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

Extended van Royen-Weisskopf formalism for lepton-antilepton meson decay widths within non-relativistic quark models

The classical van Royen-Weisskopf formula for the decay width of a meson into a lepton-antilepton pair is modified in order to include non-zero quark momentum contributions within the meson as well as relativistic effects. Besides, a phenomenological electromagnetic density for quarks is introduced. The meson wave functions are obtained from two different models: a chiral constituent quark model and a quark potential model including instanton effects. The modified van Royen-Weisskopf formula is found to improve systematically the results for the widths, giving an overall good description of all known decays.Comment: 22 pages, 3 figures, RevTex, epsfig. To be published in Nucl. Phys.

Precision oncology by point-of-care therapeutic drug monitoring and dosage adjustment of conventional cytotoxic chemotherapies: A perspective.

Therapeutic drug monitoring (TDM) of conventional cytotoxic chemotherapies is strongly supported yet poorly implemented in daily practice in hospitals. Analytical methods for the quantification of cytotoxic drugs are instead widely presented in the scientific literature, while the use of these therapeutics is expected to keep going for longer. There are two main issues hindering the implementation of TDM: turnaround time, which is incompatible with the dosage profiles of these drugs, and exposure surrogate marker, namely total area under the curve (AUC). Therefore, this perspective article aims to define the adjustment needed from current to efficient TDM practice for cytotoxics, namely point-of-care (POC) TDM. For real-time dose adjustment, which is required for chemotherapies, such POC TDM is only achievable with analytical methods that match the sensitivity and selectivity of current methods, such as chromatography, as well as model-informed precision dosing platforms to assist the oncologist with dose fine-tuning based on quantification results and targeted intervals

Better outcome for parotid versus neck metastasis of head and neck cutaneous squamous cell carcinoma: a new report on reemerging data

Introduction: Regional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis. Objective: The purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis. Methods: A retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained. Results: Thirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ‒ HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02). Conclusion: Head and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis

Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

Introduction: Cutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies. Objective: The purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma. Methods: We developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed “inadequate” or “incomplete”. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression. Results: In total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins. Conclusion: Gross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins

A computational analysis of lower bounds for big bucket production planning problems

In this paper, we analyze a variety of approaches to obtain lower bounds for multi-level production planning problems with big bucket capacities, i.e., problems in which multiple items compete for the same resources. We give an extensive survey of both known and new methods, and also establish relationships between some of these methods that, to our knowledge, have not been presented before. As will be highlighted, understanding the substructures of difficult problems provide crucial insights on why these problems are hard to solve, and this is addressed by a thorough analysis in the paper. We conclude with computational results on a variety of widely used test sets, and a discussion of future research

Bilingualism alters children’s frontal lobe functioning for attentional control

Bilingualism is a typical linguistic experience, yet relatively little is known about its impact on children’s cognitive and brain development. Theories of bilingualism suggest that early dualâ language acquisition can improve children’s cognitive abilities, specifically those relying on frontal lobe functioning. While behavioral findings present much conflicting evidence, little is known about its effects on children’s frontal lobe development. Using functional nearâ infrared spectroscopy (fNIRS), the findings suggest that Spanishâ English bilingual children (n = 13, ages 7â 13) had greater activation in left prefrontal cortex during a nonâ verbal attentional control task relative to ageâ matched English monolinguals. In contrast, monolinguals (n = 14) showed greater right prefrontal activation than bilinguals. The present findings suggest that early bilingualism yields significant changes to the functional organization of children’s prefrontal cortex for attentional control and carry implications for understanding how early life experiences impact cognition and brain development.This fNIRS study investigated the impact of bilingual exposure on children’s brain organization for attentional control (N = 27, ages 7â 13). During a nonâ verbal attention task, bilinguals showed greater left frontal lobe activation than monolinguals. Monolinguals showed greater right frontal lobe activation than bilinguals. The findings suggest that bilingualism affects the functionality of children’s left prefrontal cortex for attentional control.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136694/1/desc12377-sup-0001-FigS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136694/2/desc12377.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136694/3/desc12377_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136694/4/desc12377-sup-0003-SupInfo.pd

A multibaker map for shear flow and viscous heating

A consistent description of shear flow and the accompanied viscous heating as well the associated entropy balance is given in the framework of a deterministic dynamical system. A laminar shear flow is modeled by a Hamiltonian multibaker map which drives velocity and temperature fields. In an appropriate macroscopic limit one recovers the Navier-Stokes and heat conduction equations along with the associated entropy balance. This indicates that results of nonequilibrium thermodynamics can be described by means of an abstract, sufficiently chaotic and mixing dynamics. A thermostating algorithm can also be incorporated into this framework.Comment: 11 pages; RevTex with multicol+graphicx packages; eps-figure

Photo-production of Nucleon Resonances and Nucleon Spin Structure Function in the Resonance Region

The photo-production of nucleon resonances is calculated based on a chiral constituent quark model including both relativistic corrections H{rel} and two-body exchange currents, and it is shown that these effects play an important role. We also calculate the first moment of the nucleon spin structure function g1 (x,Q^2) in the resonance region, and obtain a sign-changing point around Q^2 ~ 0.27 {GeV}^2 for the proton.Comment: 23 pages, 5 figure