The Syrophoenician Woman

Matthew 15:21-28

To Dance Again

Exodus 15:1-11,20-21

Five Strong Women Charged with

Exodus

Exploring the relationship between two health state classification systems and happiness using a large patient data set

The economic evaluation of health care technologies employs a standard economic approach based on preferences to provide utility information. This paper investigates an alternative approach that uses happiness to weight the health states of two preference-based measures (EQ-5D and SF-6D) in a follow-up of a large hospital patient sample (N=15,184). Logit models relating the health state classifications of these two measures to happiness suggests a different weighting across dimensions to that from preference elicitation techniques such as time trade-off. While mental health (depression and anxiety), vitality and social functioning were found to have a large significant association to a patient’s own happiness assessment, pain was less so and physical health had none. The implications of these results for health policy are discussed

Using Rasch analysis to form plausible health states amenable to valuation: the development of CORE-6D from CORE-OM in order to elicit preferences for common mental health problems

Purpose: To describe a new approach for deriving a preference-based index from a condition specific measure that uses Rasch analysis to develop health states. Methods: CORE-OM is a 34-item instrument monitoring clinical outcomes of people with common mental health problems. CORE-OM is characterised by high correlation across its domains. Rasch analysis was used to reduce the number of items and response levels in order to produce a set of unidimensionally-behaving items, and to generate a credible set of health states corresponding to different levels of symptom severity using the Rasch item threshold map. Results: The proposed methodology resulted in the development of CORE-6D, a 2-dimensional health state description system consisting of a unidimensionally-behaving 5-item emotional component and a physical symptom item. Inspection of the Rasch item threshold map of the emotional component helped identify a set of 11 plausible health states, which, combined with the physical symptom item levels, will be used for the valuation of the instrument, resulting in the development of a preference-based index. Conclusions: This is a useful new approach to develop preference-based measures where the domains of a measure are characterised by high correlation. The CORE-6D preference-based index will enable calculation of Quality Adjusted Life Years in people with common mental health problems

Efficiency, equity, and NICE clinical guidelines

The stated purpose of clinical guidelines from the United Kingdom's National Institute for Clinical Excellence (NICE) is to "help healthcare professionals and patients make the right decisions about healthcare in specific clinical circumstances." However, what constitutes "the right decisions" depends on your point of view. For individual patients the right decision is that which maximises their wellbeing, and this is properly the concern of the clinician. Yet in resource constrained healthcare systems this will not always coincide with the right decisions for patients in general or society as a whole, thereby leading to some understandable tensions. NICE is a national policy making body whose responsibility is clearly broader than the individual patient. This wider viewpoint is reflected in NICE's technology appraisals by the central role afforded to cost effectiveness. We argue that the methods currently used by the NICE clinical guideline programme confuse these two viewpoints

Evolution of the SPS Power Converter Controls towards the LHC Era

By the end of the nineties, the power converter control system (Mugef) of the CERN proton accelerator (SPS) had undergone a complete modernization. This resulted in newly developed hardware for function generation, measurement and I/O in a VME environment, under the LynxOS real-time operating system. This has provided a platform on which extensions can be developed for future operation in the Large Hadron Collider (LHC) era. This paper describes some of these extensions, in particular a fast Surveillance and Interlock system for monitoring the power converter output currents. This will be mandatory for the safe operation of the SPS transfer lines TI2 & TI8 to LHC and for similar applications in the future. The strategies employed to cope with various failure modes of the power converters and the timely activation of the interlock are outlined. The new SPS controls infrastructure now under development, will give rise to new modes of operation for the Mugef systems. Integration with the proposed middleware must be undertaken in a structured evolution, while retaining compatibility with the current usage.Comment: Paper is 3 pages for ICAPEPCS 01 27 - 30 November 2001 San Jose. John C L Brazier is the principal author and a consultant to CERN (hence the CERN Email address but UK Organisation

Mapping Functions in Health-Related Quality of Life: Mapping From Two Cancer-Specific Health-Related Quality-of-Life Instruments to EQ-5D-3L.

BACKGROUND: Clinical trials in cancer frequently include cancer-specific measures of health but not preference-based measures such as the EQ-5D that are suitable for economic evaluation. Mapping functions have been developed to predict EQ-5D values from these measures, but there is considerable uncertainty about the most appropriate model to use, and many existing models are poor at predicting EQ-5D values. This study aims to investigate a range of potential models to develop mapping functions from 2 widely used cancer-specific measures (FACT-G and EORTC-QLQ-C30) and to identify the best model. METHODS: Mapping models are fitted to predict EQ-5D-3L values using ordinary least squares (OLS), tobit, 2-part models, splining, and to EQ-5D item-level responses using response mapping from the FACT-G and QLQ-C30. A variety of model specifications are estimated. Model performance and predictive ability are compared. Analysis is based on 530 patients with various cancers for the FACT-G and 771 patients with multiple myeloma, breast cancer, and lung cancer for the QLQ-C30. RESULTS: For FACT-G, OLS models most accurately predict mean EQ-5D values with the best predicting model using FACT-G items with similar results using tobit. Response mapping has low predictive ability. In contrast, for the QLQ-C30, response mapping has the most accurate predictions using QLQ-C30 dimensions. The QLQ-C30 has better predicted EQ-5D values across the range of possible values; however, few respondents in the FACT-G data set have low EQ-5D values, which reduces the accuracy at the severe end. CONCLUSIONS: OLS and tobit mapping functions perform well for both instruments. Response mapping gives the best model predictions for QLQ-C30. The generalizability of the FACT-G mapping function is limited to populations in moderate to good health

A Case Study of the Population Ecology of a Topmouth Gudgeon (Pseudorasbora parva) Population in the UK and the Implication for Native Fish Communities

1. The topmouth gudgeon Pseudorasbora parva is a small Asian cyprinid species that has proved invasive throughout many European countries. Following an initial introduction into the wild in 1996, the species is now proving invasive in the UK, with at least 25 infested waters in England and Wales, of which 10 are known to have direct connection to a major river catchment. 2. To demonstrate the threat of P. parva to fisheries in the UK, a case study is presented on a lake located in the Lake District of England where the species was introduced in 2000. The species rapidly established a breeding population that, by 2003, was the dominant species in size classes <70 mm. In 2004, they were the only species in the lake that produced young-of-the-year. 3. Individual P. parva adopted the reproductive tactics of early maturity, multiple spawning, male dominance and male nest guarding; sexual dimorphism was manifested in larger body size of males. These traits were in contrast to the resident, native species of the lake, including roach Rutilus rutilus and gudgeon Gobio gobio, which adopted traits of later maturity and single spawning. 4. This case study, therefore, revealed relatively rapid establishment of a P. parva population, their subsequent numerical dominance of the fish community, and the impediment of the recruitment of native fish. The implications for UK fisheries are concerning: should P. parva continue to disperse and individuals adopt similar traits as those in this case study, there may be few waters immune from their invasion, numerical dominance and subsequent impacts