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The trouble with radicalization
Though widely used by academics and policy-makers in the context of the 'war on terror', the concept of radicalization lacks clarity. This article shows that while radicalization is not a myth, its meaning is ambiguous and the major controversies and debates that have sprung from it are linked to the same inherent ambiguity. The principal conceptual fault-line is between notions of radicalization that emphasize extremist beliefs ('cognitive radicalization') and those that focus on extremist behavior ('behavioural radicalization'). This ambiguity explains the differences between definitions of radicalization; it has driven the scholarly debate, which has revolved around the relationship between cognition and behavior; and it provides the backdrop for strikingly different policy approaches—loosely labeled 'European' and 'Anglo-Saxon'—which the article delineates and discusses in depth. Rather than denying its validity, the article calls on scholars and policy-makers to work harder to understand and embrace a concept which, though ambiguous, is likely to dominate research and policy agendas for years to come.
Journal Article
Jena 1800 : the republic of free spirits
\"The history of the German idealist oasis where discussions of revolution, literature, beliefs, romance, and concepts gave birth to the modern world\"-- Provided by publisher.
BOOK
Updating Cost-Effectiveness — The Curious Resilience of the $50,000-per-QALY Threshold
The ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has long served as a benchmark for the value of U.S. health care. But evidence suggests that it is too low and might best be thought of as an implied lower boundary.
For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. Critics, meanwhile, have argued that the ratio is misunderstood and misused.
The fact that the $50,000-per-QALY yardstick has persisted attests to the medical community's need for a value threshold and to the advantages enjoyed by incumbents. It has endured even . . .
Journal Article
Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018
Objective
Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs).
Methods
We analyzed the Tufts Medical Center’s CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives.
Results
Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900–110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67–3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017–2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991–49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486–77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective.
Conclusion
Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.
Journal Article
A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted
Calculating the cost per disability-adjusted life years (DALYs) averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution.
We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA) Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases \"disability-adjusted\" or \"DALY\". Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000-2009 and 2010-2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low) to 7 (high), and examined the correlation between diseases researched and the burden of disease in different world regions.
We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%), followed by non-communicable diseases (28%). A high proportion of studies evaluated primary prevention strategies (59%). Pharmaceutical interventions were commonly assessed (32%) followed by immunizations (28%). Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included formal healthcare sector costs. A large number of the studies in Sub-Saharan Africa addressed high-burden conditions such as HIV/AIDS, tuberculosis, neglected tropical diseases and malaria, and diarrhea, lower respiratory infections, meningitis, and other common infectious diseases.
The Global Health Cost-Effectiveness Analysis Registry reveals a growing and diverse field of cost-per-DALY averted studies. However, study methods and reporting practices have varied substantially.
Journal Article
Electric and magnetic dipole modes in high-resolution inelastic proton scattering at 0
.
Inelastic proton scattering under extreme forward angles including
0
∘
and at energies of a few hundred MeV has been established as a new spectroscopic tool for the study of complete dipole strength distributions in nuclei. Such data allow an extraction of the electric dipole polarizability providing important constraints for parameters of the symmetry energy, which determine the neutron-skin thickness and the equation of state (EOS) of neutron-rich matter. Also, new insight into the much-debated nature of the pygmy dipole resonance (PDR) is obtained. Additionally, the isovector spin-
M
1 resonance can be studied in heavy nuclei, where only limited experimental information exists so far. Together with much improved results on the isoscalar spin-
M
1 strength distributions in
N
=
Z
nuclei, these data shed new light on the phenomenon of quenching of the nuclear spin response. Using dispersion matching techniques, high energy resolution (
Δ
E
/
E
≤
10
-
4
full width at half maximum, FWHM) can be achieved in the experiments. In spherical-vibrational nuclei considerable fine structure is observed in the energy region of the isovector giant dipole resonance (IVGDR). A quantitative analysis of the fine structure with wavelet methods provides information on the role of different damping mechanisms contributing to the width of the IVGDR. Furthermore, level densities can be extracted from a fluctuation analysis at excitation energies well above neutron threshold, a region hardly accessible by other means. The combination of the gamma strength function (GSF) extracted from the
E
1 and
M
1 strength distributions with the independently derived level density permits novel tests of the Brink-Axel hypothesis underlying all calculations of statistical model reaction cross sections in astrophysical applications in the energy region of the PDR.
Journal Article
Cost-Effectiveness Analysis 2.0
As prominent groups in U.S. health care ramp up use of cost-effectiveness analysis to measure and communicate the value of new drugs and other interventions, an expert panel has released updated guidelines for such analysis.
Cost-effectiveness analysis in U.S. health care seems poised for a second act of sorts. Although it has never actually gone away, efforts to apply it have encountered resistance, and the federal government and some health care organizations have sometimes prohibited its use or relegated it to a minor role. But several developments are helping to recharge the field. One is the embrace of its methods by prominent groups that are using it to measure and communicate the value of new drugs and other interventions. Another is the publication of new guidelines for such analysis from a national panel that is . . .
Journal Article