Metal(loid) bioaccessibility and risk assessment of ashfall deposit from Popocatépetl volcano, Mexico.

Ash emission from volcanic eruptions affects the environment, society, and human health. This study shows the total concentration and lung bioaccessible fraction of eight potential toxic metal(loid)s in five Popocatépetl ashfall samples. Mineralogical phases and particle size distribution of the ashfall were analyzed by X-ray diffraction (XRD) and Scanning Electron Microscope (SEM) techniques, respectively. The bioaccessibility test of Gamble solution (GS) and Artificial Lysosomal Fluid (ALF) were conducted to simulate extracellular (pH 7) and intracellular (pH 4.5) conditions, respectively. The studied metal(loid)s showed the following total concentration (mg kg-1): 1.98 (As), 0.17 (Cd), 134.09 (Cr), 8.66 (Cu), 697.33 (Mn), 55.35 (Ni), 8.77 (Pb), and 104.10 (Zn). Geochemical indices suggested that some metal(loid)s are slightly enriched compared to the local soil background concentrations. Several mineralogical phases were identified in the collected ashfall deposits, such as plagioclase, pyroxene, and Fe-Ti oxide, among others. According to the risk assessment results, the non-carcinogenic risk related to ashfall exposure returns an HQ > 1 for children. In contrast, the estimation of carcinogenic risk was found to be within the tolerable limit. Metal(loid)s showed low bioaccessibility (< 30%) in GS and ALF, with the highest values found in ALF solution for As (12.18%) and Cu (7.57%). Despite their metal-bioaccessibility, our findings also showed that dominant ash particle size ranged between fine (< 2.5 µm) and extremely fine (< 1 µm), considered highly inhalable fractions. The results obtained in this work indicate that volcanic ashes are bioinsoluble and biodurable, and exhibit low bioaccessibility when in contact with lung human fluids.

Cognitive Challenges Are Better in Distinguishing Binge From Nonbinge Drinkers: An Exploratory Deep-Learning Study of fMRI Data of Multiple Behavioral Tasks and Resting State.

BACKGROUND: Studies have identified imaging markers of binge drinking. Functional connectivity during both task challenges and resting state was shown to distinguish binge and nonbinge drinkers. However, no studies have compared the efficacy of task and resting data in the classification. HYPOTHESIS: Task outperforms resting-state functional magnetic resonance imaging (fMRI) data in the differentiation of binge and nonbinge drinkers. We tested the hypothesis via multiple deep learning algorithms. STUDY TYPE: Cross-sectional; retrospective. POPULATION: A total of 149 binge (107 men) and 151 demographically matched, nonbinge (92 men) drinkers curated from the Human Connectome Project, with 80% randomly selected for model development and 20% for validation/test. FIELD STRENGTH/SEQUENCE: A 3 T; fMRI with a blood oxygen level-dependent (BOLD) gradient-echo echo-planar sequence. ASSESSMENT: FMRI data of resting state and seven behavioral tasks were acquired. Graph convolutional network (GCN), long short-term memory, convolutional, and recurrent neural network models were built to distinguish bingers and nonbingers using connectivity matrices of 8, 116, and 268 regions of interest (ROI). Nodal metrics including betweenness centrality, degree centrality, clustering coefficient, efficiency, local efficiency, and shortest path length were calculated from the GCN model. STATISTICAL TESTS: Model performance was quantified by the area under the curve (AUC) in receiver operating characteristic analysis. A P value < 0.05 was considered statistically significant. RESULTS: Task outperformed resting data in classification by approximately 8% by AUC in the test set. Across models and ROI sets, the gambling, motor, language and working memory tasks, each with AUC of 0.614, 0.612, 0.605, and 0.603, performed better than resting data (AUC = 0.548). Models with 116 ROIs (AUC = 0.602) consistently outperformed those with 8 ROIs (AUC = 0.569). Task data performed best with GCN (AUC = 0.619). Nodal metrics of left supplementary motor area and right cuneus showed significant group main effect across tasks. CONCLUSION: Neural responses to cognitive challenges relative to resting state better characterize binge drinking. The performance of different network models may depend on behavioral tasks and the number of ROIs. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Resurrecting Multiattribute Utility Function: Developing a Value Set for Health Utility for Glaucoma.

OBJECTIVES: This study aimed to develop a scoring function to calculate health utilities for health states described by the Health Utility for Glaucoma (HUG-5) based on the preferences of the general population in the United States. METHODS: Preferences for HUG-5 health states were elicited using the standard gamble and visual analog scale through an online survey. Quota-based sampling was used to recruit a representative sample of the US general population in terms of age, sex, and race. A multiple attribute disutility function (MADUF) approach was adopted to derive scoring for the HUG-5. Model fit was assessed using mean absolute error associated with 5 HUG-5 marker health states that describe mild/moderate and severe glaucoma. RESULTS: Of 634 respondents completing the tasks, 416 were included in the estimation of the MADUF; 260 respondents (63%) considered worst possible HUG-5 health state better than death. The preferred scoring function generates the utilities ranging from 0.05 (worst HUG-5 health state) to 1 (best HUG-5 health state). The correlation between mean elicited and estimated values for marker states was strong (R2 = 0.97) with mean absolute error = 0.11. CONCLUSIONS: The MADUF for HUG-5 is used to measure health utilities on the scale of perfect health and death, which can be used to estimate quality-adjusted life-years for economic evaluations of glaucoma interventions.

Predicting the in vitro dissolution rate constant of mineral wool fibers from fiber composition.

OBJECTIVE: We developed predictive formulae for the in vitro dissolution rate constant kdis of acid-soluble synthetic vitreous fibers (SVF), paralleling our earlier work with glass wools, which are typically more soluble at neutral pH. Developing simple models for predicting the kdis of a fiber can allow prediction of in vivo behavior, aid fiber developers, and potentially reduce in vivo testing. METHODS: The kdis of several acid-soluble SVF were determined using high simulant fluid flow/fiber surface area (F/A) conditions via a single-fiber measurement system. Four fluids were employed, varying in base composition and citrate levels. Equations predicting the kdis were derived from fiber chemistry and dissolution measurements for two of the fluids. RESULTS: Testing of several fibers showed a ∼10× increase in the kdis when citrate was included in the simulant solution. Data from tests with Stefaniak's citrate-free Phagoloysosmal Simulant Fluid (PSF) yielded kdis values aligned with expectations from in vivo results, unlike results from citrate-containing modified Gamble's solution. Predictive equations relating fiber chemistry to kdis showed reasonable agreement between the measured and predicted values. CONCLUSIONS: Citrate inclusion in the solution under high F/A conditions significantly increased the measured kdis. This resulted in more biorelevant data being obtained using the PSF fluid with the high F/A method used. The developed predictive equations, sufficient for fiber development work, require refinement before a recommending their use in place of in vivo biopersistence testing. Significant fit improvements are possible through additional measurements under these experimental conditions.

Characterizing the interaction between micro(nano)plastics and simulated body fluids and their impact on human lung epithelial cells.

Micro(nano)plastics are considered an emerging threat to human health because they can interact with biological systems. In fact, these materials have already been found in the human body, such as in the lungs. However, limited data are available on the behavior of these materials under biological conditions and their impact on human cells, specifically on alveolar epithelial cells. In this study, micro(nano)plastics were exposed to various simulated biological fluids (artificial lysosomal fluids and Gamble's solution) for 2-80 h. Pristine and treated plastic particles were characterized based on their surface chemistry, zeta potentials, and elemental composition. Various toxicological endpoints (mitochondrial membrane potential, lactate dehydrogenase, protein, and antioxidant levels) were examined using A549 lung carcinoma cells. The surface characteristics of the treated micro(nano)plastics and the toxicological endpoints of A549 cells were found to be influenced by the simulated biological media, specifically with high concentrations of the treated micro(nano)plastics and increasing exposure under biological conditions. Moreover, the toxicological endpoints were strongly linked to the chemistry of plastics and included multiple processes in response to the plastics; different biological pathways were obtained in artificial lysosomal fluid and Gamble's solution.

Comparing utility functions between risky and riskless choice in rhesus monkeys.

Decisions can be risky or riskless, depending on the outcomes of the choice. Expected utility theory describes risky choices as a utility maximization process: we choose the option with the highest subjective value (utility), which we compute considering both the option's value and its associated risk. According to the random utility maximization framework, riskless choices could also be based on a utility measure. Neuronal mechanisms of utility-based choice may thus be common to both risky and riskless choices. This assumption would require the existence of a utility function that accounts for both risky and riskless decisions. Here, we investigated whether the choice behavior of two macaque monkeys in risky and riskless decisions could be described by a common underlying utility function. We found that the utility functions elicited in the two choice scenarios were different from each other, even after taking into account the contribution of subjective probability weighting. Our results suggest that distinct utility representations exist for risky and riskless choices, which could reflect distinct neuronal representations of the utility quantities, or distinct brain mechanisms for risky and riskless choices. The different utility functions should be taken into account in neuronal investigations of utility-based choice.

Risk taking propensity: Nurse, surgeon and patient preferences for diverting ileostomy.

AIM: The decision-making process to defunction a pelvic colorectal anastomosis involves complex heuristics and is framed by surgeon personality factors. Risk taking propensity may be an important factor in these decisions and patient preferences have not been evaluated alongside surgeons and nurses. METHODS: A prospective cross-sectional study involving a one-off interview and questionnaire assessing how risk taking propensity affects nurse, surgeon and patient preferences for a temporary defunctioning ileostomy (TDI) was performed. The risk taking index (RTI) was employed to evaluate risk taking propensity and the validated prospective measures of preference instruments to evaluate preferences for stoma avoidance in several scenarios by asking the individual to consider trading or gambling years of remaining life expectancy. RESULTS: One hundred and fifty participants met the inclusion criteria, which included 30 (20.0%) surgical nurses, 20 (13.3%) colorectal surgeons and 100 (66.7%) patients. Surgeons had a significantly higher RTI (mean ± SD: 26.8 ± 6.7) than patients (mean ± SD: 20.0 ± 9.8) and nurses (mean ± SD: 23.0 ± 6.6) p = 0.002. Surgeons would consider that it would be in a patient's best interest to have a TDI at an AL rate of 15% or greater, whereas nurses and patients would do so at 28% and 25%, respectively (p = 0.007). CONCLUSION: Surgeons were shown to have a higher risk taking propensity than patients and nurses but a significantly lower threshold of AL where they would consider a TDI is in the best interest of the patient.

The Role of PnTCP2 in the Lobed Leaf Formation of Phoebe neurantha var. lobophylla.

A lobed leaf is a common trait in plants, but it is very rare in Lauraceae plants, including species of Phoebe. In the study of germplasm resources of Phoebe neurantha, we found lobed leaf variant seedlings, and the variation could be inherited stably. Studying the lobed leaf mechanism of P. neurantha var. lobophylla can offer insight into the leaf development mechanism of woody plants. RNA-seq and small RNA-seq analysis results showed that a total of 8091 differentially expressed genes (DEGs) and 16 differentially expressed miRNAs were identified in P. neurantha var. lobophylla. Considering previous research results, a leaf margin morphological development related miRNA, pne-miRNA319a, was primary identified as a candidate miRNA. Target gene prediction showed that a total of 2070 genes were predicted to be the target genes of differentially expressed miRNAs. GO enrichment analysis of differentially expressed target genes suggested that PnTCP2 is related to lobed leaf formation. The TRV-VIGS gene silencing of PnTCP2 led to lobed leaves in P. neurantha seedlings. The downregulation of PnTCP2 led to lobed leaves. The yeast two-hybrid test and bimolecular fluorescence complementation test confirmed that the PnTCP2 protein interacted with the PnLBD41 protein. Based on the expression analysis of gene-silenced leaves and RNA-seq and small RNA-seq analysis results, pne- miRNA319a and PnLBD41 might also play important roles in this process. In conclusion, PnTCP2 plays an important and vital role in the formation of the lobed leaves of P. neurantha var. lobophylla.

UPLC-Q-TOF-MS/MS Analysis of Phenolic Compounds from the Fruit of Cephalostachyum fuchsianum Gamble and Their Antioxidant and Cytoprotective Activities.

Bamboo is a widely distributed graminaceous plant in China and is a potential source of bioactive substances. Incidentally, bamboo's fruit is rich in phytochemicals such as polyphenols and flavonoids, which are significant to human health. In this study, we identified the phenolic compounds of the fruit and investigated the antioxidant activities of Cephalostachyum fuchsianum Gamble (CFG) fruit polyphenols with in vitro and in vivo tests for the first time. UPLC-Q-TOF-MS/MS analysis results showed that the fruit contained 43 phenolic compounds, including 7 hydroxybenzoic acids, 12 flavonoids, 7 coumarins, 10 hydroxycinnamic acids, 1 terpenoid, and 5 lignans. The TPC of SP extracts was higher than that of IBPs extracts in FP and FF. The SP extracts in FP showed better antioxidant activities in vitro compared to those in FF. In addition, polyphenols from CFG fruits protected against H2O2-induced oxidative damage in HepG2 cells, and the protective effect of polyphenols in FP was superior to that in FF. The analysis results showed that CFG fruit has great potential in exploiting natural chemical substances, which can provide valuable pieces of information for the further development and utilization of CFG.

Decision experience in hyperchoice: the role of numeracy and age differences.

Due to new technologies, a profusion of products is released onto store shelves and the Internet, resulting in a special choice condition termed hyperchoice. Past research on whether hyperchoice deteriorates decision experience is mixed. The present study hypothesizes the experience in the scenario of hyperchoice may be moderated by individual characteristics, including numeracy and age differences. A total of 116 older adults and 112 younger adults were recruited from Amazon Mechanical Turk. Along with the Rasch-based numeracy scale, each participant completed a consumer and a gamble choice task. In both tasks, the number of options being presented to participants was manipulated to create a hyperchoice condition (sixteen options) and a simple-choice condition (four options). Dependent variables were post-choice difficulty and satisfaction. Multiple regressions were performed with SPSS 24.0 to test the hypothesis. As a result, hyperchoice was related to greater decision difficulty in both choice tasks. Moreover, there was an interaction between numeracy and hyperchoice in the gamble task. Specifically, whereas higher numerate participants' experienced difficulty and satisfaction were relatively stable between the two choice conditions, lower numerate participants experienced more difficulty and dissatisfaction in the hyperchoice condition than in the simple-choice condition. Additionally, compared to younger adults, older adults reported greater decision difficulty and lower decision satisfaction, regardless of choice condition. The study supported the notion that the specific effect of hyperchoice was moderated by individual factors. The study implied merchants should adopt strategies to ease decision experience and advocated for numeracy education.

Quality of life and health-related utility after trans-oral surgery for head and neck cancers.

PURPOSE: The purpose of this study was to assess utility coefficients of health states following two minimally invasive surgical approaches for head and neck cancer, namely trans-oral robotic surgery and trans-oral laser microsurgery. Those utility coefficients will be later exploited in an economic evaluation study comparing the two approaches. METHODS: The above cited economic evaluation will be done from the Swiss healthcare system perspective and, as such, Swiss healthcare professionals were interviewed to elicit utility coefficients. Health states, ranging from remission to palliative care, were described using clinical vignettes. A computerized tool (UceWeb) implementing standard gamble and rating scale methods was used. RESULTS: Utility coefficients for 18 different health states were elicited with the two methods from 47 individuals, for a total of 1692 values. Elicited values varied from 0.980 to 0.213. Comparison with values elicited in previous studies show the need for population-specific elicitation, mainly for the worst health states. CONCLUSION: Herein we report health utility coefficients for the Swiss population for health states following minimally invasive trans-oral surgery. This study provides utility values that can be used not only for a specific cost-utility analysis, but also for future studies involving the same health states.

Health utility and quality of life in pediatric liver transplant recipients.

To measure HU and HRQOL in pediatric liver transplant (LT) recipients, a cross-sectional study of patient-parent dyads was conducted. Direct HU were assessed in 48 adolescents ≥12 years using SG and TTO techniques. Indirect HU were measured by Health Utility Index 2 and HUI3 for subjects ≥12 years and CHU9D for ≥7 years. Patients reported HRQOL using PedsQL™ GC and PedsQL™ TM. A total of 108 dyads participated (55.6% female; 73.2% Caucasian; 42.6% biliary atresia; 35.2% living donor; 37.0% Medicaid). Mean age at survey was 13.6 ± 3.5 years, and time from LT was 8.9 ± 4.9 years. 61.2% were on monotherapy, 25 (23.2%) had acute rejection within 3 years, and 15 (13.9%) had a biliary obstruction within 5 years. Mean indirect HU and HRQOL scores by child report were lower than norms (P < .001). LRD recipients had higher PedsQL™ GC, PedsQL™ TM, and HUI3 scores (P < .01). HU in pediatric LT recipients are lower than norms. Availability of HU scores for post-transplant health states will enable measurement of quality-adjusted life years for future comparative effectiveness studies.

What is it going to be, TTO or SG? A direct test of the validity of health state valuation.

Standard gamble (SG) typically yields higher health state valuations than time trade-off (TTO), which may be caused by biases affecting both methods. It has been suggested that TTO yields more accurate health state valuations, because TTO is subject to both upward and downward biases that may cancel out. Verifying this claim, however, would require a golden standard to test validity against. In this study, we attempted to provide a first direct test of the validity of health state valuation. A total of 119 students completed five TTO and SG tasks. Afterwards, their health state valuations elicited with TTO and SG were shown to them in an interactive graph. Respondents were asked to indicate which of the methods represented their valuation of a health state best. They could also adjust their valuation. Overall, we found that respondents indicated that TTO valuations better reflected health state valuations, a result that was more pronounced for more severe health states. When offered the opportunity, on average, respondents adjusted health state valuations downwards. These findings may have implications for future work on (bias correction in) health state valuations.

Scratch Card Near-Miss Outcomes Increase the Urge to Gamble, but Do Not Impact Further Gambling Behaviour: A Pre-registered Replication and Extension.

Scratch card near-misses, outcomes in which two out of three required jackpot symbols are uncovered, have been shown to erroneously increase the urge to continue gambling. It remains unknown if and how these outcomes influence further gambling behaviour. Previous studies examining the influence of near-misses on purchasing behaviour offered a low-stakes gamble to participants after experiencing a near-miss or a regular loss. We sought to investigate the influence of these outcomes on scratch card purchasing behaviour with a stronger test of participants' gambling behavior by having them either "cash out" or risk all of their winnings to purchase another card. Additionally, we sought to test an original hypothesis that endorsement of the illusion of control might influence the decision to purchase additional scratch cards. We pre-registered our hypotheses, sample size, and data analysis plan. 138 subjects experienced two custom-made scratch card games that included a win on the first card (for all participants) and either a regular loss or a near-miss in the final outcome position on the second card (between-subjects manipulation). Although near-miss outcomes increased the urge to continue gambling relative to regular losses, no differences in the rates of purchasing were found between the conditions. Additionally, no support for our hypotheses concerning the influence of the illusion of control in near-miss outcomes was found. These results are discussed in terms of previous studies on scratch card gambling behaviour and subjective reactivity.

Patients choose certainty over burden in bladder cancer surveillance.

BACKGROUND: Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker. METHODS: We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, non-parametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics. RESULTS: Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories. CONCLUSIONS: Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.

QALYs without bias? Nonparametric correction of time trade-off and standard gamble weights based on prospect theory.

Common health state valuation methodologies, such as standard gamble (SG) and time trade-off (TTO), typically produce different weights for identical health states. We attempt to alleviate these differences by correcting the confounding influences modeled in prospect theory: loss aversion and probability weighting. Furthermore, we correct for nonlinear utility of life duration. In contrast to earlier attempts at correcting TTO and SG weights, we measure and correct all these tenets simultaneously, using newly developed nonparametric methodology. These corrections were applied to three less-than-perfect health states, measured with TTO and SG. We found considerable loss aversion and probability weighting for both gains and losses in life years, and we observe concave utility for gains and convex utility for losses in life years. After correction, the initially significant differences in weights between TTO and SG disappeared for all health states. Our findings suggest new opportunities to account for bias in health state valuations but also the need for further validation of resulting weights.

What were they thinking when providing preference measurements for generic health states? The evidence for HUI3.

BACKGROUND: Multi-attribute generic preference-based measures of health-related quality of life are used as comprehensive outcome measures. Typically preferences for health states defined by these systems are elicited from a representative sample of the general population. An important element in that elicitation process is the information that respondents were instructed to consider in providing their responses. METHODS: A random sample of community-dwelling respondents in Canada was surveyed in face-to-face interviews. Respondents provided preference scores for selected Health Utilities Index Mark 3 (HUI3) health states. Respondents also answered questions about the most important attributes and the importance of various impacts of the health states in providing their preference scores. RESULTS: Fifty per cent of respondents reported that they focussed on two, and 21% on three, attributes of the eight HUI3 attributes. Each of the eight attributes was identified as important; pain (49%), vision (37%), cognition (34%), emotion (28%), and ambulation (28%) were the most important. The null hypothesis that all of the attributes were equally important was rejected (p < 0.001). With respect to the impacts, 89% of respondents indicated that the ability to take care of oneself was quite or very important; similarly 76% reported the same for impact on family life, 69% for impact on the happiness of others, 61% for the impact on their ability to work, and 42% for the impact on their leisure activities. The null hypothesis that all of the impacts were equally important was rejected (p < 0.001). CONCLUSIONS: In providing preference scores for HUI3 health states, respondents thoughtfully examined the implications of the health states for their ability to live, work, socialize, and function.

Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients.

BACKGROUND: Health state utility values (HSUVs) are an important input to economic evaluations and the choice of HSUV can affect the estimate of relative cost-effectiveness between interventions. This systematic review identified utility scores for patients with metastatic non-small cell lung cancer (mNSCLC), as well as disutilities or utility decrements relevant to the experience of patients with mNSCLC, by treatment line and health state. METHODS: The MEDLINE®, Embase and Cochrane Library databases were systematically searched (September 2016) for publications describing HSUVs in mNSCLC in any treatment line. The EQ-5D website, the School of Health and Related Research Health Utilities Database (ScHARRHUD) and major pharmacoeconomic and clinical conferences in 2015-2016 were also queried. Studies in adults with previously treated mNSCLC were selected for further analysis. The information extracted included study design, description of treatment and health state, respondent details, instrument and tariff, HSUV or (dis) utility decrement estimates, quality of study, and appropriateness for use in economic evaluations. RESULTS: Of 1883 references identified, 36 publications of 34 studies were included: 19 reported EQ-5D scores; eight reported HSUVs from valuations of vignettes made by members of the public using standard gamble (SG) or time trade-off (TTO); two reported SG or TTO directly elicited from patients; two reported EQ-5D visual analogue scale scores only; one reported Assessment of Quality of Life instrument scores; one reported HSUVs for caregivers to patients with mNSCLC using the 12-item Short-Form Health Survey; and one estimated HSUVs based on expert opinion. The range of HSUVs identified for comparable health states showed how differences in study type, tariff, health state and the measures used can drive variation in HSUV estimates. CONCLUSIONS: This systematic review provides a set of published HSUVs that are relevant to the experience of adult patients previously treated for mNSCLC. Our review begins to address the challenge of identifying reliable estimates of utility values in mNSCLC that are suitable for use in economic evaluations, and also highlights how varying estimates result from differences in methodology.

Reducing preference reversals: The role of preference imprecision and nontransparent methods.

Preferences elicited with matching and choice usually diverge (as characterised by preference reversals), violating a basic rationality requirement, namely, procedure invariance. We report the results of an experiment that shows that preference reversals between matching (Standard Gamble in our case) and choice are reduced when the matching task is conducted using nontransparent methods. Our results suggest that techniques based on nontransparent methods are less influenced by biases (i.e., compatibility effects) than transparent methods. We also observe that imprecision of preferences influences the degree of preference reversals. The preference reversal phenomenon is less strong in subjects with more precise preferences.

Utility elicitation in adults and children for allergic rhinoconjunctivitis and associated health states.

PURPOSE: Allergic rhinitis and asthma symptoms are detrimental to health-related quality of life (HRQoL). Health technology appraisal agencies often require cost-utility analysis when assessing new interventions. Appropriate utility estimates, which quantify the value of different conditions in cost-utility analyses, are scarce for allergic rhinitis and asthma health states. This study aimed to generate utilities for allergic rhinitis and asthma health states from a European general population sample of adults and children. METHODS: Health state descriptions incorporating symptoms, impact of symptoms on daily life and symptom treatment were developed using clinical guidelines. Descriptions were amended with clinician and patient input, and incorporated into a survey in which each health state was followed by a standard gamble (adults) or visual analogue scale (children) item. The survey was distributed to samples of adults and children aged 8 to 11 from four European countries that were stratified to represent the general population within that country. RESULTS: 1454 adults and 1082 children completed the survey. Mean health utilities ranged from 0.635 to 0.880 and those elicited in children were lower (0.635 to 0.705) than those elicited in adults (0.812 to 0.880). Disutilities assessing the impact of increased allergic rhinitis severity and comorbidities were also greater in children than in adults. CONCLUSIONS: Symptoms of allergic rhinitis and asthma were valued as having a clinically meaningful impact on HRQoL. Children valued health states as poorer than adults, and further research should investigate whether this reflects true preferential differences or results from methodological and/or comprehension differences between the two groups.