The relationship between EQ-5D, HAQ and pain in patients with rheumatoid arthritis: further validation and development of the limited dependent variable, mixture model approach

Objective To provide robust estimates of EQ-5D as a function of the Health Assessment Questionnaire (HAQ) and pain in patients with rheumatoid arthritis. Method Repeated observations of patients diagnosed with RA in a US observational cohort (n=100,398 observations) who provided data on HAQ, pain on a visual analogue scale and the EQ-5D questionnaire. We use a bespoke mixture modelling approach to appropriately reflect the characteristics of the EQ-5D instrument and compare this to results from linear regression. Results The addition of pain alongside HAQ as an explanatory variable substantially improves explanatory power. The preferred model is a four component mixture. Unlike the linear regression it exhibits very good fit to the data, does not suffer from problems of bias or predict values outside the feasible range. Conclusions It is appropriate to model the relationship between HAQ and EQ-5D but only if suitable statistical methods are applied. Linear models underestimate the QALY benefits, and therefore the cost effectiveness, of therapies. The bespoke mixture model approach outlined here overcomes this problem. The addition of pain as an explanatory variable greatly improves the estimates

A comparison of direct and indirect methods for the estimation of health utilities from clinical outcomes

Background: Analysts often need to estimate health state utility values as a function of other outcome measures. Utility values like EQ-5D have several unusual characteristics that make standard statistical methods inappropriate. We have developed a bespoke approach based on mixture models to directly estimate EQ-5D. An indirect method, “response mapping”, first estimates the level on each of the five dimensions of the EQ-5D descriptive system and then calculates the expected tariff score. These methods have never previously been compared. Methods: We use a large observational database of patients diagnosed with Rheumatoid Arthritis (n=100,398 observations). Direct estimation of UK EQ-5D scores as a function of Health Assessment Questionnaire (HAQ), pain and age was performed using a limited dependent variable mixture model. Indirect modelling was undertaken using a set of generalized ordered probit models with expected tariff scores calculated mathematically. Linear regression was reported for comparison purposes. Results: The linear model fits poorly, particularly at the extremes of the distribution. Both the bespoke mixture model and the generalized ordered probit approach offer improvements in fit over the entire range of EQ-5D. Mean average error is 10% and 5% lower compared to the linear model respectively. Root mean squared error is 3% and 2% lower. The mixture model demonstrates superior performance to the indirect method across almost the entire range of pain and HAQ. Limitations: There is limited data from patients in the most extreme HAQ health states. Conclusions: Modelling of EQ-5D from clinical measures is best performed directly using the bespoke mixture model. This substantially outperforms the indirect method in this example. Linear models are inappropriate, suffer from systematic bias and generate values outside the feasible range

Housing flexibility effects on rotor stability

Preliminary rotordynamic evaluations are performed with a housing stiffness assumption that is typically determined only after the hardware is built. In addressing rotor stability, a rigid housing assumption was shown to predict an instability at a lower spin speed than a comparable flexible housing analysis. This rigid housing assumption therefore provides a conservative estimate of the stability threshold speed. A flexible housing appears to act as an energy absorber and dissipated some of the destabilizing force. The fact that a flexible housing is usually asymmetric and considerably heavier than the rotor was related to this apparent increase in rotor stability. Rigid housing analysis is proposed as a valuable screening criteria and may save time and money in construction of elaborate housing finite element models for linear stability analyses

Synthesis of aromatic secondary diamines

A series of N-methyl substituted aromatic polyamides derived from the secondary aromatic diamines, 4,4'-bis(methylamino)diphenylmethane, 3,3'-bis(methylamino) diphenylmethane, 4,4'-bis(methylamino)benzophenone or 3,3'-bis(methylamino)benzophenone and isophthaloyl dichloride, terphthaloyl dichloride or 3,3'diphenylmethane dicarboxylic acid dichloride was prepared by high temperature solution polymerization in s-tetrachloroethane. Compared to analogous unsubstituted and partially N-methylated aromatic polyamides, the full N-methylated polyamides exhibited significantly lower glass transition temperatures, reduced crystallinity, improved thermal stability and good solubility in chlorinated solvents

The kinetic temperature in a damped Lyman-alpha absorption system in Q2206-199 - an example of the warm neutral medium

By comparing the widths of absorption lines from OI, SiII and FeII in the redshift z=2.076 single-component damped Lyman alpha absorption system in the spectrum of Q2206-199 we establish that these absorption lines arise in Warm Neutral Medium gas at ~12000 +/- 3000K. This is consistent with thermal equilibrium model estimates of ~ 8000K for the Warm Neutral Medium in galaxies, but not with the presence of a significant cold component. It is also consistent with, but not required by, the absence of CII* fine structure absorption in this system. Some possible implications concerning abundance estimates in narrow-line WNM absorbers are discussed.Comment: 9 pages, 3 figures. MNRAS accepte

Waiting for the Robert E. Lee / music by Louis F. Muir; words by Wolfe Gilbert

Cover: drawing of silhouette figures waiting on an incoming steamboat; Publisher: F. A. Mills (New York)https://egrove.olemiss.edu/sharris_c/1041/thumbnail.jp

Manny Jinny\u27s Jubilee / music by Lewis F. Muir; words by L. Wolfe Gilbert

Cover: drawing of a large crowd coming to visit Mammy Jinny, most of the crowd bears gifts: a chicken, a watermelon, flowers; photo inset of two Caucasians: Valeska Suratt and George Baldwin. (see 428); Publisher: F. A. Mills (New York)https://egrove.olemiss.edu/sharris_c/1053/thumbnail.jp

Take Me to that Swanee Shore / music by Lewis F. Muir; words by L. Wolfe Gilbert

Cover: a profile photo of a woman; photo inset of George Austin Moore; Publisher: F. A. Mills (New York)https://egrove.olemiss.edu/sharris_c/1046/thumbnail.jp