There are also important limitations of our study. Firstly, the second opinion physicians (physiatrists and orthopaedic surgeons) are salaried employees of HIAE and therefore may have an inherent bias towards justifying their importance by disputing private practice diagnoses and by saving HIAE money recommending against surgery. However, we think this is unlikely to account for the large observed discrepancy in diagnoses and treatment recommendations between first and second opinions. We did not record the time interval between the first and second opinions and it is therefore possible that for some patients, differences of opinion regarding surgery may be explained by improvement in clinical status over time. Pa- tients who were referred to HIAE had an existing relation- ship with their original spine surgeon and more than half chose not to have treatment at HIAE. We were unable to obtain follow up data for these patients and it is therefore possible that their outcomes differed systematically from patients who chose to have treatment at HIAE. We did not collect data regarding the duration of symptoms or concurrent management and these might be important confounders.
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Our institutional review board (The University of Calgary Conjoint Health Research Ethics Board) ap- proved the retrospective review of patient data for this study, and waived the requirement for informed consent. All cases (n = 94) of biopsy proven or clinic- ally suspected head and neck cancer presenting to our academic tertiary referral center with outside computed tomography (CT) or magnetic resonance (MR) imaging during the 2010 calendar year were retrospectively identified from our institutional head and neck cancer database (Table 1). As part of our routine practice, a fellowship-trained academic neu- roradiologist with expertise in head and neck imaging and three years of post-fellowship experience had is- sued a formal second opinion report in all cases. Hardcopies of the original and second opinion re- ports were collected, randomized, and distributed to three reviewers: a fellowship-trained academic head and neck surgeon with 20 years of post-fellowship experience, an otolaryngology-head and neck surgery resident with four years of residency experience, and a fellowship-trained academic neuroradiologist with 15 years of post-fellowship experience (a different neuroradiologist than the one who had issued the second opinion reports).
This study is unique in exploring the relation between the utilization of SO in the private system vs the public system. Previous studies did not look into the reasons for preferring a private physician over a public one for a SO. This study has several limitations. First, our de- finition of a SO as ‘visiting another specialist, in the same specialty, in order to get a SO on the same medical problem during the past 12 months (excluding visits to family physicians)’ does not capture all cases of SO. For example, patients may seek a SO on the same episode from specialists in different clinical domains (e.g., seeking advice about back pain from both an orthopedic surgeon and a neurologist). We chose this definition after thorough methodological considerations, to avoid misinterpretation of the question by patients. Second, as Table 4 Perceived outcomes of getting a second opinion in the private vs. the public system (n = 339 respondents)
information written in lay language, and formal or informal second opinions. 6 However, they can also spread disempowering false news and perpetuate existing hierarchies and power structures, as in this case, in which social media provided yet another forum in which physicians could exercise their professional privilege. Given the double-edged sword, health care providers should treat this new communication tool as they treat old tools: with caution and self-awareness. The fact that the request for a second opinion comes from another physician does not obviate the ethical burden on the responding physician.
The tension between public and private medicine is evident in the current struggle over the existence and quality of public health care in Israel as expressed in the recent physicians’ and nurses’ strikes as well as in the Ministry of Health goals to reduce health disparities in Israel. For example, the provision of private medicine in public hospitals in Israel has been a subject of a major debate [31-33]. According to the physicians interviewed, they think that patients who seek second opinions do so in the private sector. Getting a private second opinion apparently has an element of a premium product, with increased individual attention, shorter waiting time, and greater privacy, that is absent from the public system. The physicians interviewed perceived that patients prefer a private second opinion because they believe that “pri- vate” physicians are superior to “public” physicians, and likewise, they prefer to choose a consultant by them- selves and to have “personal time” dedicated exclusively to them. This is probably one of the reasons for the ten- dency of patients to attribute greater value to the second rather than to the first opinion [34-36]. Getting a second opinion in the private medical sector also allows patient access to high-ranking professors who, although they serve as department chairs in the public health system,
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Second opinions are used in medicine in order to make better-informed decisions. Only a few studies have examined patient-initiated second opinions, and even fewer have examined it in the context of acute hospitalization. It is not clear whether patients and families are aware of this right and how often they exercise it during acute hospitalization. The objective of this paper is to identify factors associated with the awareness and utilization of patient-initiated second opinions. A survey was conducted among 92 neurosurgical patients who completed a questionnaire that included information regarding: awareness of second opinion consultations, reasons for not seeking a second opinion, satisfaction from the second opinion and sharing the results of the second opinion with the first physician. Multivariate Logistic Regression analysis was performed to identify potential confounders associated with awareness and seeking a second opinion. Findings revealed that 79% percent of the participants were aware of their right to receive a second opinion; however, only 31% opted to receive a second opinion before/during the hospitalization. Fifty-eight percent received a second opinion related to previous medical conditions. Fifty-four percent did not inform the first physician about the results. The Logistic Regression showed that health insurance, education, religiosity and gender predicted awareness and utilization of second opinions. Current findings indicate that although patients are aware of their right to a second opinion and many have used it in the past, they rarely use it during acute hospitalization. Encouraging health
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This review outlines the use of telemedicine as an impor- tant cost-effective tool providing at least the same quality of medical care as face-to-face consultation in numerous medical fields. It allows rapid consultation among spe- cialists, and erases geographic distance. Telemedicine opens new horizons for medical consultation, increases benefits for patients, and allows rapid exchange of infor- mation and techniques. Information and communication technology provides medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. For this reason, in terms of costs and benefits, private and public health institutions need such a network to optimize their resources. The use of telemedicine opens new perspec- tives for the growing number of patients seeking a medi- cal second opinion for their pathology, 84,85 since they can
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With regard to border management, the premise is that security must start at the point of origin, rather than at the point of destination. This assumption has been indirectly applied in North America in cases such as the U.S. meat inspectors that routinely visit Canadian packing plants or the U.S. agricultural inspectors posted at Mexican avocado orchards. The second point develops the idea of a strong defence for all modes of entry into the perimeter (NAFTA area), considering four aspects: a) intelligence sharing is a precursor of everything else; b) NAFTA partners should seek agreement on circumstances that justify electronic surveillance of suspects within the common frontier; c) NAFTA partners should define circumstances when a NAFTA arrest warrant can be issued to detain a suspect anywhere within the common frontier; and c) NAFTA coast guard services need to enhance their cooperation.
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None of the women interviewed were in their first trimester of pregnancy. Due to the sampling technique employed, it was observed by the authors that the women approached to take part in the study who were in their first trimester of pregnancy did not want to be interviewed until they had reached the second trimester. This is understandable due to the increased risks of pregnancy loss in the first 12 weeks (first trimester). However, since the first trimester is a particularly worrying time for pregnant women and a time when symptoms such as morning sickness are often most persistent, it would be interesting for research to gain an insight of how women may change their online information or health searching during this period. No longer helping, saturation, and feeling reassured where the main reasons why women stopped their online pregnancy-related searches. Women in the study felt confident they could navigate through the mass of data and there was an element of knowing when to stop searching. However, more research is needed to dig deeper and understand how pregnant women, and indeed other people seeking health information online, evaluate the quality of information sourced in order to gain a more complete insight into what constitutes skillful surfing.
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This last fact leads to our second criticism of the Advisory Council Opinion: since the Convention drafters themselves employed the substance- procedure distinction in determining the proper scope of the CISG, where does the Council come by the authority to declare that distinction is not a proper tool of analysis because it is “outdated and unproductive”? The Advisory Council is, quite obviously, not an “international legislature”; unlike those who drafted the Convention and utilized the substance-procedure distinction, the Council is comprised merely of self-appointed representatives of the CISG scholarly community. It is certainly a distinguished group of scholars, but organizing themselves into a (private) body gives their opinions no more inherent authority concerning the meaning of the CISG than the opinions of other scholars: Advisory Council opinions have authority only insofar as they present a convincing analysis, and where those opinions depart from the intention of those who have actual law-making authority—as clearly is the case with regard to the substance-procedure distinction—the Council’s opinions have no authority whatsoever. The Advisory Council is welcome to think (and opine) that the substance procedure distinction is “outdated and unproductive,” but the Council has not been authorized to excise the distinction from scholarly Convention analysis when the drafters in fact themselves used that distinction to explain what they thought was the proper scope of the CISG.
One of the scenarios is US intervention. Currently, the US military is overstretched and any military intervention can be perilous due to the certain characteristics of Iran. Likewise, the international community would hardly support such an enterprise. The second scenario points to the direction of the diplomatic effort and recent offer of the EU-3+3. This makes the current EU- 3 approach to dealing with Iran the most feasible scenario. Along these lines, William Luers, Thomas R. Pickering and Jim Walsh have also proposed a solution close to the reviewed package of 2006. This initiative states that the US and its allies should propose turning Iran’s national enrichment efforts into a multinational program. Under this approach, the Iranian government would agree to allow two or more additional governments (for example, France and Germany) to participate in the management and operation of activities in Iran. In exchange, Iran would be able to jointly own and operate an enrichment facility without facing international sanctions and enjoy a variety of other benefits such as membership into WTO, increased trade with Europe, access to equipment for its aviation and energy industries, and perhaps normalized relations with the United States. 37 In this regard, the EU-3+3 must be clear about the incentives offered to Iran,
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This paper presents a system to summarize a Microblog post and its responses with the goal to provide readers a more constructive and concise set of information for efficient digestion. We introduce a novel two-phase summarization scheme. In the first phase, the post plus its responses are classified in- to four categories based on the intention, interrogation, sharing, discussion and chat. For each type of post, in the second phase, we exploit different strategies, including opinion analysis, response pair identifica- tion, and response relevancy detection, to summarize and highlight critical informa- tion to display. This system provides an al- ternative thinking about machine- summarization: by utilizing AI approaches, computers are capable of constructing dee- per and more user-friendly abstraction.
Assessing the link between policy-making and public opinion has been a major concern of representation research since Robert Dahl’s famous notion that a key characteristic of democracy is a “continuing responsiveness of the government to the preferences of its citizens” (1971: 1-2). A large body of literature from American and comparative political science has investigated the extent and conditions under which a variety of elected ‘policy-makers’– from presidents, over parliamentarians, to judges – react to the ups and downs in public sentiment when they design, negotiate, vote on, and interpret policies. In the majority, these studies could establish that policy-making in Western democracies is subject to substantial democratic responsiveness (e.g. Erikson et al. 2002; Page and Shapiro 1983; Stimson et al. 1995; Hakhverdian 2010, 2012; Hobolt and Klemmensen 2008; Soroka and Wlezien 2010; Wlezien and Soroka 2012; Wlezien 1995). However, some recent studies have become more cautious with generalised claims and stressed policy-makers ability to manipulate public opinion (e.g. Jacobs and Shapiro 2000), the perils of ‘over- responsiveness’ (Lax and Phillips 2012) as well as the stratification of responsiveness according to people’s income (Gilens 2012).
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Ultimately, while negative perceptions of the U.S. historically do not have deep roots in Russian culture (Shlapentoch, 2011), they still can be triggered by Russian domestic and foreign policies. In fact, dramatic shifts in public opinion regarding America have occurred over time. For example, in 1997 only 18% of Russians had negative perceptions of America while the number of Russians disliking America increased to 54% in 1999 (Levada Center, 2016). The Russian 1998 economic crisis and NATO’s invasion to Yugoslavia happened between these two public opinion polls. In 2009 and 2010, with the “reset” of American- Russian relationships, the number of Russians who negatively perceived America went down to 27% (Levada center, 2016). Starting from the end of 2013, Russian anti-Americanism gets stronger, and it reaches its peak in 2015 with 81% of people having negative perceptions of the U.S. In the next section, I describe possible triggers that could cause the last shift in public opinion.
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The word’s sentiment score is fixed in Opinion PageRank. This may encounter problem when the sentiment score definition is not suitable for the specific question. We propose another opin- ion sentence ranking model based on the popular graph ranking algorithm HITS (Kleinberg, 1999). This model can dynamically learn the word senti- ment score towards a specific question. HITS al- gorithm distinguishes the hubs and authorities in the objects. A hub object has links to many au- thorities, and an authority object has high-quality content and there are many hubs linking to it. The hub scores and authority scores are computed in a recursive way. Our proposed opinion HITS algo- rithm contains three layers. The upper level con- tains all the sentiment words from a lexicon, which represent their opinion information. The lower level contains all the words, which represent their topic information. The middle level contains all the opinion sentences to be ranked. We consider both the opinion layer and topic layer as hubs and the sentences as authorities. Figure 2 gives the bi- partite graph representation, where the upper opin- ion layer is merged with lower topic layer together as the hubs, and the middle sentence layer is con- sidered as the authority.
We present an end-to-end pipeline including a user interface for the production of word- level annotations for an opinion-mining task in the information technology (IT) domain. Our pre-annotation pipeline selects candidate sentences for annotation using results from a small amount of trained annotation to bias the random selection over a large corpus. Our user interface reduces the need for the user to understand the “meaning” of opinion in our domain context, which is related to commu- nity reaction. It acts as a preliminary buffer against low-quality annotators. Finally, our post-annotation pipeline aggregates responses and applies a more aggressive quality filter. We present positive results using two differ- ent evaluation philosophies and discuss how our design decisions enabled the collection of high-quality annotations under subjective and fine-grained conditions.
An advantage of this study is its low drop- out rate, as the response rate affects the validity of the study (Hasson, Keeney, & McKenna, 2000). Of initially 19 experts who agreed to participate in the study only 2 dropped out in the first round. In the second round there were even no drop outs. This is consistent with evidence which can be found about the validity of Delphi studies. The low drop- out rate is reported as a main advantage of Delphi studies (Okoli & Pawlowski, 2004). The low drop- out rate indicates that the motivation of the participants was obviously quite high. This may be a result of the sampling method, the gate keeping of the expert group child & youth of Zuyd University apparently facilitated the search for motivated and knowledgeable experts. Concerning the sample it is worth mentioning that the various disciplines were distributed quite evenly. Hence, it was possible to analyse data stratified into these groups, with the exception of the ambulant coach, who was the only participant of this discipline.
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There are three main types of SO: the first one reflects the patient’s desire to confirm the best diagnosis, treat- ment, or prognosis suggested by his first physician . The second type, initiated by the physician, who is look- ing for the advice of a second specialist. The third type, related to SO programs usually imposed, on patients and doctors alike, by third party insurers as a cost contain- ment measure (often referred to as prior authorization). SO programs were first introduced in the US in the 1970s by insurance companies as a pre-authorization tool before elective surgery. There are major differences among countries in health policy, access and payment mechanisms for SOs. Some states in the US (e.g., Florida, Indiana, Louisiana, Missouri, New Hampshire and New York) have passed laws in the 1990s to ensure the patient right for a SO . Some plans in the US require a referral from the primary care physician, and require seeing an in- network physician . In Canada, there is no mandatory SO requirement for surgery . In some other countries in Europe it is not a formal right. For example, in the UK, patients do not have a legal right to a SO, although a healthcare professional will rarely refuse to refer them for one .
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The researchers used descriptive analytical method, which is known as the way in research dealing with the events, phenomena, and practices are available for study and measurement as it is without any intervention of its processes, but researchers can interact with to describe and analyzes. This approach considered to be the most appropriate to achieve the objectives of this study from point of views of research population. A questionnaire is designed for data collection based on review of previous literature, studies, interviews and discussions with experienced clients and employees. The questionnaire is divided into two parts. The first part covered the five questions about the demographic information while the second part investigates the quality of banking services. The study population was chosen randomly from employees of different sectors of activities in the city of Jeddah such as banks, petrochemical companies, investment firms, educational institutions, government agencies and telecommunication firms. For easy filling of questioner and for reaching to a maximum number of respondents; the researchers used electronic copies that were distributed through emails, websites and social communications tools. The researchers received 192 questionnaires where 167 were found usable for analysis.
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• Finally, to complete the evaluation process and unlock all the game restrictions, the player was asked to fill a questionnaire composed by 15 questions. Different aspects, important for assessing the impact of the approach, were considered: usability of the user interface, interest and motivation to play, intuitiveness of the game, players’ ful- filment with the available features, and will to recommend the game to other play- ers. The majority of the questions are linear scaled from one to five, while a few are based on multiple choice and checkbox answers and others are open answers regard- ing some more explicit content and players’ opinion. The main objective of these last questions was to collect opinions on the main usability drawbacks and most success- ful functionalities as well as on new functionalities that the users would like to have included. All the questions are available on Table 3.
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