***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patients with chronic health conditions often rate their quality of life ( QoL ) significantly higher than non- patients . One explanation for this discrepancy is that non- patients focus on the negative aspects of the onset of a condition , especially the early difficulties people face when they first experience a debilitating condition , without considering that patients can adapt to it over time . To test this hypothesis , we had 359 people perform person tradeoff ( PTO ) elicitations in an online survey  , varying whether the treatment programs under consideration saved the lives of patients ( a ) with pre-existing paraplegia ; or ( b ) who would experience new onset of paraplegia . Half of each group completed an " adaptation exercise " which encouraged them to consider their own ability to emotionally adapt to negative events in general and specifically to having paraplegia . The adaptation manipulation increased the value participants placed on pre-existing paraplegia ( p=0.03 ) and on new onset paraplegia ( p=0.05 ) , relative to saving healthy lives . Moreover , the adaptation exercise dramatically reduced the differences between evaluations of pre-existing and new onset paraplegia to values within 2 % of each other . Our findings suggest that asking non- patients to do an adaptation exercise before giving QoL ratings may help close the gap in ratings between patients and citizen non- patients Objective : To correlate time to loss of ambulation ( LoA ) and different truncating DMD gene mutations in a large , prospect i ve natural history study of Duchenne muscular dystrophy ( DMD ) , with particular attention to mutations amenable to emerging molecular treatments . Methods : We analyzed data from the Cooperative International Neuromuscular Research Group Duchenne Natural History Study for participants with DMD single- or multi-exon deletions or duplications with defined exon boundaries ( n = 186 ) , or small mutations identified by sequencing ( n = 26 , including 16 nonsense point mutations ) . We performed a time-to-event analysis of LoA , a strong indicator of overall disease severity , adjusting for glucocorticoid treatment and genetic modifiers . Results : Participants with deletions amenable to skipping of exon 44 had later LoA ( median 14.8 years , hazard ratio 0.31 , 95 % confidence interval 0.14–0.69 , p = 0.004 ) . Age at LoA did not differ significantly in participants with deletions amenable to exon 45 , 51 , and 53 skipping , duplications , and small rearrangements . Nonsense mutation DMD also showed a typical median age at LoA ( 11.1 years ) , with a few outliers ( ambulatory around or after 16 years of age ) carrying stop codons within in-frame exons , more often situated in the rod domain . Conclusions : As exon 44 skipping – amenable DMD has a later LoA , mutation-specific r and omization and selection of placebo groups are essential for the success of clinical trials BACKGROUND Glucocorticoid treatment is recommended as a st and ard of care in Duchenne muscular dystrophy ; however , few studies have assessed the long-term benefits of this treatment . We examined the long-term effects of glucocorticoids on milestone-related disease progression across the lifespan and survival in patients with Duchenne muscular dystrophy . METHODS For this prospect i ve cohort study , we enrolled male patients aged 2 - 28 years with Duchenne muscular dystrophy at 20 centres in nine countries . Patients were followed up for 10 years . We compared no glucocorticoid treatment or cumulative treatment duration of less than 1 month versus treatment of 1 year or longer with regard to progression of nine disease-related and clinical ly meaningful mobility and upper limb milestones . We used Kaplan-Meier analyses to compare glucocorticoid treatment groups for time to st and from supine of 5 s or longer and 10 s or longer , and loss of st and from supine , four-stair climb , ambulation , full overhead reach , h and -to-mouth function , and h and function . Risk of death was also assessed . This study is registered with Clinical Trials.gov , number NCT00468832 . FINDINGS 440 patients were enrolled during two recruitment periods ( 2006 - 09 and 2012 - 16 ) . Time to all disease progression milestone events was significantly longer in patients treated with glucocorticoids for 1 year or longer than in patients treated for less than 1 month or never treated ( log-rank p<0·0001 ) . Glucocorticoid treatment for 1 year or longer was associated with increased median age at loss of mobility milestones by 2·1 - 4·4 years and upper limb milestones by 2·8 - 8·0 years compared with treatment for less than 1 month . Deflazacort was associated with increased median age at loss of three milestones by 2·1 - 2·7 years in comparison with prednisone or prednisolone ( log-rank p<0·012 ) . 45 patients died during the 10-year follow-up . 39 ( 87 % ) of these deaths were attributable to Duchenne-related causes in patients with known duration of glucocorticoids usage . 28 ( 9 % ) deaths occurred in 311 patients treated with glucocorticoids for 1 year or longer compared with 11 ( 19 % ) deaths in 58 patients with no history of glucocorticoid use ( odds ratio 0·47 , 95 % CI 0·22 - 1·00 ; p=0·0501 ) . INTERPRETATION In patients with Duchenne muscular dystrophy , glucocorticoid treatment is associated with reduced risk of losing clinical ly meaningful mobility and upper limb disease progression milestones across the lifespan as well as reduced risk of death . FUNDING US Department of Education/National Institute on Disability and Rehabilitation Research ; US Department of Defense ; National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases ; and Parent Project Muscular Dystrophy 
    Output:
    
Variability in utilities was observed based on instrument , respondent type , and country .
Utility estimates for health states within non-ambulatory DMD are under reported ; nor were utilities for DMD-related health states such as scoliosis or preserved upper limb function identified .
Published health state utilities document the substantial HRQoL impacts of DMD , particularly with disease progression .