Purpose Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques.... Show morePurpose Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. Methods A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period. Results Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%. Conclusion In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates. Show less
Valid and reliable estimates of the policy preferences of political parties' supporters are essential for the study of political representation. However, such estimates are not directly available... Show moreValid and reliable estimates of the policy preferences of political parties' supporters are essential for the study of political representation. However, such estimates are not directly available from standard surveys of public opinion, which are typically representative by design only at the national level and rarely ask questions about public support for specific policies. In this article, we explore the possibility to use data from voting advice applications (VAA) to estimate the policy preferences of party supporters. To do that, first, we identify 10 questions on preferences towards issues of public policy that were asked around the same time and with similar wording in traditional surveys of public opinion and in VAAs fielded in Germany and in the Netherlands. Then we compare the VAA data disaggregated by political affiliation of the respondents to the survey data adjusted via multilevel regression modeling with poststratification (MRP). We find strong positive correlations between the estimates derived from both methods, especially after weighting the VAA data. Yet, point estimates are not always very close, and the match is sensitive to the treatment of neutral and ‘don't know’ answers. Overall, our results bode well for the validity of using VAA data in empirical research on political representation. Show less
The aim of this article is to understand why the EU opted to conclude the ‘EU–Turkey refugee deal’ in March 2016 in the context of the Syrian refugee crisis, despite the fact that the agreement... Show moreThe aim of this article is to understand why the EU opted to conclude the ‘EU–Turkey refugee deal’ in March 2016 in the context of the Syrian refugee crisis, despite the fact that the agreement deeply contradicts fundamental EU values and norms. The article seeks to explain the outcome—the conclusion of the EU–Turkey refugee deal—by analysing not only the ability of EU institutions to shape decisions, but also their motivations, ideas and preferences in justifying the EU’s actions in responding to the refugee challenge. It is argued that the deal results from ideational and power struggles between supranational (the European Parliament and the European Commission) and intergovernmental institutions (the European Council and the Council of the European Union). It is demonstrated that while the former put forward normative arguments, the latter invoked security as a main concern to avoid internal divisions between Member States. This article also reveals that such ideational and power struggles have consequences for the EU’s identity. Theoretically, the article builds on the new intergovernmentalist claims and on the normative/civilian power literature. Empirically, it explores the usage of normative justifications by EU institutions and points to inter-institutional tensions in framing the EU’s response to the refugee challenge. Show less
Background The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are... Show moreBackground The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are. Methods We conducted a preference-eliciting survey incorporating a best-worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design. Results According to the mean (SD) BWS scores, which can be (+ 4) in maximum and (- 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (- 3. 03 (1.03)), nausea/headache (- 2.69 (0.94)), and treatment discontinuation due to side effects (- 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals. Conclusion The rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases. Show less
Wentink, M.; Bodegom-Vos, L. van; Brouns, B.; Arwert, H.; Houdijk, S.; Kewalbansing, P.; ... ; Meesters, J. 2019
When it comes to voting in parliament, party group unity is the rule rather than the exception in most (European) parliamentary democracies. But how do individual MPs come to their decision to vote... Show moreWhen it comes to voting in parliament, party group unity is the rule rather than the exception in most (European) parliamentary democracies. But how do individual MPs come to their decision to vote according to the party group line? This book introduces a theoretical model of MP decision making in which the main decision-making mechanisms, derived from the existing literature on the pathways to party group unity __ cue-taking, agreement, loyalty and obedience __, are placed in a particular sequential order. The three empirical studies in this book assess the relative role of each of the mechanisms, both independent and when possible as a part of the sequential model, in getting MPs to toe the party group line and contribute to party group unity, and explore whether this varies not only between parliaments (chapter 4), but also by levels of government (chapter 5), and through time (chapter 6). Show less
This thesis presents a series of translational research studies to explore topics of importance to a patient stakeholder community--Duchenne and Becker muscular dystrophy. The overarching objective... Show moreThis thesis presents a series of translational research studies to explore topics of importance to a patient stakeholder community--Duchenne and Becker muscular dystrophy. The overarching objective was to inform a patient/family foundation's interventions and policy and advocacy approaches. Results from a longitudinal study on mothers__ wellbeing support the need for systematic exploration of caregivers__ unmet support needs, especially those related to coping with DMD-related uncertainty and fear. Efforts to improve mothers__ adaptation should focus on fostering resilience and enhancing benefit finding. A study on treatment preferences and disease impact that used Best-Worst Scaling found that caregivers were willing to accept a serious or fatal risk when balanced with a non-curative treatment, even absent lifespan improvement. Parents__ most pressing worries were about symptom progression and access to medical care. The final qualitative studies highlight the complexity of clinical trial decision making, especially for rare, progressive pediatric disorders, where participants equated doing __nothing__ with doing harm. Parents developed intentions to participate in trials before the informed consent process. Parents__ decisions were strongly influenced by the anticipation of individual benefit. The adaptive optimism engendered by the availability of trial was highly valued by both parents and clinicians on trial teams. Show less
