BACKGROUND: HIV molecular epidemiology (HIV ME) can support the early detection of emerging clusters of new HIV infections by combining HIV sequence data routinely obtained during the clinical treatment of people living with HIV with behavioral, geographic, and sociodemographic information. While information about emerging clusters promises to facilitate HIV prevention and treatment efforts, the use of this data also raises several ethical concerns. We sought to assess how those working on the frontlines of HIV ME, specifically public health practitioners (PHPs) and researchers, prioritized these issues.
METHODS: Ethical issues were identified through literature review, qualitative in-depth interviews, and stakeholder engagement. PHPs and researchers using HIV ME prioritized the issues using best-worst scaling (BWS). A balanced incomplete block design was used to generate 11 choice tasks each consisting of a sub-set of 5 ethical concerns. In each task, respondents were asked to assess the most and least concerning issue. Data were analyzed using conditional logit, with a Swait-Louviere test of poolability. Latent class analysis was then used to explore preference heterogeneity.
RESULTS: In total, 57 respondents completed the BWS experiment May-June 2023 with the Swait-Louviere test indicating that researchers and PHPs could be pooled (p = 0.512). Latent class analysis identified two classes, those highlighting \"Harms\" (n = 29) (prioritizing concerns about potential risk of legal prosecution, individual harm, and group stigma) and those highlighting \"Utility\" (n = 28) (prioritizing concerns about limited evidence, resource allocation, non-disclosure of data use for HIV ME, and the potential to infer the directionality of HIV transmission). There were no differences in the characteristics of members across classes.
CONCLUSIONS: The ethical issues of HIV ME vary in importance among stakeholders, reflecting different perspectives on the potential impact and usefulness of the data. Knowing these differences exist can directly inform the focus of future deliberations about the policies and practices of HIV ME in the United States.

The use of taboo words represents one of the most common and arguably universal linguistic behaviors, fulfilling a wide range of psychological and social functions. However, in the scientific literature, taboo language is poorly characterized, and how it is realized in different languages and populations remains largely unexplored. Here we provide a database of taboo words, collected from different linguistic communities (Study 1, N = 1046), along with their speaker-centered semantic characterization (Study 2, N = 455 for each of six rating dimensions), covering 13 languages and 17 countries from all five permanently inhabited continents. Our results show that, in all languages, taboo words are mainly characterized by extremely low valence and high arousal, and very low written frequency. However, a significant amount of cross-country variability in words\' tabooness and offensiveness proves the importance of community-specific sociocultural knowledge in the study of taboo language.

BACKGROUND: Shared decision-making (SDM) is a patient-centred approach to improve the quality of care. An essential requirement for the SDM process is to be fully aware of patient information needs.
OBJECTIVE: Our study aimed to assess patient information needs for new antidiabetic medications using the best-worst scaling (BWS) experiment.
METHODS: BWS tasks were developed according to a literature review and the focus group discussion. We used a balanced incomplete block design and blocking techniques to generate choice sets. The final BWS contains 11 attributes, with 6-choice scenarios in each block. The one-to-one, face-to-face BWS survey was conducted among type 2 diabetic patients in Jiangsu Province. Results were analyzed using count-based analysis and modelling approaches. We also conducted a subgroup analysis to observe preference heterogeneity.
RESULTS: Data from 539 patients were available for analysis. The most desired information domain was the comparative effectiveness of new antidiabetic medications. It consists of the incidence of macrovascular complications, the length of extended life years, changes in health-related quality of life, the incidence of microvascular complications, and the control of glycated haemoglobin. Of all the attributes, the incidence of macrovascular complications was the primary concern. Patients\' glycemic control and whether they had diabetes complications exerted a significant influence on their information needs.
CONCLUSIONS: Information on health benefits is of critical significance for diabetic patients. Patients have different information needs as their disease progresses. Personalized patient decision aids that integrate patient information needs and provide evidence of new antidiabetic medications are worthy of being established.
UNASSIGNED: Before data collection, a pilot survey was carried out among diabetic patients to provide feedback on the acceptability and intelligibility of the attributes.

Environmental crises, such as wildfires, can cause major losses of human life, infrastructure, biodiversity, and cultural values. In many such situations, incident controllers must make fateful choices about what to protect-and hence what to abandon. With an online representative survey of >2000 adult Australians, we investigated social attitudes to this dilemma. We used best-worst scaling to assess preferences across a set of 11 assets representing human life, infrastructure, biodiversity, and cultural values. Survey respondents overwhelmingly prioritized a single human life (best-worst score of 6647 out of possible score ranging from -10695 to 10695), even if that choice resulted in extinction of other species. Inanimate (replaceable) objects were accorded lowest priority (best-worst scores of -4655 for a shed and -3242 for a house). Among biodiversity assets, respondents prioritized protecting a population of the iconic koala (Phascolarctos cinereus) (best-worst score of 1913) ahead of preventing the extinction of a snail (score -329) and a plant species (-226). These results variably support current policy in that they emphasize the importance the community places on protection of human life, but results diverged from conventional practice in rating some biodiversity assets ahead of infrastructure. The preference for protecting a population of koalas ahead of action taken to prevent the extinction of an invertebrate and plant species corroborates previous research reporting biases in the way people value nature. If noncharismatic species are not to be treated as expendable, then the case for preventing their extinction needs to be better made to the community. Given the increasing global incidence of high-severity wildfires, further sampling of societal preferences among diverse asset types is needed to inform planning, policy, and practice relating to wildfire. Other preemptive targeted management actions (such as translocations) are needed to conserve biodiversity, especially noniconic species, likely to be imperiled by catastrophic events.
Valoración social de la biodiversidad en relación con otros tipos de activos en riesgo durante los incendios Resumen Las crisis ambientales, como los incendios, pueden causar pérdidas mayores de infraestructura, vida humana, biodiversidad y valores culturales. En muchas de estas situaciones, quienes controlan el incidente deben tomar decisiones fatídicas sobre qué proteger y, por lo tanto, qué abandonar. Aplicamos en línea una encuesta representativa a más de 2000 australianos adultos para investigar las actitudes sociales ante este dilema. Usamos la escala de mejor‐peor para valorar las preferencias en once activos que representaban la vida humana, infraestructura, biodiversidad y valores culturales. Los encuestados priorizaron de manera abrumadora la vida humana (puntaje de 6647 en la escala de mejor‐peor con un puntaje posible entre ‐10695 y 10695), incluso si esto implicaba la extinción de otras especies. Los objetos inanimados (reemplazables) fueron los de menor prioridad (puntaje de ‐4655 para una choza y ‐3242 para una casa). Entre los activos de biodiversidad, los encuestados priorizaron la protección de una población del icónico koala (Phascolarctos cinereus) (puntaje de 1913) por encima de la extinción de una especie de caracol (‐329) y una de planta (‐226). Estos resultados respaldan de forma variada la política actual pues resaltan la importancia que la comunidad le da a la protección de la vida humana, pero los resultados discreparon de la práctica convencional al puntear a algunos activos de la biodiversidad por encima de la infraestructura. La preferencia por proteger la población de koalas por encima de evitar la extinción de una especie invertebrada y una especie botánica corrobora las investigaciones anteriores que reportan un sesgo en la forma en la que la población valora la naturaleza. Si queremos que las especies carismáticas no sean tratadas como prescindibles, entonces se le debe plantear de mejor manera a la población el caso para prevenir su extinción. Con el aumento en la incidencia mundial de incendios de gravedad, se necesita un mayor muestreo de las preferencias sociales por los diferentes tipos de activos para guiar la planeación, políticas y prácticas en relación con los incendios. Se requieren otras acciones de manejo preventivo enfocado (como las reubicaciones) para conservar la biodiversidad con probabilidad de estar en peligro durante eventos catastróficos, especialmente las especies que no son icónicas.

BACKGROUND: Atopic dermatitis (AD)-a chronic inflammatory skin disease characterized by intense itching-can have a detrimental impact on quality of life (QoL). We report results of a quantitative assessment of pediatric patient, caregiver, and physician perceptions of AD burden in children and adolescents.
METHODS: Pediatric patients (aged 6-11 [children] or 12-17 [adolescents] years) with moderate-to-severe AD, their caregivers, and independent physicians were recruited in 13 countries. Caregivers and their children/adolescents completed an online survey about the impact of AD on 16 key items of patient QoL. Physicians completed surveys on their patients aged 6-11 and 12-17 years. Best-worst scaling was used to rank the importance of the QoL items.
RESULTS: Overall, 1447 children/adolescents with moderate-to-severe AD (aged 6-11 years: 701; 12-17 years: 746), 1447 caregivers, and 1092 physicians participated. Patients and caregivers in both age groups ranked disturbed sleep as the most important QoL item, followed by feeling ashamed because of AD. Independent physicians ranked feeling ashamed because of AD as the most important QoL item for both age groups, followed by disturbed sleep for those aged 6-11 years and being singled out for those aged 12-17 years. The relative importance of the 16 QoL items to patients was strongly aligned between patients in both age groups and their caregivers, but somewhat less so between patients and physicians. Between-country differences were more apparent in physician- versus patient-/caregiver-reported results.
CONCLUSIONS: The most burdensome QoL items were impact of AD on sleep and feeling ashamed. Caregivers and physicians correctly identified the QoL items most burdensome to patients. However, patient and caregiver perceptions were generally more closely aligned than patient and physician perceptions. Between-country differences in perceptions (particularly for physicians) were observed, probably due to multifactorial reasons, necessitating further evaluation. Video Abstract (MP4 42,877 kb) INFOGRAPHIC.

Honey production is currently experiencing a great deal of media attention, with many positive attributes of this hive product emerging. The purpose of the study is to investigate consumer preference and what key information informs people\'s purchase of honey. This study is based on consumer surveys and experimental evaluation. First of all, the relative importance assigned by consumers to 12 honey product attributes was defined by using the best-worst scaling (BWS) methodology. Secondly, the latent class analysis (LCA) was used to identify different honey consumers based on preferences. The findings demonstrate that \"health aspects\" and \"organoleptic compound\" are the main categories of information that consumers tend to research. The sample segmentation defined four different consumer clusters: people who value health, sustainability, organic sourcing and quality. Additionally, socio-demographic characteristics such as age, education level and profession also played a part on consumer choice and the characterisation of each cluster. This study can contribute to fostering good nutrition and improving sustainability within communities.

BACKGROUND: Respondents in a health valuation study may have different sources of error (i.e., heteroskedasticity), tastes (differences in the relative effects of each attribute level), and scales (differences in the absolute effects of all attributes). Although prior studies have compared values by preference-elicitation tasks (e.g., paired comparison [PC] and best-worst scaling case 2 [BWS]), no study has yet controlled for heteroskedasticity and heterogeneity (taste and scale) simultaneously in health valuation.
METHODS: Preferences on EQ-5D-5L profiles were elicited from a random sample of 380 adults from the general population of the Netherlands, using 24 PC and 25 BWS case 2 tasks. To control for heteroskedasticity and heterogeneity (taste and scale) simultaneously, we estimated Dutch EQ-5D-5L values using conditional, heteroskedastic, and scale-adjusted latent class (SALC) logit models by maximum likelihood.
RESULTS: After controlling for heteroskedasticity, the PC and BWS values were highly correlated (Pearson\'s correlation: 0.9167, CI: 0.9109-0.9222) and largely agreed (Lin\'s concordance: 0.7658, CI: 0.7542-0.7769) on a pits scale. In terms of preference heterogeneity, some respondents (mostly young men) failed to account for any of the EQ-5D-5L attributes (i.e., garbage class), and others had a lower scale (59%; p-value: 0.123). Overall, the SALC model produced a consistent Dutch EQ-5D-5L value set on a pits scale, like the original study (Pearson\'s correlation:0.7295; Lin\'s concordance: 0.6904).
CONCLUSIONS: This paper shows the merits of simultaneously controlling for heteroskedasticity and heterogeneity in health valuation. In this case, the SALC model dispensed with a garbage class automatically and adjusted the scale for those who failed the PC dominant task. Future analysis may include more behavioral variables to better control heteroskedasticity and heterogeneity in health valuation.
CONCLUSIONS: The Dutch EQ-5D-5L values based on paired comparison [PC] and best-worst scaling [BWS] responses were highly correlated and largely agreed after controlling for heteroskedasticity. Controlling for taste and scale heterogeneity simultaneously enhanced the Dutch EQ-5D-5Lvalues by automatically dispensing with a garbage class and adjusting the scale for those who failed the dominant task. After controlling for heteroskedasticity and heterogeneity, this study produced Dutch EQ-5D-5L values on a pits scale moderately concordant with the original values.

BACKGROUND: Despite the increased demand for pharmacogenetic (PGx) testing to guide antidepressant use, little is known about how to implement testing in clinical practice. Best-worst scaling (BWS) is a stated preferences technique for determining the relative importance of alternative scenarios and is increasingly being used as a healthcare assessment tool, with potential applications in implementation research. We conducted a BWS experiment to evaluate the relative importance of implementation factors for PGx testing to guide antidepressant use.
METHODS: We surveyed 17 healthcare organizations that either had implemented or were in the process of implementing PGx testing for antidepressants. The survey included a BWS experiment to evaluate the relative importance of Consolidated Framework for Implementation Research (CFIR) constructs from the perspective of implementing sites.
RESULTS: Participating sites varied on their PGx testing platform and methods for returning recommendations to providers and patients, but they were consistent in ranking several CFIR constructs as most important for implementation: patient needs/resources, leadership engagement, intervention knowledge/beliefs, evidence strength and quality, and identification of champions.
CONCLUSIONS: This study demonstrates the feasibility of using choice experiments to systematically evaluate the relative importance of implementation determinants from the perspective of implementing organizations. BWS findings can inform other organizations interested in implementing PGx testing for mental health. Further, this study demonstrates the application of BWS to PGx, the findings of which may be used by other organizations to inform implementation of PGx testing for mental health disorders.

BACKGROUND: Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients\' experiences regarding the burden of PsA symptoms and disease impacts, and patients\' preferences for treatment.
METHODS: Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively.
RESULTS: Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate.
CONCLUSIONS: Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making.

OBJECTIVE: Policymakers must decide on interventions to control the pandemic. These decisions are driven by weighing the risks and benefits of various non-pharmaceutical intervention alternatives. Due to the nature of the pandemic, these decisions are not based on sufficient evidence regarding the effects, nor are decision-makers informed about the willingness of populations to accept the economic and health risks associated with different policy options. This empirical study seeks to reduce uncertainty by measuring population preferences for non-pharmaceutical interventions.
METHODS: An online-based discrete choice experiment (DCE) was conducted to elicit population preferences. Respondents were asked to choose between three pandemic scenarios with different interventions and impacts of the Corona pandemic. In addition, Best-worst scaling (BWS) was used to analyze the impact of the duration of individual interventions on people\'s acceptance. The marginal rate of substitution was applied to estimate willingness-to-accept (WTA) for each intervention and effect by risk of infection.
RESULTS: Data from 3006 respondents were included in the analysis. The DCE showed, economic effect of non-pharmaceutical measures had a large impact on choice decisions for or against specific lockdown scenarios. Individual income decreases had the most impact. Excess mortality and individual risk of infection were also important factors influencing choice decisions. Curfews, contact restrictions, facility closures, personal data transmissions, and mandatory masking in public had a lesser impact. However, significant standard deviations in the random parameter logit model (RPL) indicated heterogeneities in the study population. The BWS results showed that short-term restrictions were more likely to be accepted than long-term restrictions. According to WTA estimates, people would be willing to accept a greater risk of infection to avoid loss of income.
CONCLUSIONS: The results can be used to determine which consequences of pandemic measures would be more severe for the population. For example, the results show that citizens want to limit the decline in individual income during pandemic measures. Participation in preference studies can also inform citizens about potential tradeoffs that decision-makers face in current and future decisions during a pandemic. Knowledge of the population\'s preferences will help inform decisions that consider people\'s perspectives and expectations for the future. Survey results can inform decision-makers about the extent to which the population is willing to accept certain lockdown measures, such as curfews, contact restrictions, lockdowns, or mandatory masks.