Coverage and development of specialist palliative care services across the World Health Organization European region (2005-2012): results from a European association for palliative care task force survey of 53 countries

Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Palliative Care in Europe. Significant development of each type of services was demonstrated by adjusted residual analysis, ratio of services per population and 2012 coverage (relationship between provision of available services and demand services estimated to meet the palliative care needs of a population). For the measurement of palliative care coverage, we used European Association for Palliative Care White Paper recommendations: one home care team per 100,000 inhabitants, one hospital support team per 200,000 inhabitants and one inpatient palliative care service per 200,000 inhabitants. To estimate evolution at the supranational level, mean comparison between years and European sub-regions is presented. Results: Of 53 countries, 46 (87%) provided data. Europe has developed significant home care team, inpatient palliative care service and hospital support team in 2005–2012. The improvement was statistically significant for Western European countries, but not for Central and Eastern countries. Significant development in at least a type of services was in 21 of 46 (46%) countries. The estimations of 2012 coverage for inpatient palliative care service, home care team and hospital support team are 62%, 52% and 31% for Western European and 20%, 14% and 3% for Central and Eastern, respectively. Conclusion: Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population

Risk attitudes in medical decisions for others: an experimental approach

The aim of this paper is to investigate how risk attitudes in medical decisions for others vary across health contexts. A lab experiment was designed to elicit the risk attitudes of 257 medical and nonmedical students by assigning them the role of a physician who must decide between treatments for patients. An interval regression model was used to estimate individual coefficients of relative risk aversion, and an estimation model was used to test for the effect of type of medical decision and experimental design characteristics on elicited risk aversion. We find that (a) risk attitudes vary across different health contexts, but risk aversion prevails in all of them; (b) students enrolled in health‐related degrees show a higher degree of risk aversion; and (c) real rewards for third parties (patients) make subjects less risk‐averse. The results underline the importance of accounting for attitudes towards risk in medical decision making.Ministerio de Ciencia y Tecnología and FEDER, Grant numbers: ECO2012‐3648, ECO2013‐43526‐R, ECO2015‐65031‐R and ECO2015‐65408‐R; Junta de Andalucía, Grant number: SEJ‐0499

Valuation and modeling of EQ-5D-5L health states using a hybrid approach

Background: The EQ-5D instrument is the most widely used preference-based health-related quality of life questionnaire in cost-effectiveness analysis of health care technologies. Recently, a version called EQ-5D-5L with 5 levels on each dimension was developed. This manuscript explores the performance of a hybrid approach for the modeling of EQ-5D-5L valuation data. Methods: Two elicitation techniques, the composite time trade-off, and discrete choice experiments, were applied to a sample of the Spanish population (n=1000) using a computer-based questionnaire. The sampling process consisted of 2 stages: stratified sampling of geographic area, followed by systematic sampling in each area. A hybrid regression model combining composite time trade-off and discrete choice data was used to estimate the potential value sets using main effects as starting point. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony. Results: Twenty-seven participants from the 1000 were removed following the exclusion criteria. The best-fitted model included 2 significant interaction terms but resulted in marginal improvements in model fit compared to the main effects model. We therefore selected the model results with main effects as a potential value set for this methodological study, based on the parsimony criteria. The results showed that the main effects hybrid model was consistent, with a range of utility values between 1 and -0.224. Conclusion: This paper shows the feasibility of using a hybrid approach to estimate a value set for EQ-5D-5L valuation data.</p

Terahertz epsilon-near-zero graded-index lens

An epsilon-near-zero graded-index converging lens with planar faces is proposed and analyzed. Each perfectly-electric conducting (PEC) waveguide comprising the lens operates slightly above its cut-off frequency and has the same length but different cross-sectional dimensions. This allows controlling individually the propagation constant and the normalized characteristic impedance of each waveguide for the desired phase front at the lens output while Fresnel reflection losses are minimized. A complete theoretical analysis based on the waveguide theory and Fermat’s principle is provided. This is complemented with numerical simulation results of two-dimensional and three-dimensional lenses, made of PEC and aluminum, respectively, and working in the terahertz regime, which show good agreement with the analytical work.Effort sponsored by Spanish Government under contracts Consolider “Engineering Metamaterials” CSD2008-00066 and TEC2011-28664-C02-01. P.R.-U. is sponsored by the Government of Navarra under funding program “Formación de tecnólogos” 055/01/11. M.N.- C. is supported by the Imperial College Junior Research Fellowship. M. B. acknowledges funding by the Spanish Government under the research contract program Ramon y Cajal RYC-2011-08221. N.E. acknowledges the support from the US Office of Naval Research (ONR) Multidisciplinary University Research Initiatives (MURI) grant number N00014-10-1- 0942

Imitation - Theory and Experimental Evidence

We introduce a generalized theoretical approach to study imitation and subject it to rigorous experimental testing. In our theoretical analysis we find that the different predictions of previous imitation models are due to different informational assumptions, not to different behavioral rules. It is more important whom one imitates rather than how. In a laboratory experiment we test the different theories by systematically varying information conditions. We find significant effects of seemingly innocent changes in information. Moreover, the generalized imitation model predicts the differences between treatments well. The data provide support for imitation on the individual level, both in terms of choice and in terms of perception. But imitation is not unconditional. Rather individuals' propensity to imitate more successful actions is increasing in payoff differences

Convergent Asymptotic Expansions of Charlier, Laguerre and Jacobi Polynomials

Convergent expansions are derived for three types of orthogonal polynomials: Charlier, Laguerre and Jacobi. The expansions have asymptotic properties for large values of the degree. The expansions are given in terms of functions that are special cases of the given polynomials. The method is based on expanding integrals in one or two points of the complex plane, these points being saddle points of the phase functions of the integrands.Comment: 20 pages, 5 figures. Keywords: Charlier polynomials, Laguerre polynomials, Jacobi polynomials, asymptotic expansions, saddle point methods, two-points Taylor expansion

Ultrafast electrooptic dual-comb interferometry

The femtosecond laser frequency comb has enabled the 21st century revolution in optical synthesis and metrology. A particularly compelling technique that relies on the broadband coherence of two laser frequency combs is dual-comb interferometry. This method is rapidly advancing the field of optical spectroscopy and empowering new applications, from nonlinear microscopy to laser ranging. Up to now, most dual-comb interferometers were based on modelocked lasers, whose repetition rates have restricted the measurement speed to ~ kHz. Here we demonstrate a novel dual-comb interferometer that is based on electrooptic frequency comb technology and measures consecutive complex spectra at a record-high refresh rate of 25 MHz. These results pave the way for novel scientific and metrology applications of frequency comb generators beyond the realm of molecular spectroscopy, where the measurement of ultrabroadband waveforms is of paramount relevance