A reassessment of the cost-effectiveness of hormone replacement therapy in Sweden – results based on the Women’s Health Initiative randomised controlled trial

The cost-effectiveness of hormone replacement therapy (HRT) based on a societal perspective is reassessed based on new medical evidence found in the Women’s Health Initiative (WHI). Within a model framework using an individual state transition model the cost-effectiveness of 50-60 year old women with menopausal symptoms is assessed in Sweden. The Markov model has a 50 year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: Coronary Heart Disease (CHD), Stroke, Venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture and wrist fracture. An intervention is modelled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality adjusted life years (QALYs) with and without intervention. The resulting cost per gained QALY is compared to the value of a gained QALY, which is set to SEK 600 000. The model requires data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden. The cost-effectiveness ratios are estimated at about SEK 10 000, which is far below the value of a gained QALY. Conditional on that HRT increases the quality of life weight more than 0.013 the therapy is cost-effective. In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.cost-effectiveness analysis; hormone replacement therapy; Markov model

The Low-Risk Anomaly: Evidence From The Thai Stock Market

In many developed countries, low-risk stocks tend to earn superior risk-adjusted returns compared to high-risk stock. Using data on the Stock Exchange of Thailand between 2004 and 2015, this paper shows that the abnormal returns associated with investing in low-beta stocks are signifcant and robust. The zero-cost portfolio that longs low-beta stocks and shorts high-beta stocks delivers monthly four-factor alpha of 1.26%. This paper provides suggestive evidence that, in addition to leverage constraints, the low-risk anomaly can be caused by institutional designs that favour stocks that are index constituents

Investigative Designing: usage-oriented research in and through designing

In this paper, we discuss the practice of investigative designing. The notion is currently being used to denote a variety of ideas in design research, and we first seek to clarify some of them. We then present our own, specific take on this notion, while acknowledging that it is being used broadly. We adopted the notion as an umbrella term for our combined research and design activities: as investigative designers. We use it for the exploration of how designers can integrate designing and researching within a design process. The two main concerns we are pursuing within this are to clarify the role of a designer with research skills, and to explore the implications of a usage orientation in design. We present two studies in this paper in which we investigated how usage research for design can be specifically geared to the needs of design, and what helps designers (and what does not) in designing with usage information. In the first study, we ourselves conducted usage research, developed design ideas on the basis of that, and reflected on this process. In the second study, we observed how three other designers engaged with the same user data and developed design ideas. Our findings include that the designers tended to prefer to develop their own design ideas independently from the data, only checking or adapting the ideas to the data. Furthermore, the capacity of designers for dealing with data needs to be taken into consideration. Lastly, the form of data presentation influences how well designers can engage with it in designing. Keywords: Investigative Design; Designing; Designer; Product Usage; User Research</p

Hope and health in the face of adversity

This dissertation focuses on hope as a general concept, and more specifically on the relationship between hope and health in adversity (the impact of man-made earthquakes in Groningen). The first two chapters show 1) the impact hope and health have on each other over time, especially among people who experience adversity, and 2) that maintaining general hope even when losing hope specific to adversity is beneficial to health. So, especially for those dealing with adversity, maintaining feelings of hope is beneficial to health. However, hope can also be a sign that a person’s situation is hopeless — Nietzsche suggested: “Hope in reality is the worst of all evils because it prolongs the torments of man” (1878). We examined this paradox in a study about how people speak about hope in long-term adversity. The findings often align with the positive outcomes we would expect based on our previous findings and the literature on hope. But we also see that hope can be used to discuss dark and desperate thoughts and intentions. Hope is therefore not always a positive signal, as the presence of hope indicates that the person may find themselves in a hopeless and powerless situation. It may indicate that a person is using psychological means to avoid falling into despair. At the same time, the experience of hope in itself is not problematic: it is important to maintain hope in order to minimize negative health outcomes

Positive expressive technologies for social wellness

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Drawing on research from the fields of HCI, social and positive psychology, this thesis investigates the design of technologies that encourage the expression of positive emotions. In parallel, it details the deployment of effective design steps to guide, frame and eventually support understandings of positive mental and social usage effects of technology. Different artefacts termed PosiPost have been iteratively developed as exemplars for the discussion and exploration of the ways in which technologies can support positive communication and social sharing. Studies with these technologies have been conducted to explore how these can encourage positive communication and understand how they contribute to social wellness. Specifically, the studies undertaken validate the hypothesis that the sharing of positive emotions as mediated by technology has beneficial social and mental effects. The first stage of the research examined whether and how social technology can be designed for positive affect. A theoretical framework, named THE Medium model was developed to support the design process. Furthermore, design considerations were produced for technologies that encourage the sharing of positive emotions. This latter involved two studies, paper-based and online, which showed the potential for a prefixbased elicitation of positive emotions and drove the design and development of a mobile tool called PosiPost Me (Mobile edition). The second stage of the design process focused on how positive emotions can be mediated by technology in a mobile context and how such tools were used and understood. The iterative design study process continued, resulting in PosiPost Be, a Bluetooth edition, which allows sharing of positive messages with people in close proximity to explore the social and potential positive effects of contextualizing posiposting by adding location as a factor. Results suggest that by using a prefix-strategy, messages of a positive and mundane nature can be shared and mediated by mobile technology. Analysis of the shared messages provides insights into people’s pleasant moments in daily life. A questionnaire instrument named SPOT was developed and used for the measurement of the effects of sharing pleasant moments with the developed mobile expressive technologies in further detail. The results suggest that lightweight positive expressive technologies can have beneficial social wellness effects. In particular, the study showed significant beneficial effects in reducing depressed feelings and increasing social interest in others. Participants also believed that the mobile PosiPost applications supported social connectedness, socio-pleasure, social and positive awareness, and positive thinking

Simultaneous precise editing of multiple genes in human cells

Abstract. When double-strand breaks are introduced in a genome by CRISPR they are repaired either by non-homologous end joining (NHEJ), which often results i