Assessing the effectiveness and cost effectiveness of subcutaneous nerve stimulation in patients with predominant back pain due to failed back surgery syndrome (SubQStim study): study protocol for a multicenter randomized controlled trial

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Chronic radicular pain can be effectively treated with spinal cord stimulation, but this therapy is not always sufficient for chronic back pain. Subcutaneous nerve stimulation (SQS) refers to the placement of percutaneous leads in the subcutaneous tissue within the area of pain. Case series data show that failed back surgery syndrome (FBSS) patients experience clinically important levels of pain relief following SQS and may also reduce their levels of analgesic therapy and experience functional well-being. However, to date, there is no randomized controlled trial evidence to support the use of SQS in FBSS.Medtronic Inc

Security in the Age of Systemic Risk: Strategies, Tactics and Options for Dealing with Femtorisks and Beyond

The world today is increasingly confronted with systemic threats and challenges, in which femtorisks - small-scale dangers that are inherent to system structures and function and which pose asymmetrically catastrophic risks - can build in consequence, spreading uncontrollably like epidemics in both natural and social systems in such diverse areas as ecology, epidemiology, finance, the Internet, terrorism, and international relations. They have been successfully modeled in ecology in the context of complex adaptive systems: systems made up of individual agents, whose interactions have macroscopic consequences that feed back to influence individual behavior. While acknowledging challenges, this paper argues for the value of applying to societal systems the approaches that natural scientists have developed in quantifying and modeling biological interactions and ecosystems

Neutron Scattering study of Sr_2Cu_3O_4Cl_2

We report a neutron scattering study on the tetragonal compound Sr_2Cu_3O_4Cl_2, which has two-dimensional (2D) interpenetrating Cu_I and Cu_{II} subsystems, each forming a S=1/2 square lattice quantum Heisenberg antiferromagnet (SLQHA). The mean-field ground state is degenerate, since the inter-subsystem interactions are geometrically frustrated. Magnetic neutron scattering experiments show that quantum fluctuations lift the degeneracy and cause a 2D Ising ordering of the Cu_{II} subsystem. Due to quantum fluctuations a dramatic increase of the Cu_I out-of-plane spin-wave gap is also observed. The temperature dependence and the dispersion of the spin-wave energy are quantitatively explained by spin-wave calculations which include quantum fluctuations explicitly. The values for the nearest-neighbor superexchange interactions between the Cu_I and Cu_{II} ions and between the Cu_{II} ions are determined experimentally to be J_{I-II} = -10(2)meV and J_{II}= 10.5(5)meV, respectively. Due to its small exchange interaction, J_{II}, the 2D dispersion of the Cu_{II} SLQHA can be measured over the whole Brillouin zone with thermal neutrons, and a novel dispersion at the zone boundary, predicted by theory, is confirmed. The instantaneous magnetic correlation length of the Cu_{II} SLQHA is obtained up to a very high temperature, T/J_{II}\approx 0.75. This result is compared with several theoretical predictions as well as recent experiments on the S=1/2 SLQHA.Comment: Figures and equations are rearrange

Behavioral challenges in policy analysis with conflicting objectives

Public policy problems are rife with conflicting objectives: efficiency versus fairness, technical criteria versus political goals, costs versus multiple benefits. Multi-Criteria Decision Analysis provides robust methodologies to support policy makers in making tough choices and in designing better policy options when considering these conflicting objectives. However, important behavioral challenges exist in developing these models: the use of expert judgments, whenever evidence is not available; the elicitation of preferences and priorities from policy makers and communities; and the effective management of group decision processes. The extensive developments in behavioral decision research, social psychology, facilitated decision modeling, and incomplete preference models shed light on how decision analysts should address these issues, so we can provide better decision support and develop high quality decision models. In this tutorial I discuss the main findings of these extensive, but rather fragmented, literatures providing a coherent and practical framework for managing behavioral issues, minimizing behavioral biases, and optimizing the quality of human judgments in policy analysis models with conflicting objectives. I illustrate these guidelines with policy analysis interventions that we have conducted over the last decade for several organizations, such as the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the UK Department of Environment Food and Rural Affairs (DEFRA), the Malaria Consortium/USAID, the UK National Audit Office, among others

Thinking styles and doctors' knowledge and behaviours relating to acute coronary syndromes guidelines

Background How humans think and make decisions is important in understanding behaviour. Hence an understanding of cognitive processes among physicians may inform our understanding of behaviour in relation to evidence implementation strategies. A personality theory, Cognitive-Experiential Self Theory (CEST) proposes a relationship between different ways of thinking and behaviour, and articulates pathways for behaviour change. However prior to the empirical testing of interventions based on CEST, it is first necessary to demonstrate its suitability among a sample of healthcare workers. Objectives To investigate the relationship between thinking styles and the knowledge and clinical practices of doctors directly involved in the management of acute coronary syndromes. Methods Self-reported doctors' thinking styles (N = 74) were correlated with results from a survey investigating knowledge, attitudes, and clinical practice, and evaluated against recently published acute coronary syndrome clinical guidelines. Results Guideline-discordant practice was associated with an experiential style of thinking. Conversely, guideline-concordant practice was associated with a higher preference for a rational style of reasoning. Conclusion Findings support that while guidelines might be necessary to communicate evidence, other strategies may be necessary to target discordant behaviours. Further research designed to examine the relationships found in the current study is required

Valuing health states: is the MACBETH approach useful for valuing EQ-5D-3L health states?

Background Quality Adjusted Life Years (QALYs) are a key outcome measure widely used within health technology assessment and health service research studies. QALYs combine quantity and quality of life, with quality of life calculations relying on the value of distinct health states. Such health states’ values capture the preferences of a population and have been typically built through numerical elicitation methods. Evidence points to these value scores being influenced by methods in use and individuals reporting cognitive difficulties in eliciting their preferences. Evidence from other areas has further suggested that individuals may prefer using distinct elicitation techniques and that this preference can be influenced by their numeracy. In this study we explore the use of the MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) non-numerical preference elicitation approach for health states’ evaluation. Methods A new protocol for preference elicitation based on MACBETH (only requiring qualitative judgments) was developed and tested within a web survey format. A sample of the Portuguese general population (n=243) valued 25 EQ-5D-3L health states with the MACBETH protocol and with a variant of the time trade-off (TTO) protocol, for comparison purposes and for understanding respondents’ preference for distinct protocols and differences in inconsistent evaluations. Respondents answered to a short numeracy test, and basic socio-economic information collected. Results Results show that the mean values derived from MACBETH and the TTO variant are strongly correlated; however, there are substantial differences for several health states’ values. Large and similar numbers of logical inconsistencies were found in respondents’ answers with both methods. Participants with higher levels of numeracy according to the test preferred expressing value judgments with MACBETH, while participants with lower levels were mostly indifferent to both methods. Higher correlations between MACBETH and TTO variant evaluations were observed for individuals with higher numeracy. Conclusion Results suggest that it is worth researching the use of non-numerical preference elicitation methods. Numeracy tests more appropriate for preference elicitation when no explicit considerations of uncertainty are made need to be explored and used. Further behavioural research is needed to fully understand the potential for using these methods in distinct settings (e.g. in different evaluation contexts and in face-to-face and non-face-to-face environments), as well as to explore the effect of literacy on assessments and on respondents’ preferences.UID/MULTI/4066/2016info:eu-repo/semantics/publishedVersio