Development of a patient-reported palliative care-specific health classification system: the POS-E

BackgroundGeneric preference-based measures are commonly used to estimate quality-adjusted life-years (QALYs) to inform resource-allocation decisions. However, concerns have been raised that generic measures may be inappropriate in palliative care.ObjectiveOur objective was to derive a health-state classification system that is amenable to valuation from the ten-item Palliative Care Outcome Scale (POS), a widely used patient-reported outcome measure in palliative care.MethodsThe dimensional structure of the original POS was assessed using factor analysis. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of items that represent the dimensions covered by the POS. Data from six studies of patients receiving palliative care were combined (N = 1011) and randomly split into two halves for development and validation. Analysis was undertaken on the development data, and results were validated by repeating the analysis with the validation dataset.ResultsFollowing Rasch and factor analyses, a classification system of seven items was derived. Each item had two to three levels. Rasch threshold map helped identify a set of 14 plausible health states that can be used for the valuation of the instrument to derive a preference-based index.ConclusionCombining factor analysis and Rasch analysis with psychometric criteria provides a valid method of constructing a classification system for a palliative care-specific preference-based measure. The next stage is to obtain preference weights so the measure can be used in economic evaluations in palliative care

Patient and health care professional decision-making to commence and withdraw from renal dialysis: A systematic review of qualitative research

Background and objectives. To ensure decisions to start and stop dialysis in end stage kidney disease are shared, the factors that affect patients and healthcare professionals in making such decisions need to be understood. This systematic review aims to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, and measurements. Medline, Embase, CINAHL and PsychINFO were searched for qualitative studies of factors that affect patients’ and/or healthcare professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results. Of 494 articles screened, 12 studies (conducted: 1985-2014) were included. These involved 206 predominantly haemodialysis patients and 64 healthcare professionals (age range: patients 26-93; professionals 26-61 years). (i) Commencing dialysis: patients based their choice on ‘gut-instinct’ as well as deliberating the impact of treatment on quality-of-life and survival. How individuals coped with decision-making was influential, some tried to take control of the problem of progressive renal failure, whilst others focussed on controlling their emotions. Healthcare professionals weighed-up biomedical factors and were led by an instinct to prolong life. Both patients and healthcare professionals described feeling powerless. (ii) Dialysis withdrawal: Only after prolonged periods of time on dialysis, were the realities of life on dialysis fully appreciated and past choice questioned. By this stage however patients were physically treatment dependent. Similar to commencing dialysis, individuals coped with treatment withdrawal in a problem or emotion-controlling way. Families struggled to differentiate choosing versus allowing death. Healthcare teams avoided and queried discussions regarding dialysis withdrawal. Patients however missed the dialogue they experienced during pre-dialysis education. Conclusions. Decision-making in end stage kidney disease is complex, dynamic, and evolves over time and towards death. The factors at work are multi-faceted and operate differently for patients and health professionals. More training and research on open-communication and shared decision-making is needed

Ward's Hierarchical Clustering Method: Clustering Criterion and Agglomerative Algorithm

The Ward error sum of squares hierarchical clustering method has been very widely used since its first description by Ward in a 1963 publication. It has also been generalized in various ways. However there are different interpretations in the literature and there are different implementations of the Ward agglomerative algorithm in commonly used software systems, including differing expressions of the agglomerative criterion. Our survey work and case studies will be useful for all those involved in developing software for data analysis using Ward's hierarchical clustering method.Comment: 20 pages, 21 citations, 4 figure

Microwave temperature and pressure measurements with the Odin satellite: I. Observational method

The Odin satellite is equipped with millimetre and sub-millimetre receivers for observations of several molecular lines in the middle and upper atmosphere of our planet (~25–100 km, the particular altitude range depending on the species) for studies in dynamics, chemistry, and energy transfer in these regions. The same receivers are also used to observe molecules in outer space, this being the astrophysical share of the project. Among the atmospheric lines that can be observed, we find two corresponding to molecular oxygen (118.75 GHz and 487.25 GHz). These lines can be used for retrievals of the atmospheric temperature vertical profile. In this paper, we describe the radiative-transfer modeling for O2 in the middle and upper atmosphere that we will use as a basis for the retrieval algorithms. Two different observation modes have been planned for Odin, the three-channel operational mode and a high-resolution mode. The first one will determine the temperature and pressure on an operational basis using the oxygen line at 118.75 GHz, while the latter can be used for measurements of both O2 lines, during a small fraction of the total available time for aeronomy, aimed at checking the particular details of the radiative transfer near O2 lines at very high altitudes (>70 km). The Odin temperature measurements are expected to cover the altitude range ~30–90 km

Psychosocial factors related to children’s active school travel : A comparison of two European regions

Peer reviewedPublisher PD

Moral, wasteful, frugal, or thrifty? Identifying consumer identities to understand and manage pro-environmental behaviour

Moral motives are important for pro-environmental behavior. But such behavior is not only motivated by moral or environmental concerns. We examined what higher order motives, other than morality, may be important for understanding pro-environmental behavior, by studying consumer identities. In three studies (N = 877) four consumer identities were distinguished: moral, wasteful, frugal, and thrifty. Frugal and moral consumer identities were most salient and were the strongest predictors of pro-environmental behaviors, but in different ways. Frugality, which is related to, but distinct from thriftiness, was particularly important for behaviors associated with waste reduction of any kind (including money). The findings suggest that people adopt the same behavior for different reasons, in ways consistent with their consumer identities. People manage multiple consumer identities simultaneously, and environmental policy is likely to be more effective if it addresses these multiple identities