How can health economics be used in the design and analysis of adaptive clinical trials? A qualitative analysis

Introduction Adaptive designs offer a flexible approach, allowing changes to a trial based on examinations of the data as it progresses. Adaptive clinical trials are becoming a popular choice, as the prudent use of finite research budgets and accurate decision-making are priorities for healthcare providers around the world. The methods of health economics, which aim to maximise the health gained for money spent, could be incorporated into the design and analysis of adaptive clinical trials to make them more efficient. We aimed to understand the perspectives of stakeholders in health technology assessments to inform recommendations for the use of health economics in adaptive clinical trials. Methods A qualitative study explored the attitudes of key stakeholders—including researchers, decision-makers and members of the public—towards the use of health economics in the design and analysis of adaptive clinical trials. Data were collected using interviews and focus groups (29 participants). A framework analysis was used to identify themes in the transcripts. Results It was considered that answering the clinical research question should be the priority in a clinical trial, notwithstanding the importance of cost-effectiveness for decision-making. Concerns raised by participants included handling the volatile nature of cost data at interim analyses; implementing this approach in global trials; resourcing adaptive trials which are designed and adapted based on health economic outcomes; and training stakeholders in these methods so that they can be implemented and appropriately interpreted. Conclusion The use of health economics in the design and analysis of adaptive clinical trials has the potential to increase the efficiency of health technology assessments worldwide. Recommendations are made concerning the development of methods allowing the use of health economics in adaptive clinical trials, and suggestions are given to facilitate their implementation in practice

Book Review: Space, Time and Medicine

Book Review of: Space, Time and Medicine by Larry Dossey (Shambhala, 1982

Stable isotopes of Hawaiian spiders reflect substrate properties along a chronosequence.

The Hawaiian Islands offer a unique opportunity to test how changes in the properties of an isolated ecosystem are propagated through the organisms that occur within that ecosystem. The age-structured arrangement of volcanic-derived substrates follows a regular progression over space and, by inference, time. We test how well documented successional changes in soil chemistry and associated vegetation are reflected in organisms at higher trophic levels-specifically, predatory arthropods (spiders)-across a range of functional groups. We focus on three separate spider lineages: one that builds capture webs, one that hunts actively, and one that specializes on eating other spiders. We analyze spiders from three sites across the Hawaiian chronosequence with substrate ages ranging from 200 to 20,000 years. To measure the extent to which chemical signatures of terrestrial substrates are propagated through higher trophic levels, we use standard stable isotope analyses of nitrogen and carbon, with plant leaves included as a baseline. The target taxa show the expected shift in isotope ratios of δ15N with trophic level, from plants to cursorial spiders to web-builders to spider eaters. Remarkably, organisms at all trophic levels also precisely reflect the successional changes in the soil stoichiometry of the island chronosequence, demonstrating how the biogeochemistry of the entire food web is determined by ecosystem succession of the substrates on which the organisms have evolved

Is Religion Banned From Our Schools?

Three hundred years ago Anglo-American teaching was done chiefly by the church. In early days English and American education was, in the main, created and sustained, inspired and controlled, by religious groups. But, today, in the greater part of the Protestant world, at least, education is secular. The school has been, or is being, cut off from the church. With the exception of some private schools and colleges it has been taken over by another social institution. What institution is that? There can be no doubt that, with conscious intention or without it, Anglo-American Protestant civilization has drifted into an answer to that question. It is the state which is replacing the church. It is government, nation, provincial, or local, which has control of teaching. Education is not only becoming secular. It is also becoming political

Recreation for the Handicapped

Recreation has become an important resource in the treatment of the mentally and physically handicapped. People with serious handicaps can be trained to lead happy, normal, productive lives. Such training is one of the greatest triumphs of modern medicine and education. Progress in the use of music and drama, including organization of groups in radio drama, was made in veterans\u27 hospitals, especially during and after World War II. With the development of occupational therapy, even bedridden patients found many activities possible, including both work and play. Those in wheel chairs have become proficient in various games. The obvious need for skill in the direction of such activities has led to the expansion of several professions, including music therapy and group work. At best these services and the centers in which they are provided have the benefit of medical and much psychiatric supervision. Equipment and leadership has turned many a center into a place where recreation has its place in the daily routine. We must (as a whole society) meet the needs of our handicapped before they can ever begin to enjoy life. They must be well clothed, fed, loved, etc. before we can ever succeed in providing recreation for them to enjoy and to forget their burdens. To build up a realization that there are games and recreation which a handicapped person can enjoy builds the morale of our country as well as gives a feeling of security to our pupils

Physical Education for Today\u27s Youth

I have dealt with the future trends in health and physical curricula and the problems young people face in physical education today. Each adult had their own ideal of recreation in their time of youth, but today\u27s youth has a will and wisdom all its own. Thus, they must be permitted to see health and recreation in the future as something to look forward to. We must work to make this possible

An Investigation to Determine If the Study of Shorthand Affects a Student\u27s Spelling Ability

Every business educator is aware that the spelling ability of beginning office workers is often criticized. There are several articles in the professional publications suggesting techniques used by teachers to cope with the problem, but most teachers leave to elementary and English teachers the task to develop this skill. Too frequently teachers overlook spelling and grammatical errors made by students because these are by-products of a more important goal which they are trying to reach. The increased demand for a better trained office worker necessitates an examination of the spelling ability of business education students. It is important to know whether there are weaknesses and, if possible, the causes of these difficulties

Modern Breakthroughs and Forecasts in Education

In September, 1957, many Americans pictured Russia as a vast slum composed largely of baggy-trousered peasants who couldn\u27t make a decent refrigerator or automobile. On October 4, 1957, when the Russians placed the first man-made hardware in orbit around the earth, this illusion exploded into bleak reality. The American people were staggered. The Eisenhower administration was in serious trouble--but not for long. Within weeks the nation was given to understand that the school teachers were to blame. America had fallen behind because John Dewey\u27s fuzzy-minded disciples had failed to teach children enough science. Suddenly, American secondary education became our national embarrassment