A discrete choice experiment to elicit preferences for a chronic disease screening programme in Queensland, Australia

OBJECTIVE

Patient-centred care, increasingly highlighted in healthcare strategies, necessitates understanding public preferences for healthcare service attributes. We aimed to understand the preferences of the Australian population regarding the attributes of chronic disease screening programmes.

STUDY DESIGN

The preferences were elicited using the discrete choice experiment (DCE) methodology.

METHODS

A DCE was administered to a sample of the Australian general population. Respondents were asked to make choices, each offering two hypothetical screening scenarios defined by screening conduct, quality and accuracy of the test results, cost to the patient, wait time and source of information. Data were analysed using a panel mixed multinomial logit model.

RESULTS

A strong preference for highly accurate screening tests and nurse-led screenings at local health clinics was evident. They expressed disutility for waiting time and out-of-pocket costs but were indifferent about the source of information. Their preference for a nurse-led programme was highlighted by the fact that they were willing to pay $81 and $88 to get a nurse-led programme when they were offered a general practitioner-led and a specialist-led programme, respectively. Furthermore, they were willing to pay $32 to reduce a week of waiting time and $205 for a 95% accurate test compared to a 75% accurate test. Preferences remained consistent irrespective of the respondent's place of residence.

CONCLUSIONS

Our findings highlight the importance of diagnostic test accuracy and nurse-led service delivery in chronic disease screening programmes. These insights could guide the development of patient-centric services by enhancing test accuracy, reducing waiting times and promoting nurse-led care models.

The Emirates Mars Mission

The Emirates Mars Mission (EMM) was launched to Mars in the summer of 2020, and is the first interplanetary spacecraft mission undertaken by the United Arab Emirates (UAE). The mission has multiple programmatic and scientific objectives, including the return of scientifically useful information about Mars. Three science instruments on the mission's Hope Probe will make global remote sensing measurements of the Martian atmosphere from a large low-inclination orbit that will advance our understanding of atmospheric variability on daily and seasonal timescales, as well as vertical atmospheric transport and escape. The mission was conceived and developed rapidly starting in 2014, and had aggressive schedule and cost constraints that drove the design and implementation of a new spacecraft bus. A team of Emirati and American engineers worked across two continents to complete a fully functional and tested spacecraft and bring it to the launchpad in the middle of a global pandemic. EMM is being operated from the UAE and the United States (U.S.), and will make its data freely available.

An innovative Antimicrobial Stewardship Program for children in remote and regional areas in Queensland, Australia: optimizing antibiotic use through timely intravenous-to-oral conversion

BACKGROUND

Little is known about the benefits of timely conversion from intravenous (IV) to oral antibiotic therapy in children. We evaluated appropriateness of IV to oral conversion of antibiotic therapy in remote and regional areas following the implementation of a multifaceted package of interventions.

METHODS

The intervention package: clinician guidelines, medication review stickers, patient information leaflets, and educational resources was implemented in seven facilities in Queensland, Australia. Children with community acquired pneumonia and skin and soft tissue infections were switched to oral therapy if they met the required 'IV-to-oral switch' criteria. Data was collected for a 7-month period from May to November for the baseline (2018) and the intervention (2019) phases.

RESULTS

There were 357 patients enrolled in the study with 178 in the baseline and 179 in the intervention phase. The percentage of patients who were eligible to switch to oral therapy, within 24 hours of eligibility, increased from (156/178) 87.6% in the baseline phase to (174/179) 97.2% in the intervention phase (p = 0.003). The average number of extra IV days decreased from 0.45 days in the baseline period to 0.18 days in the intervention period (p < 0.001). The median patient length of stay was 2 days for both phases. The only adverse events recorded were line-associated infiltrates, with a decrease from 34.3% (61/178) (baseline) to 17.9% (32/179) (intervention) (p < 0.001).

CONCLUSION

A multifaceted intervention package to enhance timely IV to oral conversion of antibiotic therapy for children in remote and regional facilities is effective.

MAVEN observations of the response of Mars to an interplanetary coronal mass ejection

Coupling between the lower and upper atmosphere, combined with loss of gas from the upper atmosphere to space, likely contributed to the thin, cold, dry atmosphere of modern Mars. To help understand ongoing ion loss to space, the Mars Atmosphere and Volatile Evolution (MAVEN) spacecraft made comprehensive measurements of the Mars upper atmosphere, ionosphere, and interactions with the Sun and solar wind during an interplanetary coronal mass ejection impact in March 2015. Responses include changes in the bow shock and magnetosheath, formation of widespread diffuse aurora, and enhancement of pick-up ions. Observations and models both show an enhancement in escape rate of ions to space during the event. Ion loss during solar events early in Mars history may have been a major contributor to the long-term evolution of the Mars atmosphere.

Early MAVEN Deep Dip campaign reveals thermosphere and ionosphere variability

The Mars Atmosphere and Volatile Evolution (MAVEN) mission, during the second of its Deep Dip campaigns, made comprehensive measurements of martian thermosphere and ionosphere composition, structure, and variability at altitudes down to ~130 kilometers in the subsolar region. This altitude range contains the diffusively separated upper atmosphere just above the well-mixed atmosphere, the layer of peak extreme ultraviolet heating and primary reservoir for atmospheric escape. In situ measurements of the upper atmosphere reveal previously unmeasured populations of neutral and charged particles, the homopause altitude at approximately 130 kilometers, and an unexpected level of variability both on an orbit-to-orbit basis and within individual orbits. These observations help constrain volatile escape processes controlled by thermosphere and ionosphere structure and variability.

Plasma Acceleration Above Martian Magnetic Anomalies

Auroras are caused by accelerated charged particles precipitating along magnetic field lines into a planetary atmosphere, the auroral brightness being roughly proportional to the precipitating particle energy flux. The Analyzer of Space Plasma and Energetic Atoms experiment on the Mars Express spacecraft has made a detailed study of acceleration processes on the nightside of Mars. We observed accelerated electrons and ions in the deep nightside high-altitude region of Mars that map geographically to interface/cleft regions associated with martian crustal magnetization regions. By integrating electron and ion acceleration energy down to the upper atmosphere, we saw energy fluxes in the range of 1 to 50 milliwatts per square meter per second. These conditions are similar to those producing bright discrete auroras above Earth. Discrete auroras at Mars are therefore expected to be associated with plasma acceleration in diverging magnetic flux tubes above crustal magnetization regions, the auroras being distributed geographically in a complex pattern by the many multipole magnetic field lines extending into space.

An oblique effect in aesthetics: homage to Mondrian (1872-1944)

The effect of the orientation of Mondrian's paintings on their aesthetic appeal was examined. Eight paintings, four with horizontal/vertical frames in the original and four with oblique frames, were presented in eight different orientations and rated for aesthetic appeal on a 7-point scale. There was a stronger preference for pictures presented so that their component lines were horizontal and vertical than for pictures presented with their component lines in an oblique orientation. In addition, subjects showed a preference for the original orientation, perhaps because rotation changes the lateral balance of the paintings as well as the orientation of the component lines. There was no overall preference for one frame orientation over another, but there was an interaction between frame orientation and component orientation, resulting in a preference for paintings where the components were parallel to the surrounding frame. It is suggested that the aesthetic oblique effect reported here is related to the oblique effect in orientation perception and the privileged access which horizontal and vertical lines have to the visual system. This offers a possible mechanism for aesthetic judgments of abstract patterns: we find pleasing those stimuli which are closely tuned to the properties of the human visual system.

Interactions of contact, odor cues, and androgens in strange-male-induced early pregnancy disruptions in mice (Mus musculus)

Novel males can disrupt early pregnancy in female house mice (Mus musculus). In Experiment 1, exposure to novel males disrupted pregnancy, but exposure to male urine did not. In Experiment 2, urine from male or female mice or rats painted on females' noses did not influence pregnancy. In Experiment 3, the conjunction of urine painted on female's noses and vulval stimulation did not affect pregnancy more than water with similar stimulation. In Experiment 4, males housed above females were separated from them by a wire mesh grid; intact males disrupted pregnancy, but castrated ones did not. In Experiment 5, such housing of castrated males or ovariectomized females produced a strong disruption of pregnancy if the stimulus animal was given testosterone but not if it was given oil injections. In Experiment 6, transfers of odorous emissions failed to disrupt pregnancy. Contact and androgen activity are necessary for strange males to disrupt pregnancy.

A prospective trial of Merocel packs

A prospective trial, comparing Merocel nasal packs and glove finger packs is reported. No statistically significant difference was found in symptoms of nasal obstruction or discomfort, findings of nasal crusting or adhesions, or postoperative bleeding, between nostrils packed with Merocel packs or those packed with glove fingers.

Famous ENT surgeons of the past

History teaches us that the development of medicine and surgery, like most human activities, has not been a steady uniform process, but has occurred mainly in a series of dramatic forward spurts separated by long periods of relative inertia. We are certainly living through such an active phase today with evidence of rapid technological change all around us, and there is a tendency to believe that the rate of progress has never been greater; but this is, however, a misconception, as the golden age of medical history was a period of not much more than a decade in the middle of the nineteenth century when the whole face of medicine and surgery was completely transformed by at least seven enormous developments, each of which was dominated by a man (in one case a woman) of genius. It was then that Claud Bernard (Fig. 1) completely transformed and advanced the whole science of physiology, while another Frenchman, Louis Pasteur (Fig. 2) established the principles of practical bacteriology, and a German, Virchow (Fig. 3) founded the speciality of histopathology. By applying the discoveries of Pasteur, Lister (Fig. 4) in Edinburgh, and later in London, developed the whole concept of antiseptic surgery which rapidly led to the aseptic surgery of today. This, together with the simultaneous introduction of anaesthesia, has completely transformed the practise of surgery.