Hypothetical Option Research Articles

Patterns in student self-reported situational interest in online introductory geoscience labs during COVID

Triggered situational interest in introductory courses can encourage student engagement, motivation, and value for the geosciences. In-person labs have traditionally played a unique role in triggering situational interest compared to lectures, but the COVID transition online disrupted these dynamics. We examine students’ self-reported situational interest from 6,463 responses to weekly surveys in online introductory geoscience lab courses at five U.S. institutions during fall 2020 and spring 2021. Approximately half of students reported that labs were equally (49.4%) or more interesting (4.3%) online, compared to a hypothetical in-person option. Analysis showed a statistically-significant interaction between student situational interest and the combined effect of 1) the course the students were enrolled in and 2) the topic of the lab session (F (20, 6395) = 4.038, p < 0.001). However, topic and course together explain only about 4% of the variance in the dataset, indicating that other factors have a large role in triggering interest. Students who indicated that labs were less interesting online (46.3%) most often cited not being able to physically interact with instructional materials (56.3%) and difficulty interacting with peers (30.6%). When asked what revisions would increase their situational interest, additional hands-on interaction (22.8%) and increased relevance to their life or future career (20.2%) were the answer choices students selected most frequently. These findings identify modifications and enhancements grounded in students’ self-reported interest that can inform the design of online introductory geology labs.

Restoring areas after a radioactive fallout: A multidisciplinary study on decontamination

Land remediation is an important part of restoration measures after a radioactive fallout containing long-lived fission products such as 137Cs. In this multidisciplinary study, we focused on three main issues related to remediation of contaminated urban areas. First, we assessed how much decontamination contributes to reducing resident radiation exposure and how much this reduction depends on the timing of implemented measures. Second, we calculated direct and indirect costs of decontamination in an industrialized country such as Sweden. Finally, in a survey study, we considered reactions of Swedish citizens to being given the hypothetical option of moving to a site decontaminated after radioactive fallout and how this predicted response might influence the design of contingency plans.The main findings are that clean-up operations must be done within the first few years after a fallout to contribute significantly to reducing residual dose. If conducted within 1–2 years, large-scale decontamination can, on average, avert 20–200 manSv per km2 residential area and unit ground deposition of 137Cs (1 MBq). The estimated direct costs (in 2020 purchasing power) would amount to 100 million Euro per km2 decontaminated residential area (comparable to Japanese estimates after the Fukushima accident), generating 39,000 m3 of radioactive waste on average, mainly in the form of 137Cs-contaminated topsoil. In our survey study of 2291 Swedish respondents about their willingness to return to decontaminated homes, women, families with resident children, and high-income earners exhibited more skepticism about returning, even if authorities were to deem it safe. The demographic pattern in attitudes was similar to that found among evacuees in the Fukushima prefecture after 2011.We conclude that predefined ranges of measured 137Cs ground deposition can be used as guidance for rescue leaders in the early post-accident phase in long-term planning for affected areas. This planning should include timing and intensity of decontamination measures, duration of evacuation, and risk communication to citizens. Because some citizens expressed both high risk perception and risk aversion, however, timely and dialogic communication is unlikely to limit a shift after the incident to an older and more male-dominated population composition. There is a risk that those who can afford to do so will move away, whereas people whose wealth is locked in property (houses or businesses) will feel stuck. Perceptions of unfairness may fray the social fabric and complicate resettlement, which in some cases may mean inefficient outlay of decontamination costs. We believe that the issue of monetary compensation to affected residents requires priority in future work.

Coupled modeling of neutronics and thermal-hydraulics processes in LFR under SG-leakage condition

The lead cooled reactor BREST-OD-300 is developing as a part of Russian federal project “PRORYV”. Two- circuit scheme is used in the reactor for heat removal. An inherent risk of two- circuit reactor is the potential danger of water steam ingression in the core in the case of large leakage in steam generator initiated, for example, Steam Generator Tube Rupture (SGTR). Reactor power and temperature response on vapor penetration to the core is studied, but pressurization effects are not in the purview of the paper. The 3D multi-physics (neutronics + thermal-hydraulics) UNICO-2F code was developed for study of SGTR accident. The code calculates unsteady 3D space dependent distributions of coolant velocity, pressure and temperature, space distributions of vapor concentration and heat release density in the core and 3D temperature distributions in the fuel pins. Guillotine rupture of one tube in Steam Generator (SG) is considered as initial event of the accident. It is shown that even with the most conservative assumptions reactivity insertion due to vapor ingress in the core causes small increase of power in level and as a result maximum cladding temperature continue to stay well below safe operation design limit in the entire transient. Hypothetical option of simultaneous tube rupture in few SG belonging to different loops is also analyzed. It is demonstrated that even in the case of simultaneous large leak in two SG the transient stays mild and temperature in the core after two small oscillations is stabilized at acceptable level. In the long term the analysis confirmed the high level of reactor self-protection against SGTR accident.

A cross-sectional survey of U.S. abortion patients’ interest in obtaining medication abortion over the counter

ObjectiveTo assess abortion patients’ perspectives about a hypothetical option to access medication abortion over the counter without a prescription. Study designFrom October 2019 to March 2020, people ages 15 and over seeking abortion at 7 facilities across the United States completed a cross-sectional, self-administered survey regarding their personal interest in and general support for accessing medication abortion over the counter, including the advantages and disadvantages of over-the-counter access. We used multivariable logistic regression with generalized estimating equations to assess associations between experiencing barriers that led to delay in obtaining abortion care and personal interest in and general support for accessing medication abortion over the counter. ResultsOf the 1687 people approached, 1202 (71%) wanted to participate, and 1178 completed the survey. Most people were personally interested in (725/1119, 65%) and in favor of (925/1120, 83%) over-the-counter medication abortion. The most common advantages noted of the over-the-counter model included privacy (772/1124, 69%), earlier access (774/1124, 69%), and convenience (733/1124, 65%). The most common disadvantages noted included incorrect use (664/1124, 59%), not seeing a clinician beforehand (439/1124, 39%), and could be less effective (271/1124, 24%). In adjusted analyses, cost barriers that resulted in delays to the appointment, White race/ethnicity (vs Black), and higher educational attainment were significantly associated with greater personal interest in and support for over-the-counter medication abortion. ConclusionsPeople accessing facility-based abortion care are very supportive of and interested in being able to access abortion over the counter. Those facing financial barriers obtaining facility-based care may benefit from allowing medication abortion to be available over the counter without a prescription. ImplicationsGiven people's interest in over-the-counter access to medication abortion, research is needed to assess whether people can use medication abortion appropriately without clinical supervision. Such research could help determine whether medication abortion is suitable for an over-the counter switch.

MP16-13 PATIENT PERCEPTION OF TRANSURETHRAL RESECTION OF BLADDER TUMOR VS. CHEMOABLATION FOR NON-MUSCLE INVASIVE BLADDER CANCER TREATMENT

You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-13 PATIENT PERCEPTION OF TRANSURETHRAL RESECTION OF BLADDER TUMOR VS. CHEMOABLATION FOR NON-MUSCLE INVASIVE BLADDER CANCER TREATMENT Taylor Parisse, Katy Reines, Ramsandkar Basak, Dana Mueller, and Angela Smith Taylor ParisseTaylor Parisse More articles by this author , Katy ReinesKaty Reines More articles by this author , Ramsandkar BasakRamsandkar Basak More articles by this author , Dana MuellerDana Mueller More articles by this author , and Angela SmithAngela Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with non-muscle invasive bladder cancer (NMIBC) often require invasive monitoring and treatment. As new treatments emerge, our objective was to evaluate patient treatment preference for repeat transurethral resections of bladder tumor (TURBT) versus chemoablation and examine associations between patient and disease characteristics with treatment preference. METHODS: Patients diagnosed with NMIBC who had undergone one or more TURBTs were recruited via the Bladder Cancer Advocacy Network (BCAN) Patient Survey Network (PSN) to complete a web-based survey. The survey ascertained patient demographics and clinical information. The survey also addressed treatment preference between two hypothetical options, surgical therapy (TURBT) versus intravesical chemoablation without surgery, and reasons for treatment preference. Bivariable and multivariable analyses were performed. RESULTS: A total of 350 patients responded to the survey among whom 60% preferred TURBT and 40% preferred intravesical chemoablation. Predictors of treatment preference for chemoablation included United States (U.S.) residence (p=0.02), more recent TURBT experience (p=0.03), high tumor grade (p=0.03), or expressed priority of recurrence risk (p <0.0001) (Figure). On multivariable analysis, patients were more likely to prefer chemoablation if a U.S. resident (OR=2.03; 95% CI 1.03, 4.00) or if they expressed priority of recurrence risk over effectiveness (OR=15.5; 95% CI 7.8, 30.5). CONCLUSIONS: When provided chemoablation as a hypothetical treatment option for bladder cancer recurrence, a significant proportion of patients preferred this non-surgical treatment to conventional TURBT, more commonly among U.S. patients. Patients who had a recent experience with TURBT as well as those who expressed recurrence risk as a priority in decision-making were also more likely to prefer chemoablation. Source of Funding: Funding provided by a Bladder Cancer Advocacy Network Patient Survey Network Award © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e301-e302 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taylor Parisse More articles by this author Katy Reines More articles by this author Ramsandkar Basak More articles by this author Dana Mueller More articles by this author Angela Smith More articles by this author Expand All Advertisement Loading ...

Better portfolios with higher moments

A toolset beyond mean–variance portfolio optimization is appropriate for those instances where higher return moments might need to be taken into account, either for individual decisions or for pricing studies. Maximizing expected log surplus utility is superior for compounding returns in excess of financial obligations. Here, it is matched with a more flexible scenario representation of the investor’s joint probability distribution of returns and with an agnostic optimization engine. We show simple examples based on extrapolating historical stock and bond returns and then extended using hypothetical option prices. We clarify how Black–Scholes implied volatility anomalies can arise in a portfolio context.

CAREGIVER PREFERRED STRUCTURE FOR A TELEHEALTH-BASED INTERVENTION ONE-TO-ONE VERSUS GROUP

Caring for a person with Alzheimer’s disease and related dementias (ADRD) can be stressful. Support programs are available for caregivers, but distance and cost present barriers to participation. Our mixed-methods study explored consumer acceptability and preliminary efficacy of a telehealth-based caregiver intervention, Tele-STAR. Caregivers in Tele-STAR met one-to-one with a consultant over eight weeks, via video conferencing, to address behavioral symptoms of dementia. We measured the effect of the intervention on caregiver reactivity to behavioral symptoms. Focus groups were used to assess acceptability. The literature suggests that stressed caregivers drop out of support programs. Thus, in the focus groups we asked about preference for intervention mode (one-to-one versus group). We hypothesized that more stressed caregivers would prefer the one-to-one mode. Data were analyzed using paired t-tests for the quantitative data, and a phenomenological lens for the qualitative data. Of the thirteen enrolled caregivers, twelve completed the study. Significant improvement was found in caregiver reactivity (p=0.001). Twelve caregivers participated in focus groups, in which they reported that the intervention helpful and they valued the therapeutic relationships with the consultants. Few had difficulty with the technological interface. Most liked the one-to-one mode of the intervention, but were open to a hypothetical group-based option. However, more stressed caregivers preferred a one-to-one intervention over a group intervention (p=0.06). While one-to-one interventions tend to be preferred by caregivers, they are expensive. Our findings suggest that one-to-one telehealth-based interventions should be reserved for more stressed caregivers who need intensive support with managing behavioral symptoms of dementia.

Value attributes and user preferences for the coastal wetland ecosystem in Caofeidian, China

The coastal wetland ecosystem in Caofeidian has undergone serious degradation over the past 50 years. The local government and policy makers need scientific information of integrating wetland protection and economic development. In this study, in order to evaluate the respondents’ preference for the possible attribute change of biodiversity, wetland restoration, water quality, and tourism infrastructure, choice experiment is performed, and after comparing the conditional logit model, the random parameter logit model, and the random parameter logit model with interactions, the random parameter logit model with interactions is treated as the main model to estimate the unobserved and observed preference heterogeneity and marginal willingness to pay for the corresponding attributes. Results show that “more wetland restoration” is the highest valued attribute, respondents with a high education degree are inclined to conduct wetland restoration actions, and respondents who have visited the coastal wetland ecosystem before tend to pay a high price. Furthermore, a hypothetical option of wetland ecosystem management, which is defined in terms of “medium biodiversity,” “more wetland restoration,” “best water quality,” and “more tourism infrastructure,” is recommended, and it could be regarded as the main development pattern for the future construction and restoration of the coastal wetland ecosystem.

Watershed Management Benefits in a Hypothetical, Real Intention and Real Willingness to Pay Approach

Despite growing knowledge of a disparity between stated and actual willingness to engage in pro-environmental behavior, little is known about the cognitive or attitudinal factors explaining the disparity. In the context of water quality improvement in a river basin, we address the disparity issue by applying two approaches: a typical valuation question with a hypothetical option of voluntary payment and a valuation question with a real option of voluntary payment. The latter treatment allows for further analysis of the respondents who committed to a real payment. We show empirical evidence on the psychological factors explaining the disparity between the treatments and its relationship with response uncertainty. The extent of learning from the survey about water management of the watershed increased the likelihood of stating the willingness to contribute, either with certainty or uncertainty. In turn, a previous contribution to the environmental issue, higher income, belief in the scenario, and responding to the hypothetical treatment increased the likelihood of stating certain willingness to contribute. Our findings indicate that the factors influencing the decision on the maximum payment differ between treatments. Cognitive factors, such as perceiving the valuation scenario as plausible, learning from the questionnaire, and in which mailing round the respondent completed the survey, only explained the stated amount for the willingness to pay in the treatment with a hypothetical option for voluntary payment. In the real option treatment, a higher stated willingness to pay was more likely if the respondent actually made the payment and had a higher household income.

Allogeneic Umbilical Cord-Derived Mesenchymal Stem Cells as a Potential Source for Cartilage and Bone Regeneration: An In Vitro Study.

Umbilical cord (UC) may represent an attractive cell source for allogeneic mesenchymal stem cell (MSC) therapy. The aim of this in vitro study is to investigate the chondrogenic and osteogenic potential of UC-MSCs grown onto tridimensional scaffolds, to identify a possible clinical relevance for an allogeneic use in cartilage and bone reconstructive surgery. Chondrogenic differentiation on scaffolds was confirmed at 4 weeks by the expression of sox-9 and type II collagen; low oxygen tension improved the expression of these chondrogenic markers. A similar trend was observed in pellet culture in terms of matrix (proteoglycan) production. Osteogenic differentiation on bone-graft-substitute was also confirmed after 30 days of culture by the expression of osteocalcin and RunX-2. Cells grown in the hypertrophic medium showed at 5 weeks safranin o-positive stain and an increased CbFa1 expression, confirming the ability of these cells to undergo hypertrophy. These results suggest that the UC-MSCs isolated from minced umbilical cords may represent a valuable allogeneic cell population, which might have a potential for orthopaedic tissue engineering such as the on-demand cell delivery using chondrogenic, osteogenic, and endochondral scaffold. This study may have a clinical relevance as a future hypothetical option for allogeneic single-stage cartilage repair and bone regeneration.

Healthier by Precommitment

We tested a voluntary self-control commitment device to help grocery shoppers make healthier food purchases. Participants, who were already enrolled in a large-scale incentive program that discounts the price of eligible groceries by 25%, were offered the chance to put their discount on the line. Agreeing households pledged that they would increase their purchases of healthy food by 5 percentage points above their household baseline for each of 6 months. If they reached that goal, their discount was awarded as usual; otherwise, their discount was forfeited for that month. Thirty-six percent of households that were offered the binding commitment agreed; they subsequently showed an average 3.5-percentage-point increase in healthy grocery items purchased in each of the 6 months; households that declined the commitment and control-group households that were given a hypothetical option to precommit did not show such an increase. These results suggest that self-aware consumers will seize opportunities to create restrictive choice environments for themselves, even at some risk of financial loss.

Understanding the experience of living with non-small-cell lung cancer (NSCLC): a qualitative study.

As non-small-cell lung cancer (NSCLC) treatments improve and patients live longer, it is important to develop interventions to help patients live fuller lives. We sought to identify key components of quality of life (QOL) in determining therapeutic decision making and overall value of life extension in patients with NSCLC. Three focus groups (n = 16) and telephone interviews (n = 15) were conducted with NSCLC patients (N = 31) to explore symptoms considered important to QOL. A trade-off format was used to assess the value of life extension relative to QOL. Patients were asked to consider a hypothetical treatment option offering a modest (3 month) life extension. Patients' mean age was 61.6 years, 67.6% were women, 77.4% were white, and 48.4% had stage III/IV disease. In all, 68% of patients conceptualized emotions as symptoms of NSCLC. Key symptoms changed over time: Patients reported feeling shock and fear at diagnosis (74%), and feeling fear or loneliness during the beginning of therapy (55%). Additionally, patients who reported successfully connecting with other NSCLC patients (peers), support groups, and/or community members reported a positive shift in feelings (52%) as they continued therapy or moved into a posttherapy phase. Financially, 23% of patients reported being adversely affected by copayments, 36% by unexpected gaps in coverage, and 39% by other bills. Patients reported that the most important dimension driving their decision making about life-extending therapy was somatic (84%), followed by functional (32%), relational (23%), and emotional (10%) dimensions. Study participants were likely to have received some education or support from the recruiting cancer advocacy and patient education/support organizations. In addition, participants were of a higher socioeconomic status than the average lung cancer patient population. Patients with NSCLC conflated emotional well-being after diagnosis with symptoms of their cancer and treatment toxicities. Somatic QOL concerns emerged ahead of functional, emotional, and relational QOL concerns as the dominant driver of therapeutic decision making. This study was funded by Daiichi Sankyo Inc.

Technology use among Indigenous adolescents in remote regions of Australia

Twenty-four Indigenous adolescents (mean age 16.4 years) attending a boarding school in a remote region of Western Australia participated in individual structured interviews that queried current patterns of use for each of: (1) television, (2) video games, (3) computers, (4) the Internet, and (5) mobile phones. Results suggest that television, video games and computers play a relatively minor role in the lives of participating adolescents. However, the Internet and particularly mobile phones were frequently used. Mobile phones were used by participating Indigenous adolescents in ways consistent with their collective culture (e.g. communicate with family and friends) but also similar to adolescents generally (e.g. to send text messages and access the Internet). When presented with the hypothetical option of using only one small screen technology, Indigenous adolescents overwhelmingly selected a mobile phone. The reasoning for such a preference emphasised the importance of communication and the global functionality of the device (e.g. Internet connectivity). The rapid uptake mobile phones by Indigenous adolescents may point the way to improved educational opportunities, specifically, m-learning.

What do graduates think? An analysis of intention to repeat the same studies and university

The present work analyzes the key factors in the university experience that influence graduates' intention to repeat the same studies and the same institution, given the hypothetical option – based on hindsight – of selecting afresh a course and place of study. The work is inspired by the theory of planned behavior [Ajzen, I. (1985). From intentions to actions: A theory of planned behavior, in action control: From cognition to behavior. New York: J. Kuhl and J. Beckmann; Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211]. This analysis is based on the opinion of graduates in relation to a set of variables that together form the intention to repeat, namely quality of education; services and facilities; preparation by the university for employment; fitness-for-purpose of studies for the job market; capacities and skills acquired; the time taken to find work following graduation; current salary; and satisfaction with current employment. Using multiple regression models, the principal components of service quality in a university context are determined. The findings indicate that the quality of the educational process is the most influential aspect both in the intention to repeat the same studies and also in the intention to repeat the same university. Services and facilities have a marked influence on the latter, while the time taken to find employment and current salary are the two aspects with the least impact.

Understanding the experience of living with non-small cell lung cancer (NSCLC): A qualitative study.

e20618 Background: As non-small cell lung cancer (NSCLC) treatments improve and patients live longer, it is increasingly important to develop interventions to help patients live fuller lives. We sought to identify key components of quality of life (QOL) and social support in determining therapeutic decision-making and overall value of life-extension, in patients with NSCLC. Methods: Three semi-structured focus groups (n=16) and telephone interviews (n=15) were conducted and recorded with NSCLC patients (N=31), to explore the full range of symptoms that patients considered important to QOL. A tradeoff format assessed the value of life-extension relative to QOL. Patients were asked to consider a hypothetical treatment option that offered on average a 3 month life extension. Results: Mean age was 61.6 years, 67.6% were female, 77.4% white, 61.3% were not employed/retired, 58.1% were living with a spouse/other, 93.5% had health insurance, and 48.4% were Stage III/IV. Sixty-Eight percent of patients conceptualized emotions and attitudinal orientation as symptoms of NSCLC. Key symptoms/concerns changed over time – 74% of patients reported shock and fear at diagnosis, 55% felt fear or loneliness during the beginning of therapy, 52% successfully connected with other NSCLC patients (peers) and support groups, and reported a positive shift in feelings with social/emotional support from all social networks. 26% of patients reported confusion and isolation during treatment due to education gaps. Financially, 23% of patients reported being adversely impacted by co-pays, 36% by unexpected gaps in coverage, 39% by other bills, and 52% accepted help from any/all sources. The most important factor driving treatment-decision making about life-extending therapy was the somatic (i.e., physical symptom) dimension (84% cited as important), followed by functional (32%), relational (23%), and emotional (10%) factors. Conclusions: Patients with advanced NSCLC tend to conflate emotional well-being post diagnosis with symptoms of their cancer and treatment toxicities. However, somatic QOL concerns, ahead of functional, emotional and relational QOL, emerge as the dominant driver of therapeutic decision-making.

Environmental impacts of a transition toward e-mobility: the present and future role of lithium carbonate production

Whether the environmental benefits of emerging technologies are outweighed by the environmental impacts of producing and using scarce technology metals remains an open question. We present a three-level approach to assess how increasing environmental impacts on the resource provision level affect the overall impacts on the product level and on the service level, at an early stage of technology implementation. The approach is described based on a case example: we evaluate the environmental impacts of different supply options for lithium carbonate (Li 2CO 3) – required for the production of Li-ion batteries – and their influence on the environmental impacts associated with an electric vehicle (EV). We applied the methodology of Life Cycle Assessment (LCA) and considered the production of Li 2CO 3 from three different deposit types: natural brines (currently dominant), ores (less common) and seawater (hypothetical future option). For each of the three supply options, we established an inventory dataset for both favorable and unfavorable processing conditions. The inventory datasets were combined with those used in a recently published LCA, which compared the environmental impacts of an EV with those of an internal combustion engine vehicle (ICEV). The results of this study indicate that the environmental impacts of Li 2CO 3 production as a percentage of the total transportation impacts caused by an EV are currently negligible. Only if seawater was used under unfavorable processing conditions, these impacts could outweigh the environmental benefits of EV over an ICEV; however, the uncertainty is high due to the limited data availability regarding future lithium production processes. The break-even point for the environmental impacts of 1 km driven with an EV and with an ICEV would be reached only if the impacts per kilogram of Li 2CO 3 were increased by about two orders of magnitude (more than 200 times higher for the impact assessment method Cumulative Energy Demand, about 450 times higher for Global Warming Potential and about 100 times higher for ecoindicator 99).

Elective single-embryo transfer: persuasive communication strategies can affect choice in a young British population

This study tested the effectiveness of the framing effect and fear appeals to inform young people about the risks of multiple births and the option of selecting elective single-embryo transfer (eSET). A non-patient student sample (age (mean ± SD) 23 ± 5.5 years; n = 321) were randomly allocated to one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: (3a) education and (3b) non-education. The primary outcome measure was the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences ( P < 0.001 to P < 0 .05) in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. The results demonstrate that the use of complex persuasive communication techniques on a student population to promote immediate and hypothetical eSET preferences is more successful at promoting eSET than merely reporting educational content. Future research should investigate its application in a clinical population. A multiple pregnancy is a health risk to both infant and mother following IVF treatment. The aims of this study were to test the effectiveness of two persuasive communication techniques (the framing effect and fear appeals) to inform young people about the risks of multiple births and the hypothetical option of selecting elective single-embryo transfer (eSET) (i.e., only one embryo is transferred to the uterus using IVF treatment). A total of 321 non-patient student sample (mean age 23) were randomly allocated to read a message from one of seven groups: (1) framing effect: (1a) gain and (1b) loss frame; (2) fear appeal: (2a) high, (2b) medium and (2c) low fear; or (3) a control group: education (3a) and (3b) non-education. Participants completed the Attitudes towards Single Embryo Transfer questionnaire, before exposure to the messages (time 1) and immediately afterwards (time 2). Results revealed that participants in the high fear, medium fear and gain condition demonstrated the most positive and significant differences in their knowledge, hypothetical intentions and modest changes in attitudes towards eSET than the low fear, loss frame and education and non-education messages. This study recommends that health promotion based on the framing effect and fear appeals should be tested in clinical (patient) samples in the future.

Glatiramer acetate (GA, Copolymer-1) an hypothetical treatment option for Rett syndrome

Rett syndrome (RTT) is an X-linked dominant postnatal severe and disabling neurodevelopmental disorder which is the second most common cause for genetic mental retardation in girls and the first pervasive disorder with a known genetic basis. The syndrome is primarily caused by mutations in the Methyl CpG binding protein 2 (MECP2) gene on Xq28. Its protein product MeCP2 acts as a transcriptional repressor or activator depending on the target gene associated. Brain derived neurotrophic factor (BDNF) is a neurotrophic factor playing a major role in neuronal survival, neurogenesis and plasticity. It has been identified as a major MeCP2 target through a candidate gene approach and abnormalities in BDNF homeostasis are believed to contribute to the neurologic phenotype and pato-physiology of part of the symptoms in Mecp2 null mice that show progressive deficits in its expression. Based on the presumed role of BDNF in the pathophysiology of Rett syndrome it is reasonable to assume that interventions that will elevate its levels in the brain of RTT patients will be of therapeutic benefit. Glatiramer acetate (GA, Copolymer 1, Copaxone) an immunomodulator with proven safety and efficacy in Multiple Sclerosis has been reported to cause elevated secretion of BDNF both in animal model and in MS patients. Our hypothesis is that continuous treatment of patients with RTT with Glatiramer acetate might lead to an increase in their brain's BDNF content and an improvement in at least part of the syndrome symptomatology while being safe to use and well tolerated in this population. In a pilot preliminary study we have shown that GA cause elevation of BDNF expression up to the level in naïve control mice in several cortical areas in the Mecp2 mutated mouse brain, but as of yet did not examine the behavioral aspects of this elevation.

Psychiatric out-patient clinics for older adults: highly regarded by users and carers, but irreplaceable?

Aims and MethodThe aim of this study was to explore older users' and carers' views of attending out-patient clinics for older adults. A questionnaire was designed to be distributed to all patients attending out-patient clinics for a period of 1 month in January 2007.ResultsThe response rate for returning the completed questionnaire was 71%, and 95% of these respondents were satisfied with their overall experience of attending out-patient clinics. Although satisfaction levels were high with every aspect of out-patient clinics, 49% preferred the hypothetical option of being seen at home.Clinical ImplicationsThe role of psychiatric out-patient departments for older adults merits further research, comparing cost and user/carer acceptability with home or general practitioner surgery-based treatment.

Ireland's Future in Europe: Scenarios and Implications

This report was prepared at the request of the Oireachtas Sub-Committee on Ireland's Future in the European Union. Its purpose is to identify the range of options available to the Government regarding Ireland's relationship with the European Union and, in particular, the Lisbon Treaty. It discusses the nature and foreseeable implications of each option, but does not make recommendations. Discussion of particular scenarios does not constitute their recommendation. With respect to the 'big picture' of Ireland's future relationship to the EU, the State has three major options: (1) continued membership with limitations in several policy areas, (2) economic engagement through the common currency and the European Economic Area but withdrawal from the EU's political or decision-making structures, and (3) membership in a yet-to-be-constructed two-tier Europe. A hypothetical fourth option - total disengagement - is neither economically feasible nor demanded by any major political or social group, so it is not discussed in this report. With respect to the narrower but thorny issue of the Lisbon Treaty, the Government has a wide range of options. The first three are premised upon a renewed attempt to seek ratification of the Treaty. The next three are premised upon the other Member States working with Ireland in the event of an Irish decision not to attempt to secure ratification of the Treaty or a failure of this attempt. The remaining four are premised upon Ireland not ratifying the Treaty and the other Member States pursuing a path that does not require Irish involvement.