The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. We (...) argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach. The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures. (shrink)

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

The focus of this study was to analyze the content, distribution, and comparative genome relationships of 996 chromosome bin-mapped expressed sequence tags accounting for 2266 restriction fragments on the homoeologous group 3 chromosomes of hexaploid wheat. Of these loci, 634, 884, and 748 were mapped on chromosomes 3A, 3B, and 3D, respectively. The individual chromosome bin maps revealed bins with a high density of mapped ESTs in the distal region and bins of low density in the proximal region of the (...) chromosome arms, with the exception of 3DS and 3DL. These distributions were more localized on the higher-resolution group 3 consensus map with intermediate regions of high-mapped-EST density on both chromosome arms. Gene ontology classification of mapped ESTs was not significantly different for homoeologous group 3 chromosomes compared to the other groups. A combined analysis of the individual bin maps using 537 of the mapped ESTs revealed rearrangements between the group 3 chromosomes. Approximately 232 of the consensus mapped ESTs matched sequences on rice chromosome 1 and revealed large- and small-scale differences in gene order. Of the group 3 mapped EST unigenes ∼21 and 32% matched the Arabidopsis coding regions and proteins, respectively, but no chromosome-level gene order conservation was detected. (shrink)

We apply the Galilean covariant formulation of quantum dynamics to derive the phase-space representation of the Pauli–Schrödinger equation for the density matrix of spin-1/2 particles in the presence of an electromagnetic field. The Liouville operator for the particle with spin follows from using the Wigner–Moyal transformation and a suitable Clifford algebra constructed on the phase space of a (4 + 1)-dimensional space–time with Galilean geometry. Connections with the algebraic formalism of thermofield dynamics are also investigated.

Infinite time Turing machines with only one tape are in many respects fully as powerful as their multi-tape cousins. In particular, the two models of machine give rise to the same class of decidable sets, the same degree structure and, at least for partial functions f : ℝ → ℕ, the same class of computable functions. Nevertheless, there are infinite time computable functions f : ℝ → ℝ that are not one-tape computable, and so the two models of infinitary computation (...) are not equivalent. Surprisingly, the class of one-tape computable functions is not closed under composition; but closing it under composition yields the full class of all infinite time computable functions. Finally, every ordinal that is clockable by an infinite time Turing machine is clockable by a one-tape machine, except certain isolated ordinals that end gaps in the clockable ordinals. (shrink)

Research on motivation has mainly concentrated on the role of goal orientation and self?evaluation in conducting learning activities. In this paper, we examine the relative importance of teachers? teaching and their efficacy beliefs to explain variation in student motivation. Questionnaires were used to measure the well?being, academic self?efficacy, mastery goal orientation, performance avoidance, intrinsic motivation and school investment of students (n = 3462) and the teaching practices and teachers? sense of self?efficacy (n = 194) in primary schools. Results of the (...) multi?level analyses show that connection to the students? world and cooperative learning methods had a positive effect on students? motivation, while process?oriented instruction by the teacher had a negative effect on motivational behaviour and motivational factors of students. Finally, the results lend credence to the argument that teachers? sense of self?efficacy has an impact on both teachers? teaching and students? motivation to learn. (shrink)

The complex hexaploid wheat genome offers many challenges for genomics research. Expressed sequence tags facilitate the analysis of gene-coding regions and provide a rich source of molecular markers for mapping and comparison with model organisms. The objectives of this study were to construct a high-density EST chromosome bin map of wheat homoeologous group 2 chromosomes to determine the distribution of ESTs, construct a consensus map of group 2 ESTs, investigate synteny, examine patterns of duplication, and assess the colinearity with rice (...) of ESTs assigned to the group 2 consensus bin map. A total of 2600 loci generated from 1110 ESTs were mapped to group 2 chromosomes by Southern hybridization onto wheat aneuploid chromosome and deletion stocks. A consensus map was constructed of 552 ESTs mapping to more than one group 2 chromosome. Regions of high gene density in distal bins and low gene density in proximal bins were found. Two interstitial gene-rich islands flanked by relatively gene-poor regions on both the short and long arms and having good synteny with rice were discovered. The map locations of two ESTs indicated the possible presence of a small pericentric inversion on chromosome 2B. Wheat chromosome group 2 was shown to share syntenous blocks with rice chromosomes 4 and 7. (shrink)

The language of manuals may be used to discuss inference in measurement in a general experimental context. Specializing to the context of the frame manual for Hilbert space, this inference leads to state dominance of the inferred state from partial measurements; this in turn, by Sakai's theorem, determines observables which are described by positive operator-valued measures. Symmetries are then introduced, showing that systems of covariance, rather than systems of imprimitivity, are natural objects to study in quantum mechanics. Experiments measuring different (...) polarization components simultaneously are reexamined in this language. Finally, implications of the Naimark extension theorem for the manual approach are investigated. (shrink)