Dutch Tariff for the Five-Level Version of EQ-5D M. Versteegh, Matthijs, PhD; M. Vermeulen, Karin, PhD; M. A. A. Evers, Silvia, PhD ...
Value in health,
06/2016, Letnik:
19, Številka:
4
Journal Article
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Abstract Background In 2009, a new version of the EuroQol five-dimensional questionnaire (EQ-5D) was introduced with five rather than three answer levels per dimension. This instrument is known as ...the EQ-5D-5L. To make the EQ-5D-5L suitable for use in economic evaluations, societal values need to be attached to all 3125 health states. Objectives To derive a Dutch tariff for the EQ-5D-5L. Methods Health state values were elicited during face-to-face interviews in a general population sample stratified for age, sex, and education, using composite time trade-off (cTTO) and a discrete choice experiment (DCE). Data were modeled using ordinary least squares and tobit regression (for cTTO) and a multinomial conditional logit model (for DCE). Model performance was evaluated on the basis of internal consistency, parsimony, goodness of fit, handling of left-censored values, and theoretical considerations. Results A representative sample (N = 1003) of the Dutch population participated in the valuation study. Data of 979 and 992 respondents were included in the analysis of the cTTO and the DCE, respectively. The cTTO data were left-censored at −1. The tobit model was considered the preferred model for the tariff on the basis of its handling of the censored nature of the data, which was confirmed through comparison with the DCE data. The predicted values for the EQ-5D-5L ranged from −0.446 to 1. Conclusions This study established a Dutch tariff for the EQ-5D-5L on the basis of cTTO. The values represent the preferences of the Dutch population. The tariff can be used to estimate the impact of health care interventions on quality of life, for example, in context of economic evaluations.
One of the key challenges in developing quantum networks is to generate single photons with high brightness, purity, and long temporal coherence. Semiconductor quantum dots potentially satisfy these ...requirements; however, due to imperfections in the surrounding material, the coherence generally degrades with increasing excitation power yielding a broader emission spectrum. Here we overcome this power-broadening regime and demonstrate an enhanced coherence at exciton saturation where the detected count rates are highest. We detect single-photon count rates of 460 000 counts per second under pulsed laser excitation while maintaining a single-photon purity greater than 99%. Importantly, the enhanced coherence is attained with quantum dots in ultraclean wurtzite InP nanowires, where the surrounding charge traps are filled by exciting above the wurtzite InP nanowire band gap. By raising the excitation intensity, the number of possible charge configurations in the quantum dot environment is reduced, resulting in a narrower emission spectrum. Via Monte Carlo simulations we explain the observed narrowing of the emission spectrum with increasing power. Cooling down the sample to 300 mK, we further enhance the single-photon coherence twofold as compared to operation at 4.5 K, resulting in a homogeneous coherence time, T2, of 1.2 ns, and two-photon interference visibility as high as 83% under strong temporal postselection (~5% without temporal postselection).
In economic evaluations of health care interventions, benefits are often expressed in terms of Quality-Adjusted Life-Years (QALYs). The QALY comprises length and quality of life into one measure ...which allows cross-disease comparability. The quality adjustment of the QALY is based on preferences for health states. An important normative choice is the question whose preferences for states of health we wish to capture. The answer to this question is directly related to the normative question regarding the appropriate maximand in health care decisions. Currently, preferences are commonly derived from the general public, rather than from actual patients. This choice, which can have large consequences on final outcomes of economic evaluations, has always been a topic of debate. This paper clarifies and furthers the discussion regarding the appropriate source of preferences for health state valuations, acknowledges the plurality of different perspectives, and argues that health economic guidelines could require analysis of benefit in terms of QALYs based on both patient and general public preferences.
•Preferences for health states of patients differ from those of the general public.•These differences reveal relevant information about perceived quality of life.•Both patient and general public preferences are a valid source of utility values.•Guidelines could require ICERs based on both sources of preferences.
A bright photon source that combines high-fidelity entanglement, on-demand generation, high extraction efficiency, directional and coherent emission, as well as position control at the nanoscale is ...required for implementing ambitious schemes in quantum information processing, such as that of a quantum repeater. Still, all of these properties have not yet been achieved in a single device. Semiconductor quantum dots embedded in nanowire waveguides potentially satisfy all of these requirements; however, although theoretically predicted, entanglement has not yet been demonstrated for a nanowire quantum dot. Here, we demonstrate a bright and coherent source of strongly entangled photon pairs from a position-controlled nanowire quantum dot with a fidelity as high as 0.859±0.006 and concurrence of 0.80±0.02. The two-photon quantum state is modified via the nanowire shape. Our new nanoscale entangled photon source can be integrated at desired positions in a quantum photonic circuit, single-electron devices and light-emitting diodes.
Mesenchymal stromal cells (MSCs) may reduce inflammation and promote tissue repair in pulmonary emphysema.
To study the safety and feasibility of bone marrow-derived autologous (BM-) MSC intravenous ...administration to patients with severe emphysema.
A phase I, prospective open-label study registered at ClinicalTrials.gov as NCT01306513 Eligible patients had lung volume reduction surgery (LVRS) on two separate occasions. During the first LVRS bone marrow was collected, from which MSCs were isolated and expanded ex vivo After 8 weeks, patients received two autologous MSC infusions 1 week apart, followed by the second LVRS procedure at 3 weeks after the second BM-MSC infusion.
Up to 3 weeks after the last MSC infusion adverse events were recorded. Using immunohistochemistry and qPCR for analysis of cell and proliferation markers, emphysematous lung tissue obtained during the first surgery was compared with lung tissue obtained after the second surgical session to assess BM-MSC effects.
From 10 included patients three were excluded: two did not receive MSCs due to insufficient MSC culture expansion, and one had no second surgery. No adverse events related to MSC infusions occurred and lung tissue showed no fibrotic responses. After LVRS and MSC infusions alveolar septa showed a 3-fold increased expression of the endothelial marker CD31 (P = 0.016).
Autologous MSC treatment in severe emphysema is feasible and safe. The increase in CD31 expression after LVRS and MSC treatment suggests responsiveness of microvascular endothelial cells in the most severely affected parts of the lung.
Country-specific value sets for the EQ-5D are available which reflect preferences for health states elicited from the general population. This allows the transformation of responses on EQ-5D to ...health state utility values. Only twelve European countries possess country-specific value sets and no value set reflecting the preferences of Europe exists. We aim to estimate a 'pan-European' value set for the EQ-5D-3L, reflecting the preferences for health states of the European population that could help to evaluate health care from the perspective of the European decision-maker.
We systematically assessed and compared the methodologies of available EQ-5D-3L time trade-off (TTO) value sets from twelve European countries: Denmark, France, Germany, Hungary, Italy, Netherlands, Poland, Portugal, Romania, Slovenia, Spain and UK. Using their published coefficients, a dataset with utility values for all 243 health states was simulated. Different modelling techniques and model specifications including interaction terms were tested. Model selection was based on goodness-of-fit criteria. We also explored results with application of population size weights.
Methodological, procedural and analytical characteristics of the included EQ-5D-3L valuation studies were quite comparable. An OLS based model was the preferred model to represent European preferences. Weighting with population size made little difference.
EQ-5D-3L valuation studies were considered of sufficient comparability to form the basis for a new 'pan-European' value set. The method used allows for an easy update when new national value sets become available.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite a successful surgical procedure and adherence to current recommendations, postoperative left ventricular (LV) dysfunction after mitral valve repair (MVr) for organic mitral regurgitation (MR) ...may still occur. New approaches are therefore needed to detect subclinical preoperative LV dysfunction. LV global longitudinal strain (GLS), assessed with speckle-tracking echocardiographic analysis, has been proposed as a novel measure to better depict latent LV dysfunction. The aim of this study was to investigate the value of GLS to predict long-term LV dysfunction after MVr.
A total of 233 patients (61% men, 61 ± 12 years) with moderate-severe organic MR who underwent successful MVr between 2000 and 2009 were included. Echocardiography was performed at baseline and long-term follow-up (34 ± 20 months) after MVr. LV dysfunction at follow-up was defined as LV ejection fraction (EF) <50% and was present in 29 (12%) patients. A cut-off value of -19.9% of GLS showed a sensitivity and specificity of 90 and 79% to predict long-term LV dysfunction. By univariate logistic regression analysis, baseline LVEF ≤60%, LV end-systolic diameter (ESD) ≥40 mm, atrial fibrillation, presence of symptoms, and GLS >-19.9% were predictors of long-term LV dysfunction. By multivariate analysis, GLS remained an independent predictor of LV dysfunction (odds ratio 23.16, 95% confidence interval: 6.53-82.10, P < 0.001), together with LVESD.
In a large series of patients operated within the last decade, MVr resulted in a low incidence of long-term LV dysfunction. A GLS of >-19.9% demonstrated to be a major independent predictor of long-term LV dysfunction after adjustment for parameters currently implemented into guidelines.
Global, secure quantum channels will require efficient distribution of entangled photons. Long distance, low-loss interconnects can only be realized using photons as quantum information carriers. ...However, a quantum light source combining both high qubit fidelity and on-demand bright emission has proven elusive. Here, we show a bright photonic nanostructure generating polarization-entangled photon pairs that strongly violates Bell's inequality. A highly symmetric InAsP quantum dot generating entangled photons is encapsulated in a tapered nanowire waveguide to ensure directional emission and efficient light extraction. We collect ~200 kHz entangled photon pairs at the first lens under 80 MHz pulsed excitation, which is a 20 times enhancement as compared to a bare quantum dot without a photonic nanostructure. The performed Bell test using the Clauser-Horne-Shimony-Holt inequality reveals a clear violation (S
> 2) by up to 9.3 standard deviations. By using a novel quasi-resonant excitation scheme at the wurtzite InP nanowire resonance to reduce multi-photon emission, the entanglement fidelity (F = 0.817 ± 0.002) is further enhanced without temporal post-selection, allowing for the violation of Bell's inequality in the rectilinear-circular basis by 25 standard deviations. Our results on nanowire-based quantum light sources highlight their potential application in secure data communication utilizing measurement-device-independent quantum key distribution and quantum repeater protocols.
Exchange of dissolved substances at the sediment–water
interface provides an important link between the short-term and long-term
geochemical cycles in the ocean. A second, as yet poorly understood
...sediment–water exchange is supported by low-temperature circulation of
seawater through the oceanic basement underneath the sediments. From the
basement, upwards diffusing oxygen and other dissolved species modify the
sediment, whereas reaction products diffuse from the sediment down into the
basement where they are transported by the basement fluid and released to
the ocean. Here, we investigate the impact of this “second” route with
respect to transport, release and consumption of oxygen, nitrate, manganese,
nickel and cobalt on the basis of sediment cores retrieved from the Clarion
Clipperton Zone (CCZ) in the equatorial Pacific Ocean. We show that in this
abyssal ocean region characterised by low organic carbon burial and
sedimentation rates vast areas exist where the downward- and upward-directed
diffusive fluxes of oxygen meet so that the sediments are oxic throughout.
This is especially the case where sediments are thin or in the proximity of
faults. Oxygen diffusing upward from the basaltic crust into the sediment
contributes to the degradation of sedimentary organic matter. Where the
sediments are entirely oxic, nitrate produced in the upper sediment by
nitrification is lost both by upward diffusion into the bottom water and by
downward diffusion into the fluids circulating within the basement. Where
the oxygen profiles do not meet, they are separated by a suboxic sediment
interval characterised by Mn2+ in the porewater. Where porewater
Mn2+ in the suboxic zones remains low, nitrate consumption is low and
the sediment continues to deliver nitrate to the ocean bottom waters and
basement fluid. We observe that at elevated porewater manganese
concentrations, nitrate consumption exceeds production and nitrate diffuses
from the basement fluid into the sediment. Within the suboxic zone, not only
manganese but also cobalt and nickel are released into the porewater by
reduction of Mn oxides, diffusing towards the oxic–suboxic fronts above and
below where they precipitate, effectively removing these metals from the
suboxic zone and concentrating them at the two oxic–suboxic redox
boundaries. We show that not only do diffusive fluxes in the top part of
deep-sea sediments modify the geochemical composition over time but also
diffusive fluxes of dissolved constituents from the basement into the bottom
layers of the sediment. Hence, the palaeoceanographic interpretation of
sedimentary layers should carefully consider such deep secondary
modifications in order to prevent the misinterpretation of primary signatures.
Variation in demographic and physiological attributes of life history is thought to fall on one single axis, a phenomenon termed the Pace‐of‐Life. A slow Pace‐of‐Life is characterized by low annual ...reproduction, long life span and low metabolic rate, a fast Pace‐of‐Life by the opposite characteristics. The existence of a single axis has been attributed to constraints among physiological mechanisms that are thought to restrict evolutionary potential. In that case, physiological traits should covary in the same fashion at the levels of individual organisms and species. We examined covariation at the levels of individual and subspecies in three physiological systems (metabolic, endocrine and immune) using four stonechat subspecies with distinct life‐history strategies in a common‐garden set‐up. We measured basal metabolic rate, corticosterone as endocrine measure and six measures of constitutive immunity. Metabolic rate covaried with two indices of immunity at the individual level, and with corticosterone concentrations and one index of immunity at the subspecies level, but not with other measures. The different patterns of covariation among individuals and among subspecies demonstrate that links among physiological traits are loose and suggest that these traits can evolve independent of each other.
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