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Publication

Interventions supporting cost conversations between patients and clinicians: A systematic review

(Blackwell Publishing Ltd, 2021-05-01)

Barrera F.J.

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PONCE PONTE, OSCAR JOSUE

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Espinoza N.R.

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Alvarez-Villalobos N.A.

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Zuñiga-Hernández J.A.

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Prokop L.J.

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Gionfriddo M.R.

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Rodriguez-Gutierrez R.

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Brito J.P.

Background and Aim: Discussing cost during medical encounters may decrease the financial impact of medical care on patients and align their treatment plans with their financial capacities. We aimed to examine which interventions exist and quantify their effectiveness to support cost conversations. Methods: Several databases were queried (Embase; Ovid MEDLINE(R); Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; the Cochrane databases; and Scopus) from their inception until January 31, 2020 using terms such as “clinician*”, “patient*”, “cost*”, and “conversation*”. Eligibility assessment, data extraction and risk of bias assessment were performed independently and in duplicate. We extracted study setting, design, intervention characteristics and outcomes related to patients, clinicians and quality metrics. Results: We identified four studies (1327 patients) meeting our inclusion criteria. All studies were non-randomised and conducted in the United States. Three were performed in a primary care setting and the fourth in an oncology. Two studies used decision aids that included cost information; one used a training session for health care staff about cost conversations, and the other directly delivered information regarding cost conversations to patients. All interventions increased cost-conversation frequency. There was no effect on out-of-pocket costs, satisfaction, medication adherence or understanding of costs of care. Conclusion: The body of evidence is small and comprised of studies at high risk of bias. However, an increase in the frequency of cost conversations is consistent. Studies with higher quality are needed to ascertain the effects of these interventions on the acceptability, frequency and quality of cost conversations.

Publication

Toxic effect of Annona muricata seed extracts potentiated with dimethyl sulfoxide on IV larvae and pupae of Aedes aegypti

( 2020-05-25)

Bobadilla M.C.B.

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Castro S.M.R.

The objective of this study was to demonstrate that active ingredients of Annona muricata seeds can be enhanced as a result of mixture of both ethanolic extract of A. muricata seeds and Dimethylsulfoxide (EE-DMSO). Percentage mortalities at 6, 12, 24 and 48 hours on fourth instar larvae and pupae of Aedes aegypti were calculated in order to compare bioactivities of aqueous (AE), ethanolic extracts (EE) and EE-DMSO under laboratory and simulated field conditions. Results showed larval mortality concentration- and time-dependent, and knock-down responses in pupae. In laboratory, AE and EE exerted 100% larval mortality at 5 mg.L-1 after 24 hours (LC50= 46.16 and 19.28 mg.L-1). Conversely, EE-DMSO showed between 62 – 100% mortality at 0.5 mg.L-1 for over 6 hours (LC50= 20.33 mg.L-1). Pupicidal effects in AE and EE revealed 100% mortality at 24 hours employing all concentrations, except in EE-DMSO which commenced when individuals were exposed between 6 and 12 hours. In simulated field, AE and EE provoked 100% larval mortality at 24 hours (16.91 y 21.21 mg.L-1) while pupal mortality at 12 hours (20.44 y 23.03 mg.L-1). Percentage mortality of pupae was 100% using EE-DMSO even before 6 hours. Comparative toxic effects of laboratory and simulated-field systems have shown to maintain a similar pattern of larval mortality and more sensitive responses in pupae. Accordingly, larval and pupal mortality responses of A. aegypti were enhanced with the use of EE-DMSO and active ingredients of A. muricata seeds under laboratory and simulated field conditions.

Publication

Towards an efficient genetic algorithm optimizer for sequential projection pursuit

( 2014-01-10)

Espezua S.

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Villanueva E.

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Maciel C.

Sequential projection pursuit (SPP) is a useful tool for revealing interesting structures hidden in high-dimensional data. SPP constructs sequentially the bases of a low-dimensional space where the projected data evidence such structures. Genetic algorithms (GAs) are promising finders of these bases, but their performance is determined by the choice of the crossover operator. Until now it is not clear which operator is more suitable for SPP. In this paper we compare the performance of eight crossover operators: three available in literature (arithmetic, single-point and multi-point) and five newly proposed here (two hyperconic, two fitness-biased and one extension of arithmetic crossover). The results on five benchmark datasets showed that the proposed hyperconic operators have the best performance in finding high-fitness projections. The performance of a canonical GA with one of these hyperconic operators was compared against two representative SPP optimizers, the PSO and the RSSA algorithms. We found that our GA with the hyperconic operator tends to find better solutions than the other methods at different numbers of fitness computations. These results suggest that the optimization of SPP can be improved with GAs by taking advantage of the exploratory capabilities of the proposed hyperconic operators. © 2013 Elsevier B.V.