Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Interpretation of recommended risk terms: differences between doctors and lay people

Objectives: To examine doctors' (Experiment 1) and doctors' and lay people's (Experiment 2) interpretations of two sets of recommended verbal labels for conveying information about side effects incidence rates. Method: Both studies used a controlled empirical methodology in which participants were presented with a hypothetical, but realistic, scenario involving a prescribed medication that was said to be associated with either mild or severe side effects. The probability of each side effect was described using one of the five descriptors advocated by the European Union (Experiment 1) or one of the six descriptors advocated in Calman's risk scale (Experiment 2), and study participants were required to estimate (numerically) the probability of each side effect occurring. Key findings: Experiment 1 showed that the doctors significantly overestimated the risk of side effects occurring when interpreting the five EU descriptors, compared with the assigned probability ranges. Experiment 2 showed that both groups significantly overestimated risk when given the six Calman descriptors, although the degree of overestimation was not as great for the doctors as for the lay people. Conclusion: On the basis of our findings, we argue that we are still a long way from achieving a standardised language of risk for use by both professionals and the general public, although there might be more potential for use of standardised terms among professionals. In the meantime, the EU and other regulatory bodies and health professionals should be very cautious about advocating the use of particular verbal labels for describing medication side effects.

Semantic-driven context-aware visual information indexing and retrieval: applied in the film post-production domain

A large volume of visual content is inaccessible until effective and efficient indexing and retrieval of such data is achieved. In this paper, we introduce the DREAM system, which is a knowledge-assisted semantic-driven context-aware visual information retrieval system applied in the film post production domain. We mainly focus on the automatic labelling and topic map related aspects of the framework. The use of the context- related collateral knowledge, represented by a novel probabilistic based visual keyword co-occurrence matrix, had been proven effective via the experiments conducted during system evaluation. The automatically generated semantic labels were fed into the Topic Map Engine which can automatically construct ontological networks using Topic Maps technology, which dramatically enhances the indexing and retrieval performance of the system towards an even higher semantic level.

The locally twisted cubes

This paper introduces a new variant of the popular n-dimensional hypercube network Q(n), known as the n-dimensional locally twisted cube LTQ(n), which has the same number of nodes and the same number of connections per node as Q(n). Furthermore. LTQ(n) is similar to Q(n) in the sense that the nodes can be one-to-one labeled with 0-1 binary sequences of length n. so that the labels of any two adjacent nodes differ in at most two successive bits. One advantage of LTQ(n) is that the diameter is only about half of the diameter of Q(n) We develop a simple routing algorithm for LTQ(n), which creates a shortest path from the source to the destination in O(n) time. We find that LTQ(n) consists of two disjoint copies of Q(n) by adding a matching between their nodes. On this basis. we show that LTQ(n) has a connectivity of n.

Fully automated software solution for protein quantitation by global metabolic labeling with stable isotopes

Metabolic stable isotope labeling is increasingly employed for accurate protein (and metabolite) quantitation using mass spectrometry (MS). It provides sample-specific isotopologues that can be used to facilitate comparative analysis of two or more samples. Stable Isotope Labeling by Amino acids in Cell culture (SILAC) has been used for almost a decade in proteomic research and analytical software solutions have been established that provide an easy and integrated workflow for elucidating sample abundance ratios for most MS data formats. While SILAC is a discrete labeling method using specific amino acids, global metabolic stable isotope labeling using isotopes such as (15)N labels the entire element content of the sample, i.e. for (15)N the entire peptide backbone in addition to all nitrogen-containing side chains. Although global metabolic labeling can deliver advantages with regard to isotope incorporation and costs, the requirements for data analysis are more demanding because, for instance for polypeptides, the mass difference introduced by the label depends on the amino acid composition. Consequently, there has been less progress on the automation of the data processing and mining steps for this type of protein quantitation. Here, we present a new integrated software solution for the quantitative analysis of protein expression in differential samples and show the benefits of high-resolution MS data in quantitative proteomic analyses.

Should we be utopophobes about democracy in particular?

In his book Democratic Authority, David Estlund puts forward a case for democracy, which he labels epistemic proceduralism, that relies on democracy's ability to produce good – that is, substantively just – results. Alongside this case for democracy Estlund attacks what he labels ‘utopophobia’, an aversion to idealistic political theory. In this article I make two points. The first is a general point about what the correct level of ‘idealisation’ is in political theory. Various debates are emerging on this question and, to the extent that they are focused on ‘political theory’ as a whole, I argue, they are flawed. This is because there are different kinds of political concept, and they require different kinds of ideal. My second point is about democracy in particular. If we understand democracy as Estlund does, then we should see it as a problem-solving concept – the problem being that we need coercive institutions and rules, but we do not know what justice requires. As democracy is a response to a problem, we should not allow our theories of it, even at the ideal level, to be too idealised – they must be embedded in the nature of the problem they are to solve, and the beings that have it.

Unusual isotope effect in the reaction of chlorosilylene with trimethylsilane-1-d: Absolute rate studies and quantum chemical and Rice–Ramsperger–Kassel–Marcus calculations provide strong evidence for the involvement of an intermediate complex

Time-resolved studies of chlorosilylene, ClSiH, generated by the 193 nm laser flash photolysis of 1-chloro-1- silacyclopent-3-ene, have been carried out to obtain rate constants for its bimolecular reaction with trimethylsilane-1-d, Me3SiD, in the gas phase. The reaction was studied at total pressures up to 100 Torr (with and without added SF6) over the temperature range of 295−407 K. The rate constants were found to be pressure independent and gave the following Arrhenius equation: log[(k/(cm3 molecule−1 s−1)] = (−13.22 ± 0.15) + [(13.20 ± 1.00) kJ mol−1]/(RT ln 10). When compared with previously published kinetic data for the reaction of ClSiH with Me3SiH, kinetic isotope effects, kD/kH, in the range from 7.4 (297 K) to 6.4 (407 K) were obtained. These far exceed values of 0.4−0.5 estimated for a single-step insertion process. Quantum chemical calculations (G3MP2B3 level) confirm not only the involvement of an intermediate complex, but also the existence of a low-energy internal isomerization pathway which can scramble the D and H atom labels. By means of Rice−Ramsperger−Kassel−Marcus modeling and a necessary (but small) refinement of the energy surface, we have shown that this mechanism can reproduce closely the experimental isotope effects. These findings provide the first experimental evidence for the isomerization pathway and thereby offer the most concrete evidence to date for the existence of intermediate complexes in the insertion reactions of silylenes.

Bilingual 'tagging' of financial accounts in Demotic and Greek

‘Bilingual’ documents, with text in both Demotic and Greek, can be of several sorts, ranging from complete translations of the same information (e.g. Ptolemaic decrees) to those where the information presented in the two languages is complementary (e.g. mummy labels). The texts discussed in this paper consist of a number of examples of financial records where a full account in one language (L1) is annotated with brief pieces of information in a second language (L2). These L2 ‘tags’ are designed to facilitate extraction of summary data at another level of the administration, functioning in a different language, and probably also to make the document accessible to those who are not literate in the L1.

An ethical turn in African mining: voluntary regulation through fair trade

In recent decades there has been an ethical turn in expectations of how African mineral production and trade should be conducted. Good labour conditions, the absence of conflict and mining’s potential for securing economic, social and environmental benefits are being demanded in the jewellery trade. As a consequence the quality of precious and semi-precious metals and gemstones is now being judged on their ethical credentials in addition to their aesthetic and mineral qualities. Mineral production for industrial manufacture, particularly in the electronics industry, is also coming under scrutiny. Adding value through ethics is closely associated with the use of voluntary (non-state) regulation. This includes standards and associated certification and labels, which have been widely adopted by the minerals and metals sector in efforts to ensure improvements in the social and environmental conditions of production and to enable access to the profitable and expanding global ‘ethical market’. In this chapter, we focus on ethical trading schemes that incorporate voluntary regulation, by using artisanal gold mining in Tanzania and the sale of gold through international fair trade markets as an exemplar to consider the development dynamics that emerge from ethical schemes.

Using QR codes to aid accessibility in a museum

Purpose – This paper describes visitors' reactions to using an Apple iPad or smartphone to follow trails in a museum by scanning QR codes and draws conclusions on the potential for this technology to help improve accessibility at low-cost. Design/methodology/approach – Activities were devised which involved visitors following trails around museum objects, each labelled with a QR code and symbolised text. Visitors scanned the QR codes using a mobile device which then showed more information about an object. Project-team members acted as participant-observers, engaging with visitors and noting how they used the system. Experiences from each activity fed into the design of the next. Findings – Some physical and technical problems with using QR codes can be overcome with the introduction of simple aids, particularly using movable object labels. A layered approach to information access is possible with the first layer comprising a label, the second a mobile-web enabled screen and the third choices of text, pictures, video and audio. Video was especially appealing to young people. The ability to repeatedly watch video or listen to audio seemed to be appreciated by visitors with learning disabilities. This approach can have low equipment-cost. However, maintaining the information behind labels and keeping-up with technological changes are on-going processes. Originality/value – Using QR codes on movable, symbolised object labels as part of a layered information system might help modestly-funded museums enhance their accessibility, particularly as visitors increasingly arrive with their own smartphones or tablets.

Cognitive influences on the affective representation of touch and the sight of touch in the human brain

We show that the affective experience of touch and the sight of touch can be modulated by cognition, and investigate in an fMRI study where top-down cognitive modulations of bottom-up somatosensory and visual processing of touch and its affective value occur in the human brain. The cognitive modulation was produced by word labels, 'Rich moisturizing cream' or 'Basic cream', while cream was being applied to the forearm, or was seen being applied to a forearm. The subjective pleasantness and richness were modulated by the word labels, as were the fMRI activations to touch in parietal cortex area 7, the insula and ventral striatum. The cognitive labels influenced the activations to the sight of touch and also the correlations with pleasantness in the pregenual cingulate/orbitofrontal cortex and ventral striatum. Further evidence of how the orbitofrontal cortex is involved in affective aspects of touch was that touch to the forearm [which has C fiber Touch (CT) afferents sensitive to light touch] compared with touch to the glabrous skin of the hand (which does not) revealed activation in the mid-orbitofrontal cortex. This is of interest as previous studies have suggested that the CT system is important in affiliative caress-like touch between individuals.

A radial basis function network classifier to maximise leave-one-out mutual information

tWe develop an orthogonal forward selection (OFS) approach to construct radial basis function (RBF)network classifiers for two-class problems. Our approach integrates several concepts in probabilisticmodelling, including cross validation, mutual information and Bayesian hyperparameter fitting. At eachstage of the OFS procedure, one model term is selected by maximising the leave-one-out mutual infor-mation (LOOMI) between the classifier’s predicted class labels and the true class labels. We derive theformula of LOOMI within the OFS framework so that the LOOMI can be evaluated efficiently for modelterm selection. Furthermore, a Bayesian procedure of hyperparameter fitting is also integrated into theeach stage of the OFS to infer the l2-norm based local regularisation parameter from the data. Since eachforward stage is effectively fitting of a one-variable model, this task is very fast. The classifier construc-tion procedure is automatically terminated without the need of using additional stopping criterion toyield very sparse RBF classifiers with excellent classification generalisation performance, which is par-ticular useful for the noisy data sets with highly overlapping class distribution. A number of benchmarkexamples are employed to demonstrate the effectiveness of our proposed approach.

Does energy efficiency matter to home-buyers? An investigation of EPC ratings and transaction prices in England

This paper investigates whether energy performance ratings, as measured by mandatory Energy Performance Certificates (EPCs), are reflected in the sale prices of residential properties. This is the first large-scale empirical study of this topic in England involving 333,095 dwellings sold at least twice in the period from 1995 to 2012. Applying hedonic regression and an augmented repeat sales regression, we find a positive relationship between the energy efficiency rating of a dwelling and the transaction price per square metre. The price effects of superior energy performance tend to be higher for terraced dwellings and flats compared to detached and semi-detached dwellings. The evidence is less clear-cut for rates of house price growth but remains supportive of a positive association. Overall, the results of this study suggest that energy efficiency labels have a measurable and significant impact on house prices in England

Segmenting the Italian coffee market: marketing opportunities for economic agents working along the international coffee chain

Globalization, either directly or indirectly (e.g. through structural adjustment reforms), has called for profound changes in the previously existing institutional order. Some changes adversely impacted the production and market environment of many coffee producers in developing countries resulting in more risky and less remunerative coffee transactions. This paper focuses on customization of a tropical commodity, fair-trade coffee, as an approach to mitigating the effects of worsened market conditions for small-scale coffee producers in less developed countries. fair-trade labeling is viewed as a form of “de-commodification” of coffee through product differentiation on ethical grounds. This is significant not only as a solution to the market failure caused by pervasive information asymmetries along the supply chain, but also as a means of revitalizing the agricultural-commodity-based trade of less developed countries (LDCs) that has been languishing under globalization. More specifically, fair-trade is an example of how the same strategy adopted by developed countries’ producers/ processors (i.e. the sequence product differentiation - institutional certification - advertisement) can be used by LDC producers to increase the reputation content of their outputs by transforming them from mere commodities into “decommodified” (i.e. customized and more reputed) goods. The resulting segmentation of the world coffee market makes possible to meet the demand by consumers with preference for this “(ethically) customized” coffee and to transfer a share of the accruing economic rents backward to the Fair-trade coffee producers in LDCs. It should however be stressed that this outcome cannot be taken for granted since investments are needed to promote the required institutional innovations. In Italy FTC is a niche market with very few private brands selling this product. However, an increase of FTC market share could be a big commercial opportunity for farmers in LDCs and other economic agents involved along the international coffee chain. Hence, this research explores consumers’ knowledge of labels promoting quality products, consumption coffee habits, brand loyalty, willingness to pay and market segmentation according to the heterogeneity of preferences for coffee products. The latter was assessed developing a D-efficient design where stimuli refinement was tested during two focus groups.

Information customization and food choice

In this paper we employ a hypothetical discrete choice experiment (DCE) to examine how much consumers are willing to pay to use technology to customize their food shopping. We conjecture that customized information provision can aid in the composition of a healthier shop. Our results reveal that consumers are prepared to pay relatively more for individual specic information as opposed to generic nutritional information that is typically provided on food labels. In arriving at these results we have examined various model specications including those that make use of ex-post de-brieng questions on attribute nonattendance and attribute ranking information and those that consider the time taken to complete the survey. Our main results are robust to the various model specications we examine