Evidence of preference construction in a comparison of variants of the standard gamble method

An increasingly important debate has emerged around the extent to which techniques such as the standard gamble, which is used, amongst other things, to value health states, actually serve to construct respondents' preferences rather than simply elicit them. According to standard theory, the variant used should have no bearing on the numbers elicited from respondents, i.e. procedural invariance should hold. This study addresses this debate by comparing two variants of standard gamble in the valuation of health states. It is a mixed methods study that combines a quantitative comparison with the probing of respondents in order to ascertain possible reasons for the differences that emerged. Significant differences were found between variants and, furthermore, there was evidence of an ordering effect. Respondents' responses to probing suggested that they were influenced by the method of elicitation

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

Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment

Background: NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. One of NICE’s main roles is to produce national guidance on the use of health technologies within the NHS. Despite the Institute’s recent efforts to clarify the way in which its Appraisal Committees reach their recommendations concerning the use of health technologies, there remains ambiguity about how cost-effectiveness evidence is interpreted alongside other considerations such as the degree of clinical need within the patient population, and the degree of uncertainty surrounding cost-effectiveness estimates. Objective: To explore whether the NICE takes account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services. Methods: A binary choice experiment was undertaken using NICE’s three Appraisal Committees. The experiment included five attributes: (1) Incremental cost-effectiveness (2) Degree of economic uncertainty (3) Age of the target population (4) Baseline health-related quality of life (5) Availability of other therapies A choice questionnaire detailing 18 scenarios was administered to NICE’s Appraisal Committees. For each scenario, respondents were asked to indicate whether they would recommend the intervention under consideration or not. The stated preference data obtained from respondents were analysed using a random effects logit regression model. Results: A response rate of 46% was obtained from the Appraisal Committees. The regression model suggests that increases in cost-effectiveness, economic uncertainty, and the availability of other therapies are associated with statistically significant reductions in the odds of adoption (p<0.05). The transition from a very low to a comparatively high level of health-related quality of life is also associated with a statistically significant reduction in the odds of a positive recommendation. Smaller changes in health-related quality of life, and the age of the target population are not associated with a statistically significant reduction in the odds of a positive recommendation. Analysis of revealed preference data indicates that the model is capable of distinguishing between those technologies which the Appraisal Committees would be highly likely to recommend, and those technologies which appear to be less attractive, although further external validation is warranted. Conclusion: The modelling suggests that cost-effectiveness, uncertainty and certain equity concerns influence the NICE Appraisal Committees’ recommendations on the use of health technologies. The modelling results appear to support Rawlins and Culyer’s notion of a probabilistic cost-effectiveness threshold approach; the "mythical" £30,000 per QALY gained threshold assumed within the literature is not supported by this stated preference modelling analysis

Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A binary choice experiment

Background NICE is an independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England and Wales. One of NICE’s main roles is to produce national guidance on the use of health technologies within the NHS. Despite the Institute’s recent efforts to clarify the way in which its Appraisal Committees reach their recommendations concerning the use of health technologies, there remains ambiguity about how cost-effectiveness evidence is interpreted alongside other considerations such as the degree of clinical need within the patient population, and the degree of uncertainty surrounding cost-effectiveness estimates. Objective To explore whether the NICE takes account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services. Methods A binary choice experiment was undertaken using NICE’s three Appraisal Committees. The experiment included five attributes: (1) Incremental cost-effectiveness (2) Degree of economic uncertainty (3) Age of the target population (4) Baseline health-related quality of life (5) Availability of other therapies A choice questionnaire detailing 18 scenarios was administered to NICE’s Appraisal Committees. For each scenario, respondents were asked to indicate whether they would recommend the intervention under consideration or not. The stated preference data obtained from respondents were analysed using a random effects logit regression model. Results A response rate of 46% was obtained from the Appraisal Committees. The regression model suggests that increases in cost-effectiveness, economic uncertainty, and the availability of other therapies are associated with statistically significant reductions in the odds of adoption (puncertainty; equity; cost-effectiveness; public health

Investigations on entropy layer along hypersonic hyperboloids using a defect boundary layer

A defect approach coupled with matched asymptotic expansions is used to derive a new set of boundary layer equations. This method ensures a smooth matching of the boundary layer with the inviscid solution. These equations are solved to calculate boundary layers over hypersonic blunt bodies involving the entropy gradient effect. Systematic comparisons are made for both axisymmetric and plane flows in several cases with different Mach and Reynolds numbers. After a brief survey of the entropy layer characteristics, the defect boundary layer results are compared with standard boundary layer and full Navier-Stokes solutions. The entropy gradient effects are found to be more important in the axisymmetric case than in the plane one. The wall temperature has a great influence on the results through the displacement effect. Good predictions can be obtained with the defect approach over a cold wall in the nose region, with a first order solution. However, the defect approach gives less accurate results far from the nose on axisymmetric bodies because of the thinning of the entropy layer

Hell and Damnation, Freedom and Responsibility

A review essay on Joel Buenting, ed., The Problem of Hell: A Philosophical Anthology (Farnham, 2010). 236 pages. $88.84. ISBN: 9780754667636, and Jordan C. Ferrier, Calvin and C. S. Lewis: Solving the Riddle of the Reformation (Allendale, 2010). 172 pages.$8.99. ISBN: 9781479101283

Review of Shadows and Chivalry: Pain, Suffering, Evil and the Goodness in the Works of George MacDonald and C.S. Lewis

P.H. Brazier: Review of Jeff McInnis, Shadows and Chivalry: Pain, Suffering, Evil and Goodness in the Works of George MacDonald and C. S. Lewis (Eugene, Oregon, 2008). 307 pages. $39.00. ISBN 9781556356650

Book Review

Review of Andrew Walker and Luke Bretherton (eds.), Remembering Our Future: Explorations in Deep Church (Milton Keynes: Paternoster, 2007). 224 pages. $24.99. ISBN: 9781842275047