From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking

Objectives Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria and their frequency reported in the literature on healthcare decisionmaking. Method An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing multicriteria tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured. Results Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 40 studies included. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 360 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (32 times), efficacy/effectiveness (29), stakeholder interests and pressures (28), cost-effectiveness (23), strength of evidence (20), safety (19), mission and mandate of health system (19), organizational requirements and capacity (17), patient-reported outcomes (17) and need (16). Conclusion This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-settin

An NMR-based nanostructure switch for quantum logic

We propose a nanostructure switch based on nuclear magnetic resonance (NMR) which offers reliable quantum gate operation, an essential ingredient for building a quantum computer. The nuclear resonance is controlled by the magic number transitions of a few-electron quantum dot in an external magnetic field.Comment: 4 pages, 2 separate PostScript figures. Minor changes included. One reference adde

Equivalent thermo-mechanical parameters for perfect crystals

Thermo-elastic behavior of perfect single crystal is considered. The crystal is represented as a set of interacting particles (atoms). The approach for determination of equivalent continuum values for the discrete system is proposed. Averaging of equations of particles' motion and long wave approximation are used in order to make link between the discrete system and equivalent continuum. Basic balance equations for equivalent continuum are derived from microscopic equations. Macroscopic values such as Piola and Cauchy stress tensors and heat flux are represented via microscopic parameters. Connection between the heat flux and temperature is discussed. Equation of state in Mie-Gruneisen form connecting Cauchy stress tensor with deformation gradient and thermal energy is obtained from microscopic considerations.Comment: To be published in proceedings of IUTAM Simposium on "Vibration Analysis of Structures with Uncertainties", 2009; 14 pages

Search for the Hypothetical pi -> mu x Decay

The KARMEN collaboration has reported the possible observation of a hitherto unknown neutral and weakly interacting particle x, which is produced in the decay pi -> mu + x with a mass m(x) = 33.9 MeV. We have searched for this hypothetical decay branch by studying muons from pion decay in flight with the LEPS spectrometer at the piE3 channel at PSI and find branching ratios BR(pi- to mu- anti-x) < 4e-7 and BR(pi+ to mu+ x) < 7e-8 (95\% C.L.). Together with the limit BR > 2e-8 derived in a recent theoretical paper our result would leave only a narrow region for the existence of x if it is a heavy neutrino.Comment: 10 pages, TeX (uses epsf), 3 Postscript figures uu-encode

Design and User Satisfaction of Interactive Maps for Visually Impaired People

Multimodal interactive maps are a solution for presenting spatial information to visually impaired people. In this paper, we present an interactive multimodal map prototype that is based on a tactile paper map, a multi-touch screen and audio output. We first describe the different steps for designing an interactive map: drawing and printing the tactile paper map, choice of multi-touch technology, interaction technologies and the software architecture. Then we describe the method used to assess user satisfaction. We provide data showing that an interactive map - although based on a unique, elementary, double tap interaction - has been met with a high level of user satisfaction. Interestingly, satisfaction is independent of a user's age, previous visual experience or Braille experience. This prototype will be used as a platform to design advanced interactions for spatial learning

Transmission Properties of the oscillating delta-function potential

We derive an exact expression for the transmission amplitude of a particle moving through a harmonically driven delta-function potential by using the method of continued-fractions within the framework of Floquet theory. We prove that the transmission through this potential as a function of the incident energy presents at most two real zeros, that its poles occur at energies $n\hbar\omega+\varepsilon^*$ ($0<Re(\varepsilon^*)<\hbar\omega$), and that the poles and zeros in the transmission amplitude come in pairs with the distance between the zeros and the poles (and their residue) decreasing with increasing energy of the incident particle. We also show the existence of non-resonant "bands" in the transmission amplitude as a function of the strength of the potential and the driving frequency.Comment: 21 pages, 12 figures, 1 tabl

Force-based Cooperative Search Directions in Evolutionary Multi-objective Optimization

International audienceIn order to approximate the set of Pareto optimal solutions, several evolutionary multi-objective optimization (EMO) algorithms transfer the multi-objective problem into several independent single-objective ones by means of scalarizing functions. The choice of the scalarizing functions' underlying search directions, however, is typically problem-dependent and therefore difficult if no information about the problem characteristics are known before the search process. The goal of this paper is to present new ideas of how these search directions can be computed \emph{adaptively} during the search process in a \emph{cooperative} manner. Based on the idea of Newton's law of universal gravitation, solutions attract and repel each other \emph{in the objective space}. Several force-based EMO algorithms are proposed and compared experimentally on general bi-objective $\rho$MNK landscapes with different objective correlations. It turns out that the new approach is easy to implement, fast, and competitive with respect to a $(\mu+\lambda)$-SMS-EMOA variant, in particular if the objectives show strong positive or negative correlations

Gene therapy [3]

To the Editor: We remain enthusiastic about gene therapy, despite the slower-than-hoped-for rate of progress and the inefficiency of current adenoviral-mediated and liposomal-mediated CFTR gene transfer. One of the intents of our paper was to alert researchers in the field to problems with the efficiency of the adenovirus and consequently to stimulate new approaches to increase the efficiency of this vector by the use of other serotypes or new dosing strategies

Helium bubble formation in ultrafine and nanocrystalline tungsten under different extreme conditions

We have investigated the effects of helium ion irradiation energy and sample temperature on the performance of grain boundaries as helium sinks in ultrafine grained and nanocrystalline tungsten. Irradiations were performed at displacement and non-displacement energies and at temperatures above and below that required for vacancy migration. Microstructural investigations were performed using Transmission Electron Microscopy (TEM) combined with either in-situ or ex-situ ion irradiation. Under helium irradiation at an energy which does not cause atomic displacements in tungsten (70 eV), regardless of temperature and thus vacancy migration conditions, bubbles were uniformly distributed with no preferential bubble formation on grain boundaries. At energies that can cause displacements, bubbles were observed to be preferentially formed on the grain boundaries only at high temperatures where vacancy migration occurs. Under these conditions, the decoration of grain boundaries with large facetted bubbles occurred on nanocrystalline grains with dimensions less than 60 nm. We discuss the importance of vacancy supply and the formation and migration of radiation-induced defects on the performance of grain boundaries as helium sinks and the resulting irradiation tolerance of ultrafine grained and nanocrystalline tungsten to bubble formatio