise (AE) which consisted of listening to recordings of patients discussing how they adapted to RA. Also included was a structured discussion to encourage the participant to reflect on how the patients have adapted. Participants were shown their own health state values, as well as patient values. Findings: After being informed about disease adaptation and reflecting on the information, participants were more likely to consider adaptation and alter their opinions of RA if they were able to empathise with the patients in the AE. This enabled individuals to feel that they could cope by reflecting on their experience of RA in family and friends, by drawing on others for support if they had RA, and by having a positive attitude towards life. Conclusions: The results demonstrate that there is a range of reasons for which people change their perceptions about RA; this requires further exploration

A qualitative study exploring the general population’s perception of rheumatoid arthritis after being informed about disease adaptation

Purpose: This study aimed to gain an understanding of what factors induce individuals to alter their opinions about a health condition after being informed about disease adaptation and being given time to reflect and deliberate on this information. Rheumatoid arthritis (RA) states are used as an illustration. Methods: Semi-structured interviews were conducted with 12 members of the general population. They completed two time trade-off exercises for three RA states and underwent an adaptation exercise (AE) which consisted of listening to recordings of patients discussing how they adapted to RA. Also included was a structured discussion to encourage the participant to reflect on how the patients have adapted. Participants were shown their own health state values, as well as patient values. Findings: After being informed about disease adaptation and reflecting on the information, participants were more likely to consider adaptation and alter their opinions of RA if they were able to empathise with the patients in the AE. This enabled individuals to feel that they could cope by reflecting on their experience of RA in family and friends, by drawing on others for support if they had RA, and by having a positive attitude towards life. Conclusions: The results demonstrate that there is a range of reasons for which people change their perceptions about RA; this requires further exploration.health state valuation; qualitative research; quality of life; disease adaptation

Importance of faculty role modelling for teaching professionalism to medical students:Individual versus institutional responsibility

OBJECTIVE: This study explores the perceptions of final year medical students and clinical faculty with regard to role modelling in teaching professionalism. METHODS: In this qualitative research design, we used the Constructivist Grounded Theory model. Six semi-structured interviews with faculty from six clinical specialties and three focus group discussions with 22 final year students were conducted. We applied initial, focused and selective coding along with a thematic analysis of the subject to develop a core category. This is the first part of a larger study that addresses the impact of positive role modelling on teaching professionalism. Findings relevant to negative role modelling are being reported in a subsequent paper. RESULTS: The results showed consensus that positive role modelling is the most important strategy for teaching professionalism to medical students. A disturbing finding was a perceived deteriorating level of inspirational positive role modelling. A lack of institutional support and weak regulatory control were pointed out as potential factors contributing towards this deterioration. CONCLUSION: Positive role modelling was found to be the most effective way to teach professionalism to medical students. However, it cannot be truly effective unless institutions play their role which is pivotal in promoting a culture of professionalism. This can be materialized by recognizing and facilitating conscientious and explicit role modelling by the medical faculty. In addition, an effective regulatory control by the concerned authorities could play an important role

Immune genes undergo more adaptive evolution than non-immune system genes in Daphnia pulex

<p>Abstract</p> <p>Background</p> <p>Understanding which parts of the genome have been most influenced by adaptive evolution remains an unsolved puzzle. Some evidence suggests that selection has the greatest impact on regions of the genome that interact with other evolving genomes, including loci that are involved in host-parasite co-evolutionary processes. In this study, we used a population genetic approach to test this hypothesis by comparing DNA sequences of 30 putative immune system genes in the crustacean <it>Daphnia pulex</it> with 24 non-immune system genes.</p> <p>Results</p> <p>In support of the hypothesis, results from a multilocus extension of the McDonald-Kreitman (MK) test indicate that immune system genes as a class have experienced more adaptive evolution than non-immune system genes. However, not all immune system genes show evidence of adaptive evolution. Additionally, we apply single locus MK tests and calculate population genetic parameters at all loci in order to characterize the mode of selection (directional versus balancing) in the genes that show the greatest deviation from neutral evolution.</p> <p>Conclusions</p> <p>Our data are consistent with the hypothesis that immune system genes undergo more adaptive evolution than non-immune system genes, possibly as a result of host-parasite arms races. The results of these analyses highlight several candidate loci undergoing adaptive evolution that could be targeted in future studies.</p

The Invisible Thin Red Line

The aim of this paper is to argue that the adoption of an unrestricted principle of bivalence is compatible with a metaphysics that (i) denies that the future is real, (ii) adopts nomological indeterminism, and (iii) exploits a branching structure to provide a semantics for future contingent claims. To this end, we elaborate what we call Flow Fragmentalism, a view inspired by Kit Fine (2005)’s non-standard tense realism, according to which reality is divided up into maximally coherent collections of tensed facts. In this way, we show how to reconcile a genuinely A-theoretic branching-time model with the idea that there is a branch corresponding to the thin red line, that is, the branch that will turn out to be the actual future history of the world