Preferences For Different Models Research Articles

El orden de las palabras como recurso poético en Tácito (Annales IV

In our analysis of Tacitus' work, we have explored his style, in which, among other aspects, such as ellipsis, the alteration of the order of words in the phrase stands out as a significant feature. This alteration, which contrasts with the usual SOV and «determinant-determined» structures, emerges as a crucial resource in his prose. Our approach attempts to demonstrate that dislocations affect the signified and the signifier equally, and therefore obey expressive or aesthetic motivations. Furthermore, we consider the context of linguistic change of his time and Tacitus's preferences for different models, enriching the understanding of his style and his literary legacy and connecting with the evolution towards Neo-Latin languages.

Constraining the dark energy models using baryon acoustic oscillations: An approach independent of H0 ⋅ rd

The H0 tension and the accompanying rd tension are a hot topic in current cosmology. In order to remove the degeneracy between the Hubble parameter H0 and the sound horizon scale rd from the baryon acoustic oscillation (BAO) datasets, we redefined the likelihood by marginalizing over the H0 ⋅ rd parameter and then we performed a full Bayesian analysis for different models of dark energy (DE). We find that our datasets that are uncalibrated by early or late physics cannot constrain the DE models properly without further assumptions. By adding the type Ia supernova (SNIa) dataset, the models are constrained better with smaller errors on the DE parameters. The two BAO datasets we used – one with angular measurements and one with angular and radial ones, with their covariance – show statistical preferences for different models, with the Λ cold dark matter (ΛCDM) model being the best model for one of them. Adding the Pantheon SNIa dataset with its covariance matrix boosts the statistical preference for the ΛCDM model.

Rethinking Bi-Level Optimization in Neural Architecture Search: A Gibbs Sampling Perspective

One-Shot architecture search, which aims to explore all possible operations jointly based on a single model, has been an active direction of Neural Architecture Search (NAS). As a well-known one-shot solution, Differentiable Architecture Search (DARTS) performs continuous relaxation on the architecture's importance and results in a bi-level optimization problem. However, as many recent studies have shown, DARTS cannot always work robustly for new tasks, which is mainly due to the approximate solution of the bi-level optimization. In this paper, one-shot neural architecture search is addressed by adopting a directed probabilistic graphical model to represent the joint probability distribution over data and model. Then, neural architectures are searched for and optimized by Gibbs sampling. We rethink the bi-level optimization problem as the task of Gibbs sampling from the posterior distribution, which expresses the preferences for different models given the observed dataset. We evaluate our proposed NAS method -- GibbsNAS on the search space used in DARTS/ENAS and the search space of NAS-Bench-201. Experimental results on multiple search space show the efficacy and stability of our approach.

Factors that influence specialist physician preferences for fee-for-service and salary-based payment models: A qualitative study

Most physicians across the world are paid through fee-for-service. However, there is increased interest in alternative payment models such as salary, capitation, episode-based payment, pay-for-performance, and strategic blends of these models. Such models may be more aligned with broad health policy goals such as fiscal sustainability, delivery of high-quality care, and physician and patient well-being. Despite this, there is limited research on physicians’ preferences for different models and a disproportionate focus on differences in income over other issues such as physician autonomy and purpose. Using qualitative interviews with 32 specialist physicians in Alberta, Canada, we examined factors that influence preferences for fee-for-service (FFS) and salary-based payment models. Our findings suggest that a series of factors relating to (1) physician characteristics, (2) payment model characteristics, and (3) professional interests influence preferences. Within these themes, flexibility, autonomy, and compatibility with academic roles were highlighted. To encourage physicians to select a specific payment model, the model must appeal to them in terms of income potential as well as non-monetary values. These findings can support constructive discussions about the merits of different payment models and can assist policy makers in considering the impact of payment reform.

Doctoral Trainee Preferences for Career Development Resources: The Influence of Peer and Other Supportive Social Capital

Doctoral Trainee Preferences for Career Development Resources: The Influence of Peer and Other Supportive Social Capital

Preferences for long-term follow-up care in childhood cancer survivors.

Follow-up care is important for childhood cancer survivors to facilitate early detection and treatment of late effects. We aimed to describe preferences for different organisational aspects and models of follow-up care among Swiss childhood cancer survivors, and characteristics associated with preferences for different models. We contacted 720 survivors aged 18+ years, diagnosed with cancer after 1990 (age 0-16years), registered in the Swiss Childhood Cancer Registry (SCCR), and Swiss resident, who previously participated in a baseline survey. They received questionnaires to assess attendance and preferences for follow-up (rated on 4-point scales, 0-3). Clinical information was available from the SCCR. Survivors (n=314: response rate 43.6%; 47.8% still attended follow-up) rated clinical reasons for follow-up higher than supportive reasons (p<.001). They rated checking for cancer recurrence (mean=2.78, SD=0.53) and knowing about risks for my children most important (mean=2.22, SD=0.83). They preferred to attend a children's hospital (mean=1.94, SD=1.11), adult hospital (mean=1.86, SD=0.98) or general practitioner (mean=1.86, SD=1.01) rather than a central specialised late effects clinic (mean=1.25, SD=1.06, p<.001), and be seen by paediatric (mean=2.24, SD=0.72) or medical oncologist (mean=2.17, SD=0.69). Survivors preferred decentralised clinic-based follow-up, rather than one central specialised late effects clinic. Survivors' preferences should be considered to ensure future attendance.

Preferences for the organization of long-term follow-up in adolescent and young adult cancer survivors.

As survival rates of adolescent and young adult (AYA) cancer patients increase, a growing number of AYA cancer survivors need follow-up care. However, there is little research on their preferences for follow-up care. We aimed to (1) describe AYA cancer survivors' preferences for the organization and content of follow-up care, (2) describe their preferences for different models of follow-up, and (3) investigate clinical and sociodemographic characteristics associated with preferences for the different models. AYA cancer survivors (diagnosed with cancer at age 16-25years; ≥5years after diagnosis) were identified through the Cancer Registry Zurich and Zug. Survivors completed a questionnaire on follow-up attendance, preferences for organizational aspects of follow-up care (what is important during follow-up, what should be included during appointments, what specialists should be involved, location), models of follow-up (telephone/questionnaire, general practitioner (GP), pediatric oncologist, medical oncologist, multidisciplinary team), and sociodemographic characteristics. Information on tumor and treatment was available through the Cancer Registry Zurich and Zug. Of 389 contacted survivors, 160 (41.1%) participated and 92 (57.5%) reported still attending follow-up. Medical aspects of follow-up care were more important than general aspects (p<0.001). Among different organizational models, follow-up by a medical oncologist was rated higher than all other models (p=0.002). Non-attenders of follow-up rated GP-led follow-up significantly higher than attenders (p=0.001). Swiss AYA cancer survivors valued medical content of follow-up and showed a preference for medical oncologist-led follow-up. Implementation of different models of follow-up care might improve accessibility and attendance among AYA cancer survivors.

Abstract A04: Differences in preferences for models of informed consent may affect racial composition of biobanks

Abstract Biobanks are essential resources for advancing cancer research. Research conducted with stored biospecimens can provide critical societal benefits, including advancements in oncogenomics, pharmacogenetics, and enhanced medical treatments and improved health outcomes. In order for biobanks to provide broad societal benefits and address health disparities, participation by individuals from diverse groups is needed. Various models of informed consent have been proposed for future research use of biobanked specimens, differing in level of donor control and amount of information received. Data are needed regarding how different consent models might affect participation in biobanks, particularly for individuals from racial and ethnic minority groups. We therefore conducted semi-structured interviews with 60 women to examine their attitudes and preferences for different models of informed consent for secondary research uses of biospecimens. Recruitment was stratified by race (Black/White) and prior biobank participation (yes/no). Two coders independently coded all interview transcripts; analysis was based on consensus codes. The qualitative thematic analysis was conducted using NVivo. The results showed that the majority of Black and White participants preferred “broad” consent, which requires separate blanket permission for biospecimens to be used in multiple future research studies and provides participants with general information about possible future studies. More Black participants than White participants preferred “study specific” consent, which requires separate consent for each future research study and provides specific information about that study. We found that reasons for preferring a particular model of consent often differed by race. For example, Black participants more often spoke of the importance of being informed of what was happening with their sample, of research study activities, or being informed or notified if their sample was used. In reference to “study specific” consent, one Black participant said, “[Study-specific] continuously keeps you updated which is… you know you gotta be happy with constantly getting the updates.” In contrast, White participants often felt that giving permission once for their sample to be used in multiple future research studies (broad consent), rather than before each future study (study specific consent), was sufficient. In reference to why she liked “broad” consent, one White participant noted, “Well because they ask me once and then they have my permission to use my sample in multiple future studies.” Feeling respected was also an important factor affecting preferences among Black participants. One Black participant spoke about “broad” consent, “[Y]ou're being courteous, and you're asking me, 'Will you also say yes to this?' ” There were some common themes across racial groups. Both Black and White participants felt that the notice model, in which participants are notified that their biospecimens may be used in research, violated their rights. One White participant commented, “I don't think it respects the… individual and what right they have to do with their body or their own tissue.” These findings are essential to develop informed consent processes for biobanks that address the information most important to individuals from various racial and ethnic minority groups and allow them to make informed decisions about biobank participation. Citation Format: Katherine Brown, Bettina Drake, Hannah Perkins, Leslie Wolf, James DuBois, Sarah Gehlert, Melody Goodman, Kimberly Kaphingst. Differences in preferences for models of informed consent may affect racial composition of biobanks. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A04.

Models of representation, Mobilization and Turnout: The Election of the Foreign Citizens' Council of the Province of Bologna

The Foreign Citizens' Council of the Province of Bologna is a consultative, elected body that the Province has implemented to give representation to the non-EU population, given the absence of local voting rights for these migrants in Italy. This work analyses the models of political representation implicit in the electoral rules of the council and in the organization of the main competing lists in the election, and, through the analysis of electoral data and 32 in-depth interviews with the candidates, the effect the different models had. While the vote seems to have been mostly intra-national, cross-national lists were the most successful. The different levels of turnout among the electorate suggest that the vote was based on mobilization rather than on trust in the political system, and that the analyses that link associational density with electoral participation pose some theoretical and methodological problems in this field. Policy Implications Migrants' participation policy is always based on implicit political models of participation that should always be made explicit and examined before implementation. There is always a plurality of political preferences for different models of participation in the migrant population, that should be explored and accommodated. The number of associations in existence should not be used as an indicator of a strong civil society as largely as it is presently.

Assessing patient preferences for the delivery of different community-based models of care using a discrete choice experiment.

To assess patient preferences for different models of care defined by location of care, frequency of care and principal carer within community-based health-care services for older people. Discrete choice experiment administered within a face-to-face interview. An intermediate care service in a large city within the United Kingdom. The projected sample size was calculated to be 200; however, 77 patients were recruited to the study. The subjects had recently been discharged from hospital and were living at home and were receiving short-term care by a publicly funded intermediate care service. Not applicable. The degree of preference, measured using single utility score, for individual service characteristics presented within a series of potential care packages. Location of care was the dominant service characteristics with care at home being the strongly stated preference when compared with outpatient care (0.003), hospital care (<0.001) and nursing home care (<0.001) relative to home care, although this was less pronounced among less sick patients. Additionally, the respondents indicated a dislike for very frequent care contacts. No particular type of professional carer background was universally preferred but, unsurprisingly, there was evidence that sick patients showed a preference for nurse-led care. Patients have clear preferences for the location for their care and were able to state preferences between different care packages when their ideal service was not available. Service providers can use this information to assess which models of care are most preferred within resource constraints.

Trade‐off between local access and safety considerations in childbirth: Rural Tasmanian women's perspectives

This study investigates: (i) Tasmanian rural women's preferences for different models of intrapartum care; (ii) their preferences for travel time to safe delivery; and (iii) factors which influence these preferences. Mixed-methods study using a survey questionnaire and semistructured interviews was adopted. A questionnaire explored women's preferences for different models of care and preferred travel time. Interviews were conducted to validate the survey results and provide insightful information on their preferences on the models of care. Women who have had rural childbirth experiences from six Tasmanian rural communities were invited to participate in the study. Two hundred and ten women completed the questionnaire with a response rate of 35%. Twenty-two follow-up interviews were conducted. The survey found that women preferred to give birth in a hospital setting to homebirth despite having to travel for two hours. Midwifery-led care with one hour travel time was the second preferred model of care. Women were willing to travel to access the regional hospital but within limit. Their preferences suggest that women have to trade-off between local access and safety considerations. The interviews validate the survey results. Three main themes emerged from the interview data namely (i) safety; (ii) distance from hospital; and (iii) type of delivery. Their preferences were associated with their maternal care experiences in the past. In order to achieve the maternity services that are woman centred and respond to the needs and preferences of women, the service design and provision should take into account these women's preferences.

A comparison of primary care providers’ and oncologists’ preferences for different models of cancer survivorship care.

6006 Background: There is increasing interest in developing more efficient and effective strategies for coordinating and delivering cancer and non-cancer related follow-up care to survivors. The objectives of this nationwide survey were to describe and compare US physician preferences for different cancer survivorship care models. Methods: The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was mailed to PCPs and oncologists in order to evaluate their views regarding physician responsibilities, knowledge levels about survivorship, and cancer follow-up testing. Using weighted univariate and multivariate models, we analyzed PCPs’ and oncologists’ preferences for different cancer survivorship care models (PCP/shared vs. oncologist vs. non-physician provider) and examined how physician attitudes towards and self-efficacy with their own skills during breast and colorectal cancer follow-up affected these preferences. Results: Of 3,434 physicians surveyed, 2,202 (64%) responded of whom 2,026 (59%) provided eligible outcomes for this study: 938 (46%) PCPs and 1,088 (54%) oncologists. In unadjusted analyses, most PCPs (51%) supported a PCP/shared care system whereas the majority of specialists (59%) strongly endorsed an oncologist-based model (p&lt;0.001). A number of PCPs and oncologists (23% for both) preferred to involve non-physician providers. A significant proportion of cancer specialists (87%) did not feel that PCPs can take on the primary role for cancer follow-up. Many PCPs believed that they have the skills to perform breast and colorectal cancer follow-up (57%), detect recurrent cancers (74%), and offer psychosocial support (50%), but only a minority (32%) were willing to assume exclusive responsibility. In adjusted analyses, PCPs already involved with cancer surveillance (43%) were more likely to prefer a PCP/shared care system than an oncologist-based survivorship care model (OR 2.08, 95%CI 1.34-3.23, p&lt;0.001). Conclusions: PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer follow-up was one of the strongest predictors of PCPs' willingness to assume this responsibility.

Follow-up care for cancer survivors: views of the younger adult

Background:Since the launch of the National Cancer Survivorship Initiative, there has been a surge of interest surrounding the value and organisation of long-term follow-up care after cancer treatment. We report the views of 309 adult cancer survivors (aged 18–45 years) on provision of follow-up and preferences for care.Methods:A total of 207 survivors completed questionnaires before and after routine consultant-led follow-up appointments and 102 were recruited by post. Measures of health status (including late effects, perceived vulnerability to late effects and quality of life), reasons for attending follow-up (clinical and supportive), issues to be discussed at follow-up and preferences for different models of care were assessed.Results:In all, 59% of the survivors reported experiencing one or more cancer-related health problems. Survivors rated clinical reasons for attending follow-up more highly than supportive reasons (P<0.001), although nutritional advice and counselling were considered useful (60 and 47%, respectively). Those still receiving scheduled follow-up appointments did not discuss the range of issues intended with ‘late effects’ and ‘fertility’, which were particularly under-discussed. Hospital rather than GP follow-up was more highly rated.Conclusion:Survivors value the clinical reassurance currently provided by consultant-led care. However, supportive needs are not systematically addressed. Multi-disciplinary services are recommended to meet supportive needs in addition to clinical care.

Follow-up care after childhood cancer: Survivors’ expectations and preferences for care

Aims To describe (1) self-rated quality of life, late effects and perceived future vulnerability, (2) expectations before a follow-up appointment, subsequent satisfaction and preferences for different models of care and (3) differences between survivors in quality of life, perceived late effects, vulnerability, expectations regarding follow-up, information needs (topics they want to and did discuss) and preferences for different models of care depending on risk stratification among childhood cancer survivors. Method One hundred and twelve of 141 survivors (18–45 years), diagnosed before 16 years and >5 years since diagnosis completed questionnaires before and after a follow-up appointment (or an abridged questionnaire if they did not attend an appointment within the study period). We collected data on physical (physical component score [PCS]) and mental (mental component score [MCS]) quality of life, late effects, future vulnerability and expectations about care ( clinical: identification of late effects; supportive: employment, relationships). Medical information was extracted from case notes. Results MCS and PCS were comparable to population norms, but 55.5% of survivors reported ⩾1 late effect (range 1–9). Clinical care was rated more highly than supportive care ( p < 0.001) especially in those with worse PCS ( p = 0.042). Supportive care was rated highly by survivors who reported more late effects ( p = 0.040), higher future vulnerability ( p < 0.001) and lower MCS ( p = 0.005), and by women ( p = 0.014). Regardless of risk stratification, consultant-led follow-up was valued higher than other models (nurse-led care, GP-led care or postal/telephone follow-up, p < 0.001). Conclusion Childhood cancer survivors are in favour of sustaining long-term follow-up care within the existing consultant-led model but this is not feasible given the increasing number of survivors. In the future we therefore need to develop alternative services which will provide the best medical care for each survivor’s needs.

Follow-up care for childhood cancer survivors: A focus group analysis

Follow-up of survivors of childhood cancer is recommended to improve detection of late-effects, and provide individuals with information and advice. This study aimed to follow-up survivors of childhood cancer and report on their attitudes to current follow-up methods. Twenty-six survivors (13–25 years) of childhood cancer and their parent(s) attended focus groups ( n = 7) to discuss views about follow-up care. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three themes were identified: strategies to achieve a normal life (through playing down possibility of late-effects or careful monitoring of health); expectations about follow-up (facts and information, advice about self-care, everyday living, and psychosocial consequences) and preferences for different models of care. Given that some families had reservations about the benefits of follow-up, it is important that services address survivors’ interests and meet their expectations. Changes to service delivery must take account of individual needs and expectations. Possible limitations of focus group methods (recruitment, bias reduction, methods of analysis and influence of other participants’ views) are discussed.

Editor's Choice

Many obstetric and gynaecological interventions would benefit from evaluation by randomised controlled trials which never happen because researchers and funders assume that no one would agree to join. When it comes to decisions like whether to have a home or hospital birth, a medical or surgical late pregnancy termination, or when to time delivery, experts often assume that anyone who is intelligent enough to appreciate the need for randomisation is also likely to have a strong preference for one or other treatment. That is not always so; about 10 years ago, I recruited 10 women to a pilot trial of home versus hospital birth,1 and a few months ago, BJOG reported a pilot comparing medical and surgical late abortion.2 This month we report one of water versus land-based birth (pages 537–545). It turned out that a midwife working 4 hours a week in a single unit for 11 months was able to recruit 60 women to be allocated in a 2:1 ratio to deliver in water or on land. Another 88 potentially eligible women did not get randomised for various reasons. These numbers sound pretty good but there was a problem; only 10 of the 40 women allocated to deliver in water actually did so. That does not preclude someone designing a pragmatic trial to compare the intention to deliver in water with the intention to deliver on land, but it will need to be taken into account in sample size calculations. Whether these data should encourage or discourage researchers to design definitive trials of water birth I leave to others. The history of premenstrual syndrome has been a story of repeated uncontrolled studies reporting favourable results with a range of sensible, and some not so sensible, treatments. Almost invariably, mixed results from randomised trials are eventually followed by clear evidence of ineffectiveness from systematic reviews. The only exception to this rule so far has been selective serotonin reuptake inhibitors which have stood up to the tests of evidence-based medicine. This month we report the second exception. A systematic review from Stoke on Trent (pages 585–593) of ovulation suppression with gonadotrophin releasing hormone analogues, with and without oestrogen ‘add back’ therapy, suggests that both therapies are effective in the short term. Whether they are worth the long term costs and inconvenience remains to be seen. Similar reviews of experimental dietary interventions do not exist so we have to rely on observational data (pages 549–599). I hope nobody will be so foolish as to alter their diet directly for this reason, but this study from Japan will help guide dietary intervention trials. Many people are sceptical of health surveys both as methods to judge the quality of health care and to measure patients' priorities. Responses are often influenced more by how an illness turned out than by the quality of the care received, and when asked what they want in the future people frequently say that they like the sorts of care with which they are already familiar. On pages 550–560 Vanora Hundley and Mandy Ryan from Aberdeen have demonstrated some of these problems in an experimental survey of women's preferences for different models of maternity care provision. It turns out that people tend to prefer the sort of care that they already have. For example, women from areas with the least continuity of carer rated this aspect of care lower than did women from other areas. The authors conclude that tailoring health services to local survey-revealed preferences may simply reinforce current provision and existing inequalities. They are surely correct, but others may draw wider conclusions. By allowing health care everywhere to be organised by governments who respond to regular national surveys called elections, perhaps we are all locking ourselves into our historical systems, however good or bad they may be. Every accoucheur thinks they know that labour is longer and delivery is more difficult if the fetal head presents in an occipito-posterior position early on, but studies claiming to show a relationship are almost invariably biased and inaccurate. They are biased in that patients in slow labour undergo a different number of vaginal assessments by different staff, and they are inaccurate because the clinical assessment of fetal position is difficult and poorly reproducible. Nevertheless, it turns out that the association is true (pages 532–536). When position was assessed by ultrasound early in labour, the 35% of pregnancies with a posterior position had a caesarean section rate of 19%, and the remainder had one of only 11%. The raised risk persisted after adjustment for other caesarean risk factors. Trials of interventions designed to improve labour outcomes may wish to take this into account.

Identifying and analysing dominant preferences in discrete choice experiments: An application in health care

The assumption that goods are traded-off to maximise utility underpins many choice-based empirical methods used to elicit stated preferences. The aim of this paper is to test and examine the implications of this assumption in the context of a discrete choice experiment that examined stated preferences for different models of out of hours care provided by General Practitioners. The results indicated that 45% of individuals exhibited evidence of dominant preferences, a special case of a lexicographic ordering. Factors influencing the existence of dominant preferences included the complexity of the choices, but also individuals' past experiences. The analysis of dominant preferences provided important information about individuals with particularly strong preferences, and suggested different policy conclusions for this group of respondents.