Meaningless gestures or pathway to healing and reconciliation? Comparing the perspectives on political apologies in victim and non-victim communities in El Salvador, the Republic of Korea and the United Kingdom

Political apologies have been theorized to play an important role in healing and reconciliation processes in post-conflict settings. Whether they actually fulfil this function, however, remains unclear as the voices and perspectives of victim communities have largely been underrepresented in research. To address this, we examined the role of apologies that were offered for the El Mozote massacre (El Salvador), the Jeju 4.3 massacres (Republic of Korea) and Bloody Sunday (United Kingdom), according to members of these communities and the broader public. Although we anticipated that victim community members should find the apology more valuable and meaningful and should, therefore, be more positive about its role in healing and reconciliation processes, we found that this varies across countries. This variation could be explained by people's trust in the country's institutions. Across the samples, we found that the apology was seen as a relatively important gesture. For the apology to be perceived as impactful, however, it had to be seen as a meaningful (i.e. sincere) gesture. Our findings suggest that apologies have a role to play in the aftermath of human rights violations, but that it is essential to take the broader context into account.

Group-based shame, guilt, and regret across cultures

To date, there has been no systematic examination of cross-cultural differences in group-based shame, guilt, and regret following wrongdoing. Using a community sample (N = 1358), we examined people's reported experiences of shame, guilt, and regret following transgressions by themselves and by different identity groups (i.e., family, community, country) in Burkina Faso, Costa Rica, Indonesia, Japan, Jordan, the Netherlands, Poland, and the United States. We assessed whether any variation in this regard can be explained by the relative endorsement of individualistic or collectivistic values at the individual level and at the country level. Our findings suggest that people's reported experience of these emotions mostly depends on the transgression level. We also observe some variation across individuals and countries, which can be partially explained by the endorsement of collectivistic and individualistic values. The results highlight the importance of taking into account individual and cultural values when studying group-based emotions, as well as the identity groups involved in the transgression.

Trolls Without Borders: A Cross-Cultural Examination of Victim Reactions to Verbal and Silent Aggression Online

Trolling-the online exploitation of website, chat, or game mechanics at another user's expense-can and does take place all over cyberspace. It can take myriad forms, as well-some verbal, like trash-talking an opponent in a game, and some silent, like refusing to include a new player in a team effort during an in-game quest. However, despite this variety, there are few to no studies comparing the effects of these differing trolling types on victims. In addition, no study has yet taken into account users' offline cultural context and norms into the trolling victim experience. To fill this gap in the literature, the present study put participants from three culturally-distinct countries-Pakistan, Taiwan, and the Netherlands-in a simulated trolling interaction using the Cyberball game. Participants were either flamed (read: harshly insulted) or ostracized by a member of their own cultural group (ingroup) or a minority member (outgroup), and the participants' emotional responses, behavioral intentions toward the other players, and messages sent during the game were taken as indicators of their response to the trolling. Results showed that our Taiwanese sample used the most reactive aggression when trolled and our Dutch sample was the most passive. In addition, ostracism generally produced the desire to repair relationships, irrespective of cultural context, and perpetrator culture (ingroup or outgroup) only produced an effect in the behavioral intentions of our Pakistani sample. Overall, it would appear that online and offline culture interact to produce the variety of responses to trolling seen in extant literature. Additional implications for future research into computer-mediated communication and online aggression are also discussed.

An international survey of perceptions of the 2014 FIFA World Cup: National levels of corruption as a context for perceptions of institutional corruption

We conducted a survey about the 2014 FIFA World Cup that measured attitudes about FIFA, players, and officials in 18 languages with 4600 respondents from 29 countries. Sixty percent of respondents perceived FIFA officials as being dishonest, and people from countries with less institutional corruption and stronger rule of law perceived FIFA officials as being more corrupt and less competent running the tournament than people from countries with more corruption and weaker rule of law. In contrast, respondents evaluated players as skilled and honest and match officials as competent and honest. We discuss the implications of our findings for perceptions of corruption in general.

Under the bridge: An in-depth examination of online trolling in the gaming context

Trolling is a subject of apparent academic confusion; the few studies conducted thus far yielded a variety of conflicting definitions regarding what constitutes trolling behaviour and little information regarding trolling motivations. In order to shed further light on this phenomenon, the present study aimed to (1) determine which behaviours actual trolls consider as trolling, (2) explore the motivations behind trolling, and (3) examine the online community's response to trolling as perceived by the troll. After performing semi-structured interviews with 22 self-confessed trolls, we found that there is a variety of behaviours trolls consider trolling which can now be put in clear categories based on target and method. Three key motivations to troll emerged: personal enjoyment, revenge, and thrill-seeking. Trolling also appears to be a cyclical, self-perpetuating phenomenon enabled by the online community at large. Theoretical implications for future trolling research are also discussed.

Endovascular Management of Acute Stroke in the Elderly: A Systematic Review and Meta-Analysis

BACKGROUND

Acute ischemic stroke occurs more frequently, presents with more severe symptoms, and has worse outcomes in elderly patients. The safety and efficacy of endovascular therapy for acute stroke in this age group has not been fully established.

PURPOSE

We present the results of a systematic review and meta-analysis examining clinical, procedural, and radiologic outcomes of endovascular therapy for acute stroke in patients older than 80 years of age.

DATA SOURCES

We searched PubMed, MEDLINE, and EMBASE from 1992 to week 35 of 2017 for studies evaluating endovascular therapy for acute stroke in the elderly.

STUDY SELECTION

Two independent reviewers selected studies and abstracted data. The primary end point was good functional outcome at 3 months defined as modified Rankin Scale score of ≤2.

DATA ANALYSIS

Data were analyzed using random-effects meta-analysis.

DATA SYNTHESIS

Seventeen studies reporting on 860 patients were included. The rate of good functional outcome at 3 months was 27% (95% CI, 21%-32%). Mortality at 3 months was 34% (95% CI, 23%-44%). Successful recanalization was achieved in 78% of patients (95% CI, 72%-85%). Procedure-related complications occurred in 11% (95% CI, 4%-17%). The incidence of intracranial hemorrhage was 24% (95% CI, 15%-32%), and for symptomatic intracranial hemorrhage, it was 8% (95% CI, 5%-10%). The mean time to groin was 251 minutes (95% CI, 224-278 minutes). Procedure time was 99 minutes (95% CI, 67-131 minutes).

LIMITATIONS

I² values were above 50% for all outcomes, indicating substantial heterogeneity.

CONCLUSIONS

Good functional recovery in octogenarians treated with endovascular therapy for acute stroke can be achieved in a high proportion of patients despite the higher incidence of comorbidity in this cohort. Outcomes are inferior to those reported for younger patients; however, endovascular therapy can allow at least 1 in 4 patients older than 80 years of age to regain independent function at 3 months. More research is required to improve patient selection in the elderly, but age should not be a discriminator when deciding to offer endovascular therapy for patients with acute stroke.

Registered Replication Report: Dijksterhuis and van Knippenberg (1998)

Dijksterhuis and van Knippenberg (1998) reported that participants primed with a category associated with intelligence ("professor") subsequently performed 13% better on a trivia test than participants primed with a category associated with a lack of intelligence ("soccer hooligans"). In two unpublished replications of this study designed to verify the appropriate testing procedures, Dijksterhuis, van Knippenberg, and Holland observed a smaller difference between conditions (2%-3%) as well as a gender difference: Men showed the effect (9.3% and 7.6%), but women did not (0.3% and -0.3%). The procedure used in those replications served as the basis for this multilab Registered Replication Report. A total of 40 laboratories collected data for this project, and 23 of these laboratories met all inclusion criteria. Here we report the meta-analytic results for those 23 direct replications (total N = 4,493), which tested whether performance on a 30-item general-knowledge trivia task differed between these two priming conditions (results of supplementary analyses of the data from all 40 labs, N = 6,454, are also reported). We observed no overall difference in trivia performance between participants primed with the "professor" category and those primed with the "hooligan" category (0.14%) and no moderation by gender.

Lest Formalisms Impede Insight and Success: Evaluation in Health Informatics

Objectives: To illustrate the advantages of an open-ended formative evaluation approach using a project-specific selection of methods over the controlled trial approach in the evaluation of health information systems. To illustrate factors leading to success and others impeding it in a telehealth project.

Methods: The methods and results of an evaluation of the BC Telehealth Program are summarized.

Results: The evaluation gave a comprehensive picture of the project, including assessment of the effects of an array of telehealth applications, and their economic impact. Factors leading to success and others preventing it are identified from the level of overall program management to the project specifics. The results include unanticipated effects and explanations for their reasons of occurrence. Neither the comprehensiveness of information nor the timeliness was achieved in a related project using a controlled trial approach.

Conclusions: Not all types of health information system projects can be evaluated using the controlled trial approach. This approach may impede important insights. It is also usually much less efficient. Funding agencies and journal editors have to take this into account when selecting projects for funding and submissions for publication.

Cross-cultural similarities and differences in motives to forgive: A comparison between and within cultures

Recently, researchers have begun to explore people's motives to forgive those who have offended them. Using a recall method, we examined whether such motives (relationship-, offender- or self-focused) differ between and within cultures that are more collectivistic (Moluccan Islands in Indonesia) or more individualistic (the Netherlands) and whether this depends on people's relationship with the offender. More specifically, we examined the idea that other-focused motives should be more important in cultures that are more collectivistic and that self-focused motives should prevail in more individualistic cultures. We found that Moluccan participants indeed endorsed relationship- and offender-focused motives more than Dutch participants. Moluccan and Dutch participants did not, however, differ in the extent to which they endorsed self-focused motives. Furthermore, Dutch participants were more likely to endorse relationship motives (especially in close relations) than self-focused motives. For Moluccan participants, relationship-, offender- and self-focused motives were equally important and also did not depend on how close they were with the offender. Differences between the samples could not be explained by the extent to which people defined themselves as more independent or interdependent. The implications of these findings for future research on forgiveness motives are discussed.

Cross-cultural differences in emotion suppression in everyday interactions

Previous research suggests that in collectivistic cultures, people tend to suppress their emotions more than in individualistic cultures. Little research, however, has explored cross-cultural differences in emotion regulation in everyday interactions. Using a daily social interaction method, we examined whether people from collectivistic backgrounds (Chinese exchange students and immigrants from the Moluccas, Indonesia) living in the Netherlands differed from those from individualistic backgrounds (Dutch natives) in emotion suppression during everyday interactions. We also examined whether this depended on their relationship with the interaction partner(s). We found that Chinese participants suppressed positive and negative emotions more than Dutch and Moluccan participants and that this was related to differences in interdependent and independent self-construal across the samples. We also found that Chinese participants suppressed positive emotions less in interactions with close others, whereas Dutch participants suppressed negative emotions more with non-close others. No such differences were found for Moluccans. Our findings support the idea that people from collectivistic cultures suppress emotions more than those from individualistic cultures, but they also suggest that this depends on who the interaction partner is. Furthermore, they suggest that emotion suppression may change when people with collectivistic backgrounds have been raised in individualistic cultures.

Quality of life of residents with dementia in traditional versus small-scale long-term care settings: a quasi-experimental study

BACKGROUND

The number of people living with dementia worldwide is increasing, resulting in a need for more residential care. In response to criticism of the traditional medical approach to residential dementia care, many large nursing homes are transforming their traditional care facilities into more home-like small-scale living facilities.

OBJECTIVES

This study examined the assumed benefits of small-scale living for residents with dementia, compared to traditional long-term care in the Netherlands and Belgium. The primary outcome was quality of life, divided into nine different domains.

DESIGN

The study had a longitudinal design within a one-year time interval.

SETTINGS

Five long-term care settings in the Netherlands and Belgium containing four traditional and twelve small-scale living units participated in the study.

PARTICIPANTS

Data were obtained from 179 residents with dementia (age>65 years) (Dutch small-scale N=51, traditional N=51, Belgian small-scale N=47, traditional N=30).

METHODS

Nurses and nursing assistants were trained to fill in the questionnaires.

RESULTS

In the Dutch sample, residents in small-scale settings had higher mean scores on 'social relations', 'positive affect', and 'having something to do' than residents in traditional settings. Moreover, mean scores on 'caregiver relation' and 'negative affect' remained stable over time among residents in small-scale settings, but decreased in traditional settings. These differences could not be explained by differences in behavioural characteristics, behavioural interventions, or social interaction. In the Belgian sample, fewer differences were found between traditional and small-scale settings. Nevertheless, residents in small-scale settings were reported to experience less 'negative affect' than those in traditional settings, which could be explained by differences in depression. Over time, however, residents 'felt more at home' in traditional settings, whereas no such increase was found for small-scale settings. Moreover, the mean quality of life scores on 'restless behaviour', 'having something to do' and 'social relations' decreased in small-scale settings, but remained stable in traditional settings.

CONCLUSIONS

Both small-scale and traditional settings appear to have beneficial effects on different domains of quality of life of residents with dementia. Future research should focus more on the quality and content of the care provided, than on the effects of the scale and design of the environment in long-term care settings.

Self-Construal and the Intra- and Interethnic Social Interactions of Ethnic Minorities

This study examined relationships between self-construal and the quality of daily interactions of three ethnic minority groups in Europe: ethnic Turks and Moroccans in the Netherlands and Chechens in Poland. They described the social interactions they had for 2 weeks and they completed measures of independent and interdependent self-construal. We expected that, regardless of whether individuals’ self-construals match with prevailing construals in the host society, interdependent self-construal would be positively related to the quality of intra- and interethnic contact. The results largely confirmed this expectation. Across the two samples, participants who were higher in interdependent self-construal had more positive (and less negative) interactions than participants who were lower in interdependent self-construal. Some of these relationships varied as a function of whether or not a majority group member was present, however. Persons with a more interdependent construal of self felt more liked, respected, accepted, and free to express opinion during interactions in which a majority group member was present, whereas no such relationships were found for intra-ethnic interactions. There were very few relationships between independent self-construal and the quality of either intra- or interethnic contact. The results suggest that for the quality of ethnic minorities’ daily interactions, their interpersonal orientation is more important than a match between their orientation and the dominant orientation of the majority culture.

Stability of intracranial aneurysms adequately occluded 6 months after coiling: a 3T MR angiography multicenter long-term follow-up study

BACKGROUND AND PURPOSE

The long-term fate of coiled intracranial aneurysms is largely unknown, and prolonged imaging follow-up has been advocated. The yield of follow-up imaging in coiled aneurysms adequately occluded at 6 months is unknown. In such patients, we performed time-of-flight MR angiography (MRA) to assess the incidence and therapeutic consequences of reopening 5-11 years after coiling.

MATERIALS AND METHODS

Between 1995 and 2002, 661 aneurysms in 607 patients were coiled in 3 participating centers. Six-month follow-up angiograms were obtained in 497 (75%) aneurysms, of which 316 (64%) in 297 patients were adequately occluded. Of 297 patients, 84 were excluded for various reasons and 73 could not be traced. Of 140 eligible patients, 104 (74%) with 111 aneurysms were studied with 3T MR imaging and high-resolution MRA at a mean of 6.0 years after coiling (median, 5.6 years; range, 5.0-10.6 years).

RESULTS

The proportion of aneurysms with reopening was 3.6% (4/111; 95% confidence interval [CI], 1.1%-9.2%). One reopened aneurysm, which initially contained intraluminal thrombus, was additionally coiled (0.9%; 95% CI, 0.0%-5.4%).

CONCLUSION

In intracranial aneurysms with adequate occlusion at 6 months after coiling, the proportion of reopening needing retreatment after >5 years is low. The number of reopened aneurysms with therapeutic consequences was too small to assess risk factors, but probably the presence of intraluminal thrombus is one such risk factor. Most patients with coiled intracranial aneurysms that are adequately occluded at 6 months might not need prolonged imaging follow-up.

Success factors for telehealth—A case study

PURPOSE

To present the lessons learned from an evaluation of a comprehensive telehealth project regarding success factors and evaluation methodology for such projects.

METHODS

A recent experience with the evaluation of new telehealth services in BC, Canada, is summarized. Two domains of clinical applications, as well as educational and administrative uses, and the project environment were evaluated. In order to contribute to the success of the project, the evaluation included formative and summative approaches employing qualitative and quantitative methods with data collection from telehealth events, participants and existing databases. The evaluation had to be carried out under severe budgetary and time constraints. We therefore deliberately chose a broad ranging exploratory approach within a framework provided, and generated questions to be answered on the basis of initial observations and participant driven interviews with progressively more focused and detailed data gathering, including perusal of a variety of existing data sources. A unique feature was an economic evaluation using static simulation models.

RESULTS

The evaluation yielded rich and detailed data, which were able to explain a number of unanticipated findings. One clinical application domain was cancelled after 6 months, the other continues. The factors contributing to success include: Focus on chronic conditions which require visual information for proper management. Involvement of established teams in regular scheduled visits or in sessions scheduled well in advance. Problems arose with: Ad hoc applications, in particular under emergency conditions. Applications that disregard established referral patterns. Applications that support only part of a unit's services. The latter leads to the service mismatch dilemma (SMMD) with the end result that even those e-health services provided are not used. The problems encountered were compounded by issues arising from the manner in which the telehealth services had been introduced, in particular the lack of time for preparation and establishment of routine use. Educational applications had significant clinical benefits. Administrative applications generated savings which exceeded the substantial capital investment and made educational and clinical applications available at variable cost.

CONCLUSION

Evaluation under severe constraints can yield rich information. The identified success factors, including provision of an overarching architecture and infrastructure, strong program management, thorough needs analysis and detailing applications to match the identified needs should improve the sustainability of e-health projects. Insights gained: Existing assumptions before the study was conducted: Evaluation has to proceed from identified questions according to a rigorous experimental design. Emergency and trauma services in remote regions can and should be supported via telehealth based on video-conferencing. Educational applications of telehealth directed at providers are beneficial for recruitment and retention of providers in remote areas. Insights gained by the study: An exploratory approach to evaluation using a multiplicity of methods can yield rich and detailed information even under severe constraints. Ad hoc and emergency clinical applications of telehealth can present problems unless they are based on thorough, detailed analyses of environment and need, conform to established practice patterns and rely on established trusting collaborative relationships. Less difficult applications should be introduced before attempting to support use under emergency conditions. Educational applications are of interest beyond the provider community to patients, family and community members, and have clinical value. In large, sparsely populated areas with difficult travel conditions administrative applications by themselves generate savings that compensate for the substantial capital investment for telehealth required for clinical applications.

Lest formalisms impede insight and success: evaluation in health informatics--a case study

OBJECTIVES

To illustrate the advantages of an open-ended formative evaluation approach using a project-specific selection of methods over the controlled trial approach in the evaluation of health information systems. To illustrate factors leading to success and others impeding it in a telehealth project.

METHODS

The methods and results of an evaluation of the BC Telehealth Program are summarized.

RESULTS

The evaluation gave a comprehensive picture of the project, including assessment of the effects of an array of telehealth applications, and their economic impact. Factors leading to success and others preventing it are identified from the level of overall program management to the project specifics. The results include unanticipated effects and explanations for their reasons of occurrence. Neither the comprehensiveness of information nor the timeliness was achieved in a related project using a controlled trial approach.

CONCLUSIONS

Not all types of health information system projects can be evaluated using the controlled trial approach. This approach may impede important insights. It is also usually much less efficient. Funding agencies and journal editors have to take this into account when selecting projects for funding and submissions for publication.

The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer

PURPOSE

To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated.

METHODS AND MATERIALS

Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992.

RESULTS

The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37, 134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective.

CONCLUSION

The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50, 000/QALY benchmark often cited for cost-effective care.

Response of global quality of life to high-dose palliative radiotherapy for non-small-cell lung cancer

PURPOSE

To estimate the impact of high-dose palliative radiotherapy treatment (RT) for inoperable non-small cell lung cancer (NSCLC) on the patient's quality of life (QoL) over the remaining survival period, and to compute the number of quality adjusted life days (QALDs) gained.

METHODS AND MATERIALS

The QoL of an NSCLC patient is modelled as a function of the days left to live, the days since the start of treatment, a patient specific intercept, and a random error term. Least squares regression analysis is used to fit this model to 376 monthly QoL observations supplied by 42 prospectively enrolled high-dose palliative RT patients with NSCLC. Prediction analysis, based on the regression results and on previously published estimates of the survival response to high-dose palliative RT, is used to compute QALDs gained as a result of treatment.

RESULTS

QoL improves steadily over the first 86 days after the start of treatment. This improvement then dissipates to 0 over the subsequent 140 days. Median survival after entry (266 days) yields 158.5 QALDs, of which 56.9 can be attributed treatment: 12.6 as a result of a higher daily QoL and 44.3 as a result of longer survival.

CONCLUSION

Patients with inoperable NSCLC who received high-dose palliative RT, and survived the median 266 days after entry into the study, can attribute about one-third of their 158.5 QALDs to the QoL and survival responses to treatment.

The effect of radiotherapy on the survival of non-small cell lung cancer patients

PURPOSE

To determine if thoracic radiotherapy improves the survival of non-small cell lung cancer (NSCLC) patients.

METHODS AND MATERIALS

A Cox proportional hazards model with prognostic and treatment covariates was estimated using prospective data for 129 NSCLC patients presenting at the Victoria Clinic (ViCC) of the British Columbia Cancer Agency (BCCA) 1990-1991. The estimated model was simulated to predict survival curves for groups of patients with and without treatment. The difference between the predicted median survival with treatment and without treatment is the gain in survival attributable to treatment.

RESULTS

After adjusting for the effect of TNM staging, Karnofsky performance status, weight loss, tumor size, and tumor histology on survival, high-dose palliative radiotherapy (RT) (30-50 Gy in 10-20 fractions) increased median survival by 79 days (95% confidence interval: 31-106 days), and lowered the relative risk of death rate to 0.53 (95% confidence interval: 0.35-0.85). Radical RT (50 or more Gy, in 20 or more fractions) increased median survival by 424 days (95% confidence interval: 302-488 days), and lowered the relative risk of death to 0.24 (95% confidence interval: 0.14-0.43).

CONCLUSION

Our results support the hypothesis that the increased survival of patients receiving aggressive palliative, or radical, RT is due not solely to patient selection, but also partly to a response to treatment.

Results and complications after posterior lumbar spondylodesis with the "Variable Screw Placement Spinal Fixation System"

Between March 1988 and March 1990, 45 patients underwent a spondylodesis using transpedicular screws and plates of the "Variable Screw Placement Spinal Fixation System". The indications for operation were spondylolisthesis (13), spondylolisthesis plus discopathy at the adjacent level (4), degenerative discopathy (13), pseudarthrosis after interbody fusion (7), disc herniations (4) and disc herniations plus degenerative discopathy of the adjacent segment (4). In 1992, 43 patients were available for follow-up. The mean follow-up was 3.85 years. Side effects or complications of a more permanent character were seen 25 times in 43 patients. Eight patients had evidence of screw failure: loosening (5), fracture (2), and malposition (1). Complications, screw failure and reoperation all adversely affected clinical outcome. Overall only 60% of the patients reported a positive clinical outcome at follow-up. In our opinion transpedicular instrumentation is a logical system to provide rigid stabilisation, but it has a high learning curve. The original V.S.P. system with its bulky plates and screws appears to be particularly prone to giving a high rate of unwanted side effects not offset by a high clinical success rate.

Implicit rationing criteria in non-small-cell lung cancer treatment

Data collected from lung cancer patients attending the Victoria Clinic of the British Columbia Cancer Agency are used to investigate how resources are rationed in the treatment of non-small-cell lung cancer (NSCLC). An ordered logit model is estimated to analyse empirically the relationship between treatment selection and: tumour stage, size and differentiation; the Feinstein index; Karnofsky performance status (KPS); and the patient's age, gender and marital and smoking status. Implicit rationing is found to occur with respect to all of these factors except the Feinstein index, gender and marital status. With respect to age, KPS and smoker status the main empirical results are: (a) an increase in age from 50 to 85 reduces the expected treatment expenditure by 50-70%, depending on the patient's KPS and smoker status; (b) patients with a KPS less than 80 and of 80, receive 30-46% and 75-85%, respectively, of the expected treatment expenditure for patients with a KPS of 90 or 100, depending on age and smoker status; (c) the expected treatment expenditure for active smokers is about 71-86% of the expenditure for non- or former smokers depending on age and KPS.

Comparative costs of lung cancer management

A method is outlined for comparative costing of different protocols of lung cancer management in a free-standing clinic. The costs of chemotherapy and radiation therapy are evaluated according to alternative regimens of treatment. The costs of new patient assessment, patient follow-up, and ancillary care (social work and nutrition assistance) are also included. Except for the cost of routine blood tests during chemotherapy and radiotherapy planning computerized tomography (CT) scans, costs incurred outside the clinic are excluded. The method is illustrated by application to out-patient treatment of lung cancer at the Victoria Clinic of the British Columbia Cancer Agency in Victoria, British Columbia, Canada, using data for the 1989-90 fiscal year of the Clinic. The method may be adapted for use in other disease and institutional settings.

The Karnofsky Performance Status Scale re-examined: a cross-validation with the EORTC-C30

A cross-validation of the Karnofsky Performance Status (KPS) and quality of life (QOL) as measured by item 30 of the quality of life questionnaire developed by the European Organization for Research and Treatment of Cancer Study Group (EORTC QLQ-C30) was conducted using ordered logit analysis and prospective data from a continuous sample of 139 lung cancer patients. The QOL is found to be a much broader concept than the KPS, since it likely captures not only physical functioning but also functioning in the non-physical dimensions of social, emotional, and possibly cognitive well-being as well as the level of distress in the physical dimensions of pain, breathing and fatigue. These results suggest that the palliative treatment of advanced cancer and the terminally ill should be guided by a broad concept of well-being that goes beyond one based only on physical functioning.

A new test for supplier-inducement and application to the Canadian market for dental care

The hypothesis that dentists do not induce demand for their services is tested using reduced form estimates of the price elasticity of demand. If demand is autonomous, shifts in supply for whatever reason should generate equivalent estimates provided access costs change proportionately with shifts in supply. If demand inducement is present demand can appear to be very elastic, or very inelastic, depending on what is causing the shift in supply. Each of three applications of this test, conducted in the context of jointly estimated fee and quantity equations using annual Canadian data for 1956-1989, rejects the no inducement hypothesis.

Binding of thyroid hormones to isolated hepatic nuclei from Rana catesbeiana tadpoles

This study is concerned with the characteristics of thyroid hormone binding to isolated hepatic nuclei from premetamorphic tadpoles. Conditions essential for nuclear stability and/or demonstration of saturable binding included 220-mosmol buffers containing 0.1 mM ZnCl2 and removal of most of the melanin granules; binding of T4 and T3 to melanin was significant, but unsaturable. Scatchard analysis of [125I]T3 binding to nuclei in the presence of increasing concentrations of T3 revealed the presence of two sets of saturable sites: a high affinity, low capacity set and a second set which had a lower affinity but approximately 4 times the capacity of the first set. Two sets of T4-binding sites were also detected. The data indicate that the two hormones bind to the same two sets of sites. Thus, both T3 and T4 completely displaced either [125I]T3 or [125I]T4 bound to saturable sites, although more T4 than T3 was required for 50% displacement of either hormone. Moreover, the presence of a partially saturating concentration of T4 in a displacement study of [125I]T3 by cold T3 resulted in decreased affinity of both sets of T3-binding sites. Both sets of sites have a higher affinity for T3 than for T4. It is postulated that the high affinity set of sites consists of hormone receptors.