The Relevance View: Defended and Extended

Utilitas ◽  
2020 ◽  
pp. 1-10
Author(s):  
Kirsten Mann
Keyword(s):  
Real World ◽  
Internal Logic ◽  
Life Saving ◽  
Headache Relief ◽  
Allocation Problems ◽  
Consistency Constraints ◽  
Significant Extension

Abstract The Relevance View, exemplified by Alex Voorhoeve's Aggregate Relevant Claims, has considerable appeal. It accommodates our reluctance to aggregate weak claims in canonical cases like Life for Headaches (where one person's claim to life-saving treatment competes with millions of claims for headache relief), while permitting aggregation of claims in a range of other cases. But it has been the target of significant criticism. In an important recent paper, Patrick Tomlin argues that the view suffers from failures of internal logic, violating plausible consistency constraints and generating incoherent combinations of verdicts on cases. And in cases resembling real-world healthcare allocation problems, Tomlin argues that the view offers no guidance at all. In response, I argue that the internal logic of the Relevance View is sound, and the view's core principles, suitably clarified, support a significant extension of the view beyond the simple cases to which it is typically applied.

scholarly journals Real-World Evidence of Caplacizumab Use in the Management of Acute TTP

Blood ◽  
2020 ◽  
Author(s):  
Tina Dutt ◽  
Rebecca J Shaw ◽  
Matthew James Stubbs ◽  
Jun Yong ◽  
Benjamin Bailiff ◽  
...  
Keyword(s):  
Platelet Count ◽  
Real World ◽  
Patient Characteristics ◽  
Patient Access Scheme ◽  
Fda Approval ◽  
Immune Mediated ◽  
Real World Evidence ◽  
Life Saving ◽  
The Uk ◽  
Von Willebrand

The cornerstone of life-saving therapy in immune mediated thrombotic thrombocytopenic purpura (iTTP) has been plasma exchange (PEX) combined with immunomodulatory strategies. Caplacizumab, a novel anti-von Willebrand factor nanobody, trialled in two multicentre, randomised-placebo-controlled trials leading to EU and FDA approval, has been available in the UK through a patient-access scheme. Data was collected retrospectively from 2018-2020 for 85 patients receiving caplacizumab, including 4 children, from 22 UK hospitals. Patient characteristics and outcomes in the real-world clinical setting were compared with caplacizumab trial endpoints and historical outcomes in the pre-caplacizumab era. 84/85 patients received steroid and rituximab alongside PEX; 26% required intubation. Median time to platelet count normalisation (3 days), duration of PEX (7 days) and hospital stay (12 days) was comparable with RCT data. Median duration of PEX and time from PEX initiation to platelet count normalisation was favourable compared with historical outcomes (p<0.05). TTP recurrence occurred in 5/85 patients; all with persistent ADAMTS13 activity <5iu/dL. Of 31 adverse events in 26 patients, 17/31 (55%) were bleeding episodes and 5/31 (16%) were thrombotic events (two unrelated to caplacizumab); mortality was 6% (5/85), with no deaths attributed to caplacizumab. In 4/5 deaths caplacizumab was introduced >48 hours after PEX initiation (3-21 days). This real-world evidence represents the first and largest series of TTP patients receiving caplacizumab outside clinical trials, including paediatric patients. Representative of true clinical practice, the findings provide valuable information for clinicians treating TTP globally.

Trans-Sectoral Neuroscience Innovation for the 21st Century

2021 ◽  
pp. 545-558
Author(s):  
Michael McCullough ◽  
Laura Roberts ◽  
Diana Saville ◽  
Calvin Nguyen ◽  
Bo Shao ◽  
...  
Keyword(s):  
Computer Science ◽  
Clinical Psychiatry ◽  
21St Century ◽  
Real World ◽  
Philosophy Of Mind ◽  
High Impact ◽  
Brain Science ◽  
Commercial Use ◽  
Life Saving ◽  
Science Philosophy

Humanity is on the verge of a radically productive era in brain science, yet far too many important and impactful ideas will never leave the lab due to the profit-driven infrastructure supporting translation. BrainMind is a platform and private community connecting people developing high-impact innovations in brain science with capital and entrepreneurial resources at scale. The BrainMind ecosystem is driving the coordination of expertise, capital, and infrastructure to bring critical life-saving ideas out of the lab and into real-world. clinical and commercial use. The BrainMind community includes members from research, medicine, entrepreneurship, investing, philanthropy, and policy, with the community growing to include more interdisciplinary voices including experts in statistics, clinical psychiatry, ethics, computer science, philosophy of mind, and economics, to name a few.

scholarly journals Separate in Latent Space: Unsupervised Single Image Layer Separation

2020 ◽  
Vol 34 (07) ◽  
pp. 11661-11668 ◽  
Author(s):  
Yunfei Liu ◽  
Feng Lu
Keyword(s):  
Real World ◽  
Ground Truth ◽  
Single Image ◽  
Ground Truth Data ◽  
Layer Separation ◽  
World Vision ◽  
Image Layer ◽  
Latent Space ◽  
Consistency Constraints ◽  
Ill Posed

Many real world vision tasks, such as reflection removal from a transparent surface and intrinsic image decomposition, can be modeled as single image layer separation. However, this problem is highly ill-posed, requiring accurately aligned and hard to collect triplet data to train the CNN models. To address this problem, this paper proposes an unsupervised method that requires no ground truth data triplet in training. At the core of the method are two assumptions about data distributions in the latent spaces of different layers, based on which a novel unsupervised layer separation pipeline can be derived. Then the method can be constructed based on the GANs framework with self-supervision and cycle consistency constraints, etc. Experimental results demonstrate its successfulness in outperforming existing unsupervised methods in both synthetic and real world tasks. The method also shows its ability to solve a more challenging multi-layer separation task.

scholarly journals Real-world insight into public access defibrillator use over five years

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001251 ◽  
Author(s):  
Hannah Torney ◽  
Olibhéar McAlister ◽  
Adam Harvey ◽  
Amy Kernaghan ◽  
Rebecca Funston ◽  
...  
Keyword(s):  
Real World ◽  
Response Times ◽  
Public Access ◽  
Case Report Form ◽  
Public Places ◽  
Patient Demographics ◽  
Life Saving ◽  
Medical Facilities ◽  
Observational Cohort ◽  
The Mean

BackgroundPublic access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period.MethodsData were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack.ResultsData were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events.ConclusionThis is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.

scholarly journals Coping and co-creation: one attempt and one route to well-being

2021 ◽  
Author(s):  
Tjeerd C. Andringa ◽  
Florence C. Denham
Keyword(s):  
Real World ◽  
Psychological Safety ◽  
Well Being ◽  
The Other ◽  
Ontological Security ◽  
Healthy Development ◽  
Safe Environment ◽  
Internal Logic ◽  
Core Cognition ◽  
The Creation

All life strives to be well, but not all life is well. In this theoretical article we systematically specify the evolutionary core cognition of well-being in general living agents and we apply that to humans. We identify two strategies for the creation and protection of the conditions required for well-being and describe the associated behavioral ontologies. One strategy, coping, is for survival and the other strategy, co-creation, is for thriving. We summarize core cognition and the ontologies in two tables with defined key terms.Coping and co-creation correspond to two complementary ontologies of cognition that follow their own internal logic fine tuned by learned from real-world experiences. While both strategies are essential, the successful interplay of their strengths leads to the dominance of one of them: co-creation.We define adequacy in terms of improving or protecting viability, and we show that the four combinations of a coping and co- creation adequacy or inadequacy underlie the structure of identity in humans. The combinations also dictate how individuals attempt to protect and create the conditions for well-being, and their likelihood of success.The notion of ontological security, as it is known in literature, is an accurate description of the coping mode’s restricted capacity for the creation and protection of well-being. Ontological security leads to a self-limiting form of well-being that has been described as “abnormal normality”.Psychological safety provides the preconditions for high well-being and a safe environment promoting the healthy development of coping and co-creation adequacy.

scholarly journals Caplacizumab Is Effective in Treating Immune-Mediated Thrombotic Thrombocytopenic Purpura in Real-World Scenarios and May Lower Mortality: An Aggregative Analysis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1019-1019
Author(s):  
Linus A. Völker ◽  
Gesa Balduin ◽  
Lucas Kühne ◽  
Jessica Kaufeld ◽  
Ulf Schönermarck ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Real World ◽  
Prospective Trial ◽  
Patient Centered ◽  
Thrombocytopenic Purpura ◽  
Aggregated Data ◽  
Immune Mediated ◽  
Life Saving ◽  
The Uk ◽  
Historical Controls

Abstract Introduction: The treatment of acquired thrombotic thrombocytopenic purpura has been a subject to change lately due to the introduction of caplacizumab as a novel, and potentially life-saving agent. Here, we compare patient-centered outcomes of a historic cohort of 119 aTTP-patients and an extended real-world caplacizumab-treated cohort of 113 aTTP-patients from Germany and Austria in the context of multiple recently published international cohorts of aTTP patients. Methods: From October 2018 until May 2021, data from German and Austrian patients presenting with an acute episode of aTTP as defined by an ADAMTS13 activity below 10 % treated with caplacizumab were gathered retrospectively. We aggregated data from two published randomized controlled trials (TITAN, HERCULES), one single-arm prospective trial and two retrospective cohorts with a historical control cohort. In total, we report 846 aTTP cases, 396 of those treated with caplacizumab and 450 without. For data analysis, placebo groups from randomized trials and historical controls from retrospective analyses were combined. Results: All cohorts combined reported 30 aTTP-related deaths, predominantly in the non-caplacizumab cohort. Mortality in the caplacizumab-cohort (8 cases total) was mainly driven by 5 reported deaths in the UK-cohort, which have been ascribed to a delayed use of caplacizumab by the authors. The number of daily PEX was significantly less in the caplacizumab-treated cohort (7.2 vs 10.2 days). In line, the number of hospital (14.0 vs 18.1) and ICU (4.7 vs 8.9) days differed significantly. Exacerbations (14% vs 39%) were significantly reduced in the caplacizumab-group. In view of all treatment-related outcomes, the data presented herein argues strongly in favor of an early and consistent use of caplacizumab in all instances of aTTP. Disclosures Völker: Sanofi-Genzyme: Honoraria, Other: counselling fees.

Applying Wellbeing Insights to Existing Policy Evaluations and Appraisals

2021 ◽  
pp. 333-424
Author(s):  
Paul Frijters ◽  
Christian Krekel
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Effectiveness Analysis ◽  
Global Level ◽  
Internal Logic ◽  
Policy Responses ◽  
Business As Usual

The fifth chapter shows how insights from wellbeing could complement existing policy evaluations and appraisals, using real-world case studies from government departments and agencies. For each case study, it first summarizes the current evaluation or appraisal approach, including its internal logic. It also makes general remarks to give some academic and policy context. The chapter goes on to show how insights from wellbeing could be brought to bear on these cases. In most cases, the authors sketch what a wellbeing-augmented cost-benefit analysis (CBA) or a fully fledged wellbeing cost-effectiveness analysis (CEA) might look like. A final case study applies a wellbeing CBA at the global level for illustrative purposes to assess two very different policy responses during the Covid-19 crisis, one the being a laissez-faire, business-as-usual response to the pandemic and one being a containment and eradication response involving the kind of lockdowns and preventive measures we have seen in most countries worldwide.

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