Utility Index Research Articles

Screening for anxiety in patients with cancer: Diagnostic accuracy of GAD-7 items considering lowered GAD-7 cut-offs.

A standard questionnaire for generalized anxiety disorders is the GAD-7. Attempts to improve its screening capacity in oncological settings resulted in a discussion about lowering its cut-off. This study examines the diagnostic accuracy of the GAD-7 items depending on applied cut-offs and whether, similar to depressive symptoms, a distinction between somatic-emotional and cognitive items might be relevant. Screening data from 4705 patients with cancer who were treated at the outpatient clinic of the National Centre for Tumour Diseases in Heidelberg were analysed. For the individual GAD-7 items sensitivity, specificity, positive and negative predictive values, and Clinical Utility Index were determined for cut-off ≥ 7, ≥ 8, ≥ 10 and ≥ 15 in the GAD-7 questionnaire. The best overall diagnostic accuracy was found for a cut-off ≥ 8. The cognitive items had the best diagnostic accuracy for identifying severe GAD (cut-off ≥ 15), and the somatic-emotional items had the best diagnostic accuracy for identifying mild to moderate GAD (cut-off ≥ 7, ≥ 8 and ≥ 10). Our data support the recommendation of lowering the GAD-7 cut-off in oncology settings and suggest that in anxiety disorders, a symptom overlap between the physical illness and a possible mental disorder should be considered.

Validity, reliability and clinical utility of ASSIST-Y in assessing risk of substance-related harm and dependence in Spanish male adolescents

BackgroundSubstance use among adolescents is strongly associated with adverse physical, mental health, and social outcomes. Prevention and early intervention can reduce the likelihood of future problems, but requires valid and reliable screening tools capable of assessing risk across a range of substances. This study assessed the validity, reliability, and clinical utility of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Y) for adolescents aged 15–17 years.MethodsA sample of adolescent males (N = 101), aged 15–17 years, held in a juvenile detention facility on substance-related offences in Barcelona, Spain were eligible. Participants were administered a battery of standardized substance-use screening tools by a clinical psychologist, and underwent a diagnostic interview assessing DSM-IV-TR substance abuse and dependence by an addiction medicine specialist. Scores on the various assessments were compared to establish validity (concurrent with interview, convergent with other measures), reliability, and clinical utility of ASSIST-Y.ResultsMajority of participants (n = 77) completed assessments. While tobacco was not assessed as part of the interview, concurrent validity in detecting substance abuse was established for all remaining substances. Concurrent validity for detecting dependence was established for alcohol, cannabis, cocaine, stimulants and sedatives. Fewer numbers in higher-risk groups for inhalants, opioids and hallucinogen use limited confirmation of validity for those substances. ASSIST-Y also demonstrated good convergent validity with the other screening tools for all substances, except hallucinogens. Reliability for each subscale was established, except for tobacco (too few items), sedatives, and hallucinogens. Finally, clinical utility indices were significant for most substances (except sedatives and opioids); whilst clinical utility indices were significant for ruling out cases of non-dependence (all substances).ConclusionsAs a screening tool, the purpose of ASSIST-Y is designed to help identify adolescents who may be at-risk of substance-related harm. While the instrument was found to be valid and reliable in identifying risky use across a variety of substances, further research is needed to validate the instrument in other population groups, and for other substances. Future research should investigate the effect of the linked brief intervention to reduce risk of harm, especially for non-specialist clinicians.

Outdoor nitrogen dioxide exposure and longitudinal health status trajectory in the Canadian National Population Health Survey

Few studies have examined the association between air pollution and the trajectory of global health status measures related to the functional impacts of chronic disease. To address this gap, we examined the trajectory of the Health Utilities Index (HUI) over 17 years of follow-up among Canadian National Population Health Survey (NPHS) participants. Annual average nitrogen dioxide (NO2) exposures from a national land use regression surface were mapped to 15,631 NPHS participants at their place of residence provided at each follow-up. We modelled HUI trajectory as a cubic polynomial function of age in relation to air pollution and selected covariates using random growth curve models to account for longitudinal repeated measures. Adjusting for covariates selected based on a directed acyclic graph, we found that NO2 exposure exhibited a significant negative association with HUI in females. It also exhibited a significant positive interaction with the linear age term, and a significant negative interaction with the quadratic age term, resulting in a small non-significant decrease in quality adjusted life years lived after age 20 among females. Our analysis provides a proof of concept for examining the influence of built environment variables on the trajectory of health related quality of life in Canada.

Educational inequalities and decomposition of the urban-rural disparities in maternal health care utilization in Ethiopia: further analysis of 2019 intermediate Ethiopian demography and health survey

IntroductionThe utilization of maternal health services is vital to prevent maternal and child health problems. However, there is limited evidence as to why rural women have lower utilization and educational inequality in maternal health services utilization in Ethiopia. Identifying the causes is the first step to achieving maternal and child health initiatives.ObjectiveThe objective of this study was to decompose the urban-rural disparities and educational inequalities in maternal health care utilization in Ethiopia.MethodsThe study used the 2019 Ethiopian Demography Health Survey. Blinder-Oaxaca decomposition and multivariate decomposition analyses were done on a weighted 3,926.7 women to see the urban-rural differences in maternal health service utilization by using Stata 17.0. For the educational inequality of maternal health service utilization, concentration curve and concentration index were used by using conindex. P value < 0.005 was used to declare association.Result84.89% of urban and 70.75% of rural residents use antenatal care and 73% of urban and 44% rural use institutional delivery. There was no urban-rural difference in postnatal care utilization. There was educational inequality in antenatal care (CIx 0.0926; p < 0.001), delivery care (CIx 0.2137; p < 0.001 and postnatal care (CIx 0.1272; p < 0.001) utilization in Ethiopia. 83.3% of antenatal care urban-rural difference was explained by women’s characteristics difference. Secondary (16.51%) and higher (23.01%) educational level difference of urban and rural women widening antenatal care utilization. Living regions (-1.33%) difference of urban and rural women mitigated antenatal care utilization. About 76.07% of the urban-rural difference in institutional delivery was explained by differences in the characteristics of women. Attending primary (3.76%), secondary (11.83%), and higher (8.44%) education, antenatal care (15.81%) difference of urban and rural women were widening institutional delivery utilization.ConclusionThe urban-rural disparity in antenatal care and delivery care utilization is significant in the country. There were educational inequalities in maternal health service utilization. Attending, Secondary, higher, educational levels widening antenatal care and institutional delivery care utilization. Living regions mitigated antenatal care utilization. Antenatal care utilization widening institutional delivery utilization. Special attention is needed for rural women to improve maternal health service utilization through health extension workers and the women’s developmental army.

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage.

The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear. We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months. Secondary outcomes included 12-month functional independence as assessed with the Functional Independence Measure (FIM; scores range from 18 to 126) and quality of life as assessed with the EuroQolfive-dimension, five-level (EQ-5D-5L) utility index (scores range from -0.1 to 0.95) and a visual analogue scale (VAS; scores range from 0 to 100); on each assessment, higher scores indicate better health status or quality of life. A total of 742 patients underwent randomization at 23 centers. The analysis of the primary outcome at 12 months included 725 patients (97.7%). An unfavorable neurologic outcome occurred in 122 of 364 patients (33.5%) in the liberal-strategy group and in 136 of 361 patients (37.7%) in the restrictive-strategy group (risk ratio, 0.88; 95% confidence interval [CI], 0.72 to 1.09; P = 0.22). The mean (±SD) FIM score was 82.8±54.6 in the liberal-strategy group and 79.8±54.5 in the restrictive-strategy group (mean difference, 3.01; 95% CI, -5.49 to 11.51). The mean EQ-5D-5L utility index score was 0.5±0.4 in both groups (mean difference, 0.02; 95% CI, -0.04 to 0.09). The mean VAS score was 52.1±37.5 in the liberal-strategy group and 50±37.1 in the restrictive-strategy group (mean difference, 2.08; 95% CI, -3.76 to 7.93). The incidence of adverse events was similar in the two groups. In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy. (Funded by the Canadian Institutes of Health Research and others; SAHARA ClinicalTrials.gov number, NCT03309579.).

Operation of a hybrid heating system based on heat pumps using a photovoltaic installation

In Poland, heating systems using renewable energy sources have gained importance in construction projects, especially in newly designed buildings. This is mainly due to the Regulation of the Minister of Infrastructure, which sets technical conditions for buildings. As of December 31, 2020, the primary energy index for newly designed single-family buildings should not exceed 70 kWh/(m2year). This requires efficient energy sources in building design. Renewable energy installations have significantly lower primary energy utilization rates than fossil fuel systems, making them the preferred choice. In a facility in Batowice near Krakow, a hybrid energy system with ground-source and air-source heat pumps has been installed. These pumps are powered by electricity from a photovoltaic installation connected to the grid. The study aims to determine the optimal heat pump choice based on the facility’s conditions and optimize electricity consumption from the photovoltaic installation. Both heat pumps showed similar efficiencies during the heating season from December 2022 to March 2023: the ground-source heat pump achieved an annual coefficient of performance of 2.69, and the air-source heat pump achieved a seasonal coefficient of perfor-mance of 2.63. Given the high non-renewable primary energy factor for grid electricity, the feasibility of replacing gas boilers with heat pumps requires careful evaluation. The results indicate that integrating a heat pump with a photovoltaic installation substantially reduces the primary energy utilization index, supporting climate protection and the advancement of renewable energy sources. However, heat pumps alone may not be sufficiently efficient without the support of a PV installation.

Analysis of the Trends and Driving Factors of Cultivated Land Utilization Efficiency in Henan Province from 2000 to 2020

Amid persistent global food security challenges, the efficient utilization of cultivated land resources has become increasingly critical, as optimizing Cultivated Land Utilization Efficiency (CLUE) is paramount to ensuring food supply. This study introduced a cultivated land utilization index (CLUI) based on Fractional Vegetation Cover (FVC) to assess the spatiotemporal variations in Henan Province’s CLUE. The Theil–Sen slope and the Mann–Kendall test were used to analyze the spatiotemporal variations of CLUE in Henan Province from 2000 to 2020. Additionally, we used a genetic algorithm optimized Artificial Neural Network (ANN) and a particle swarm optimization-based Random Forest (RF) model to assess the comprehensive in-fluence between topography, climate, and human activities on CLUE, in which incorporating Shapley Additive Explanations (SHAP) values. The results reveal the following: (1) From 2000 to 2020, the CLUE in Henan province showed an overall upward trend, with strong spatial heterogeneity across various regions: the central and eastern areas generally showed decline, the northern region remained stable with slight increases, the western region saw significant growth, while the southern area exhibited complex fluctuations. (2) Natural and economic factors had notable impacts on CLUE in Henan province. Among these factors, population and economic factors played a dominant role, whereas average temperature exerted an inhibitory effect on CLUE in most parts of the province. (3) The influenced factors on CLUE varied spatially, with human activity impacts being more concentrated, while topographical and climatic influences were relatively dispersed. These findings provide a scientific basis for land management and agricultural policy formulation in major grain-producing areas, offering valuable insights into enhancing regional CLUE and promoting sustainable agricultural development.

The estimation of health state utility values for psychological distress in Australia: Implications for future economic evaluations.

Psychological distress is a state of emotional suffering and discomfort that often manifests as anxiety, depression, or other mental health symptoms, impairing daily functioning, and hindering concentration, relationships, and work or school performance. We aimed to examine the disutility associated with psychological distress. We utilized longitudinal data obtained from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We measure health state utility values (HSUVs) using the short-form six-dimension utility index (SF-6D) and psychological distress using the Kessler Psychological Distress Scale (K10). We employed a longitudinal fixed effects regression model to examine the effects of psychological distress on HSUVs. The results from fixed effects panel regression models indicate a negative effect of psychological distress on HSUVs. We found that moderate psychological distress (β = -0.057, 95% CI = -0.059, -0.055) and high psychological distress (β = -0.123, 95% CI = -0.126, -0.121) led to a significant reduction in HSUVs. These findings hold across different subsamples, such as age, gender, and race. By quantifying the reduction in HSUVs due to psychological distress, our study provides valuable data for future economic evaluations of healthcare interventions. The evidence generated from future economic evaluations will assist policymakers in making informed decisions about the most effective interventions for treating psychological distress.

Access to Care and Health-Related Quality of Life in Multiple Sclerosis.

Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL). In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL. We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed. Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.

Effects of Spent Substrate of Oyster Mushroom (Pleurotus ostreatus) on Feed Utilization and Liver Serum Indices of Hu Sheep from the Perspective of Duodenal Microorganisms.

This study aimed to evaluate the effects of Pleurotus ostreatus spent mushroom substrate (P.SMS), which is characterized by high production but low utilization, on feed utilization and liver serum indices from the perspective of duodenal microorganisms. Forty-five 3-month-old Hu sheep were randomly assigned to five groups and fed diets in which whole-plant corn silage (WPCS) was substituted with P.SMS at levels of 0% (Con), 5% (PSMS5), 10% (PSMS10), 15% (PSMS15), or 20% (PSMS20). The results indicated that the addition of P.SMS complexly influenced the apparent digestibility of dry matter, organic matter, and crude protein, with PSMS10 showing the highest digestibility of these nutrients. P.SMS inclusion significantly affected serum alanine aminotransferase levels, with PSMS5 showing higher levels than both the Con and PSMS20 groups (p < 0.05). Importantly, the inclusion of P.SMS did not affect the richness and diversity of duodenal microorganisms. Significant differences in the phyla Verrucomicrobiota and Spirochaetota were observed between the Con and PSMS20 groups. The observed trend towards an increase in the genus Trichoderma (p = 0.057) suggests that P.SMS is susceptible to contamination by this genus, which in turn affects the structure of the intestinal flora. Furthermore, functional gene predictions indicated differences in amino acid metabolism among the groups (p < 0.05). In conclusion, feeding with 10% P.SMS resulted in the highest digestibility without adversely affecting the structure of the duodenal community or liver function.

A VIKOR-Based Sequential Three-Way Classification Ranking Method

VIKOR uses the idea of overall utility maximization and individual regret minimization to afford a compromise result for multi-attribute decision-making problems with conflicting attributes. Many researchers have proposed corresponding improvements and expansions to make it more suitable for sorting optimization in their respective research fields. However, these improvements and extensions only rank the alternatives without classifying them. For this purpose, this text introduces the three-way sequential decisions method and combines it with the VIKOR method to design a three-way VIKOR method that can deal with both ranking and classification. By using the final negative ideal solution (NIS) and the final positive ideal solution (PIS) for all alternatives, the individual regret value and group utility value of each alternative were calculated. Different three-way VIKOR models were obtained by four different combinations of individual regret value and group utility value. In the ranking process, the characteristics of VIKOR method are introduced, and the subjective preference of decision makers is considered by using individual regret, group utility, and decision index values. In the classification process, the corresponding alternatives are divided into the corresponding decision domains by sequential three-way decisions, and the risk of direct acceptance or rejection is avoided by putting the uncertain alternatives into the boundary region to delay the decision. The alternative is divided into decision domains through sequential three-way decisions, sorted according to the collation rules in the same decision domain, and the final sorting results are obtained according to the collation rules in different decision domains. Finally, the effectiveness and correctness of the proposed method are verified by a project investment example, and the results are compared and evaluated. The experimental results show that the proposed method has a significant correlation with the results of other methods, ad is effective and feasible, and is simpler and more effective in dealing with some problems. Errors caused by misclassification is reduced by sequential three-way decisions.

Generic vs. Disease-Specific Patient Reported Outcome (PRO) Instruments for Assessing HRQoL Burden Among Patients Diagnosed with Alopecia Areata: Evidence from TARGET-DERM AA

Introduction Alopecia areata (AA) is a chronic, autoimmune disease characterized by patchy hair loss. Compared to other disease areas, recent work has signaled a potential shortcoming, that generic quality of life (QOL) questionnaires are not sufficiently sensitive to the impact of AA disease severity. This cross-sectional analysis investigates the Short-Form 36, the dermatology life quality index (DLQI), and the Alopecia Areata Patient Priority Outcomes (AAPPO) for similar shortcomings. Methods Patients of all ages enrolled from December 2021 to June 2024 in TARGET-DERM AA (data collection on-going) in the United States and Canada were grouped by Severity of Alopecia Tool (SALT) score (1-20, 21-49, or 50-100). At enrollment, patients completed the AAPPO and DLQI questionnaire as well as the RAND MOS Short-Form 36. The SF-36 has 8 subdomain scores (vitality, physical function, bodily pain, general health, physical role function, emotional role function, social role function, mental health) along with the physical component summaries (PCS), mental component summaries (MCS), and the SF-6D utility index score. The Kruskal-Wallis test compared differences in mean scores across SALT subgroups defined by severity. Results Of the 141 AA patients, 61.7% were female; 95.0% adults, and 67.4% Non-Hispanic White. When comparing the SALT 1-20 and the &gt;50 subgroups, significant differences in SF-36 derived mean scores were only observed in the PCS and the physical function score (p&lt;0.05). None of the other scores (MCS, SF-6D, or other SF-36 subdomains) showed any differences. Mean DLQI scores were similar across subgroups (p&gt;.05) Notably, the hair loss and activity limitation domains of the AAPPO demonstrated significant differences between the patient subgroups (p&lt;.0001 and p&lt;.05, respectively) Discussion In this real-world cohort, generic QoL instruments, namely the SF-36 and DLQI, did not capture differences in the underlying health-related QoL burden of AA patients with different AA severity. Such differences were clear when HRQoL was measured for AA patients with mild hair loss AAPPO.

Effects of Dietary Protein and Lipid Levels on the Growth Performance and Serum Biochemical Indices of Juvenile Furong Crucian Carp

The impact of dietary protein and lipid levels on the growth performance, feed utilization, and serum biochemical indices of Furong crucian carp was examined. Five hundred and forty carp (2.35 ± 0.08 g) were randomly assigned to nine groups and fed diets with three different protein levels (30.0, 35.0, and 40.0%) and three different lipid levels (4.0, 7.0, and 10.0%) for 60 days. The current findings revealed that the interaction effect between dietary lipid and protein levels exhibited significance for the final average weight (FAW), weight gain rate (WGR), specific growth rate (SGR), feed efficiency (FE), energy deposition rate (EDR), whole-fish energy, ash, and fat content (p &lt; 0.05). Specifically, there was a significant reduction in FAW, WGR, and SGR with increasing dietary fat supplementation. Conversely, FE, EDR, and protein efficiency ratios were significantly decreased with increasing dietary protein levels (p &lt; 0.05). Furthermore, serum albumin and globulin levels exhibited significant increases in response to dietary lipid inclusion (p &lt; 0.05). The findings collectively indicate that Furong crucian carp fed a diet comprising 4% lipid and 30% protein exhibited the optimal growth and feed utilization. Conversely, excessive protein and lipid supplementation were detrimental to growth and resulted in the aggravation of metabolic disorders.

Current evaluation of radiation hazards from sediments of Manzala Lake, Egypt

AbstractSurface sediment samples were collected from 12 different sites in Manzala Lake for measuring 238U, 226Ra, 232Th and 40K. Those elements were measured using High Purity Germanium (HPGe) detector. The concentrations of radionuclides were within the UNSCEAR limits. Various indices were applied to detect the environmental and human risk assessment for example activity utilization index, external hazard index and others. Environmental Risk from Ionising Contaminants: Assessment and Management (ERICA) tool was applied and showed no considered biological hazards. The results showed that concentrations of radionuclides in sediments of Manzala Lake were within the safe limits for further uses.

Quebec Health-Related Quality-of-Life Population Norms Using the Health Utilities Index Mark 3: Stratification by Sociodemographic Data and Health Problems.

To provide population utility norms from the Health Utilities Index Mark 3 (HUI3) for the province of Quebec, Canada. This study used data from the Care Trajectories Enriched Data (TorSaDE) cohort, which combines data from the Canadian Community Health Survey (CCHS) and the Quebec Provincial Insurance Board [Régie de l'assurance maladie du Quebec (RAMQ)]. The CCHS is a multiround health-related survey conducted by Statistics Canada since 2007. For each round spanning over 2 years, respondents were randomly selected and completed an online questionnaire. Quebec data for the HUI3 were available in the CCHS for rounds 2007, 2009, and 2013. The RAMQ database is an administrative database that contains information on health care services use and medical diagnostics. HUI3 scores were stratified by sociodemographic variables, as well as by self-reported health problems in the CCHS and by medical diagnostics from the RAMQ. Medical diagnostics were retrieved for the CCHS completion year and the year before and identifiable with the ICD-9 code in the RAMQ database. A total of 55,656 individuals were considered in this analysis. The mean (95% CI) and the median interquartile range of HUI3 were respectively 0.919 (0.918-0.919) and 0.973 (0.905-1) for the entire population. Individuals with lower scores were females, those aged 75 and over, divorced or widowed, unemployed during the last 12 months, less educated, or with a lower annual household income. Individuals born abroad and with normal weight of body mass index had higher utility scores. HUI3 score decreased with the number of diagnosed diseases from 0.946 (0.946-0946) for individuals without diagnosed disease to 0.682 (0.678-0.686) for individuals diagnosed with up to 18 diseases. Regardless of the number of diagnosed diseases in the RAMQ database, individuals who self-reported suffering from a single health problem presented a significantly lower HUI3 ranging from 0.944 (0.943-0.944) for Asthma to 0.789 (0.782-0.796) for Alzheimer compared with 0.956 (0.956-0.957) for individuals with no reported health problems. The same pattern was observed when considering individuals regardless of the diagnosed and self-reported diseases. Utility score norms for HUI3 were produced in the general population of Quebec. Significant differences among various health problems were identified and norms can be used to compare populations in studies that do not have a control group.

CTIM-17. INDIVIDUALIZED MULTIMODAL IMMUNOTHERAPY (IMI) FOR ADULTS WITH DIFFUSE MIDLINE GLIOMA OR DIFFUSE HEMISPHERIC GLIOMA

Abstract Diffuse Midline Glioma (DMG, H3K27 mutant) and Diffuse Hemispheric Glioma (DHG, H3G34 mutant) are rare malignant CNS tumors with dismal prognosis. We retrospectively searched in our database for adults (&amp;gt;18y) with molecularly define DMG/DHG, treated between May 2015 and 2024 with IMI as part of first-line treatment. Amongst 157 IMI-treated malignant glioma patients, four patients fit these restrictions, pointing to scarce experience of IMI for DMG/DHG adult patients. HM (M, 29y) was diagnosed with a DMG in the pons. He received radiochemotherapy, and continued after 2x TMZm with BRAF-MEK-inhibition therapy. He received one IO-Vac® dendritic cell vaccine but showed fast progression thereafter. He died 9 months after diagnosis. GJE (F, 28y) had a DMG at the corpus callosum. She received radiochemotherapy and 6x TMZm, followed by 2x IO-Vac® and 3x maintenance immunogenic cell death (ICD) immunotherapy (NDV injections, sessions of modulated electrohyperthermia), combined with WT1 and H3K27M long-peptide vaccines. She progressed after 20 months, for which a new IO-Vac® and an H3K27M short- and long-peptide vaccine were given. She died 5 months later. Overall Survival (OS) was 26 months after initial diagnosis. JD (F, 27y) was diagnosed with a DMG in C2-C6. She received radiochemotherapy followed by IMI alone, including 2x IO-Vac®, one ICD immunotherapy, and four doses of anti-PD1. She died 17 months later, making OS 27 months after diagnosis. VJ (F, 21y) had a DHG in the left cerebrum. She received radiochemotherapy and 12 cycles of maintenance TMZ (TMZm), between which ICD immunotherapy was inserted each time. Afterwards, she received two IO-Vac®. Finally, she received ICD immunotherapy (6x) combined with checkpoint inhibitors (4x anti-CTLA4, 10x anti-PD1). Thirty months after diagnosis, she is in remission with a stable Health Utility Index of 0.72. IMI might have contributed to a better OS in three out of four DMG/DHG patients, and should be explored further as part of the treatment for these patients.

Health-related quality of life predicts prognosis in individuals with COPD hospitalized with community-acquired pneumonia – a prospective cohort study

Community-acquired pneumonia (CAP) in chronic obstructive pulmonary disease (COPD) often result in sudden and persistent reduction in health-related quality of life (HRQoL), which may be alleviated with palliative care. Among individuals with COPD, we aimed to investigate potential associations between HRQoL at admission with CAP and the risk of re-hospitalization and mortality and potential associations between specific HRQoL domains and CAP treatment outcomes. HRQoL was assessed at admission and the participants were grouped into tertiles based on the HRQoL utility index and specific domains. The results revealed that participants in the middle and highest tertiles of HRQoL had a lower 90-day re-hospitalization risk compared to those in the lowest tertile, whereas no differences in re-hospitalization risk were observed 30 and 180 days after discharge. Almost one in four had severe pain or discomfort at admission and the domain pain or discomfort emerged as a predictor of re-hospitalization. In addition, participants in the middle and highest tertiles had lower risk of 180-day mortality compared to those in the lowest, while no differences were observed in 30-day or 90-day mortality risk. An increased focus on in-hospital palliative care could alleviate the pain and discomfort reported by many participants with potential to reduce re-hospitalization rates.

Evaluation of natural radioactivity levels and radiation hazards of Nkalagu limestone deposit, southeastern Nigeria.

Levels of natural radioactivity due to 40K, 232Th, and 226Ra in limestone deposits and corresponding surface soil samples from the Nkalagu community of Ebonyi State were investigated. Gamma spectroscopic analysis using a NaI (TI) detector was employed to measure the activity concentrations (ACs) of the natural radionuclides in the collected samples. The average AC of 226Ra, 232Th, and 40K was found to be 64.62 ± 11.63, 54.27 ± 8.52, and 313.06 ± 25.33Bq/kg, respectively, in limestone, whereas in the soil, the value was 60.80 ± 11.71, 44.97 ± 10.74, and 185.90 ± 18.20Bq/kg, respectively. Except for 40K, the obtained mean ACs of the radionuclides were in excess of the worldwide averages reported by the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR). The mean value of Raeq, Hex, Hin, Iγ, and AUI was obtained as 166.33Bq/kg, 0.45, 0.62, 1.18, and 1.28, respectively, in the limestone, and 139.42Bq/kg, 0.38, 0.54, 0.98, and 1.12, respectively, in the surface soil. The radiation doses in limestone ranged from 120.78-168.89 nGyh-1 and 63.86-88.88 nGyh-1 for indoor and outdoor, respectively, whereas in the soil, the range was 104.47-129.77 nGyh-1 and 54.60-68.02 nGyh-1 for indoor and outdoor, respectively. The total annual effective dose ranged from 0.671 to 0.937 mSvy-1 with an average of 0.800 mSvy-1 in limestone and 0.579 to 0.720 mSvy-1 with an average of 0.667 mSvy-1 in the soil. Values of representative gamma index and activity utilization index, and indoor and outdoor radiation doses in limestone were above the recommended world average of ≤ 1, and 84 nGyh-1 and 59 nGyh-1, respectively, suggesting a restriction in the use of the limestone in construction of houses. The study therefore recommends that the use of limestone in building construction, especially in house interiors, should be discontinued.

A Revealed Preference Test for Choquet and Max-Min Expected Utility with Ambiguity Aversion

We develop a revealed preference test for the Choquet expected utility model with ambiguity aversion, which does not rely on specific functional form assumptions on the utility index. It is computationally efficient if the number of states is not too large, even for a large number of observations. This is a nice feature compared to other existing revealed preference tests for decision models with ambiguity. We illustrate the usefulness of our results by implementing our test on two experimental datasets from the literature, and we compare the empirical fit of this model to the subjective expected utility model. (JEL C91, D81, D91, G41)

Derivation and Initial Validation of the Utility Function for the Hearing Utility Measure (HUM).

The Hearing Utility Measure (HUM) is a replacement hearing attribute for the Health Utilities Index, Mark 3 (HUI-3) designed to improve the responsiveness of utility estimates to changes in hearing-related quality of life. The final development step is to derive the instrument's utility scoring function. Residents of Ontario, Canada, aged ≥18 years participated in standard gamble and visual analogue scale exercises. Valuations for levels (response options) within each domain, and for each domain relative to the other domains were elicited and used to generate a hearing utility function. The function outputs hearing utility ranging from 0 = 'unable to hear at all' to 1 = 'perfect hearing' for each of the 25,920 hearing states classifiable by the HUM. Performance was assessed relative to the criterion standard: directly elicited standard gamble utility. Distributions of HUM-derived hearing utility were compared with legacy HUI-3 derived estimates. A total of 126 respondents participated (mean age 39.2, range 18-85 years, 53% female [67/126]). The utility function performed well in the estimation of directly elicited utilities (mean difference 0.03, RMSE 0.06). Using the legacy HUI-3, estimated hearing utility was 1.0 for 118/126 respondents (93.6%) compared with just 66/126 (52.4%) using the HUM. The new hearing attribute is capable of measuring variations in hearing utility not captured by the legacy HUI-3, especially near the ceiling of hearing function. These findings justify its application and further work to study its measurement properties in hearing loss populations. 3 Laryngoscope, 134:4754-4762, 2024.