Does responsibility affect the public valuation of health care interventions? A relative valuation approach to health care safety

This article is available open access through the publisher’s website at the link below. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Objective - Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. Method - An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or “matching” method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Results - Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Conclusion - Our results suggest that people do not attach a simple fixed premium to “safety-related” interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.Brunel University

Switchgrass Biomass Production in the Midwest USA: Harvest and Nitrogen Management

Information on optimal harvest periods and N fertilization rates for switchgrass (Panicum virgatum L.) grown as a biomass or bioenergy crop in the Midwest USA is limited. Our objectives were to determine optimum harvest periods and N rates for biomass production in the region. Established stands of \u27Cave-in-Rock\u27 switchgrass at Ames, IA, and Mead, NE, were fertilized 0, 60, 120, 180, 240, or 300 kg N ha-1. Harvest treatments were two- or one-cut treatments per year, with initial harvest starting in late June or early July (Harvest 1) and continuing at approximately 7-d intervals until the latter part of August (Harvest 7). A final eighth harvest was completed after a killing frost. Regrowth was harvested on previously harvested plots at that time. Soil samples were taken before fertilizer was applied in the spring of 1994 and again in the spring of 1996. Averaged over years, optimum biomass yields were obtained when switchgrass was harvested at the maturity stages R3 to R5 (panicle fully emerged from boot to postanthesis) and fertilized with 120 kg N ha-1. Biomass yields with these treatments averaged 10.5 to 11.2 Mg ha-1 at Mead and 11.6 to 12.6 Mg ha-1 at Ames. At this fertility level, the amount of N removed was approximately the same as the amount applied. At rates above this level, soil NO3-N concentrations increased

Anderson impurity in pseudo-gap Fermi systems

We use the numerical renormalization group method to study an Anderson impurity in a conduction band with the density of states varying as rho(omega) \propto |omega|^r with r>0. We find two different fixed points: a local-moment fixed point with the impurity effectively decoupled from the band and a strong-coupling fixed point with a partially screened impurity spin. The specific heat and the spin-susceptibility show powerlaw behaviour with different exponents in strong-coupling and local-moment regime. We also calculate the impurity spectral function which diverges (vanishes) with |omega|^{-r} (|\omega|^r) in the strong-coupling (local moment) regime.Comment: 8 pages, LaTeX, 4 figures includes as eps-file

Lessons from the evaluation of the UK's NHS R&D Implementation Methods Programme

Background: Concern about the effective use of research was a major factor behind the creation of the NHS R&D Programme in 1991. In 1994, an advisory group was established to identify research priorities in research implementation. The Implementation Methods Programme (IMP) flowed from this, and its commissioning group funded 36 projects. In 2000 responsibility for the programme passed to the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D, which asked the Health Economics Research Group (HERG), Brunel University, to conduct an evaluation in 2002. By then most projects had been completed. This evaluation was intended to cover: the quality of outputs, lessons to be learnt about the communication strategy and the commissioning process, and the benefits from the projects. Methods: We adopted a wide range of quantitative and qualitative methods. They included: documentary analysis, interviews with key actors, questionnaires to the funded lead researchers, questionnaires to potential users, and desk analysis. Results: Quantitative assessment of outputs and dissemination revealed that the IMP funded useful research projects, some of which had considerable impact against the various categories in the HERG payback model, such as publications, further research, research training, impact on health policy, and clinical practice. Qualitative findings from interviews with advisory and commissioning group members indicated that when the IMP was established, implementation research was a relatively unexplored field. This was reflected in the understanding brought to their roles by members of the advisory and commissioning groups, in the way priorities for research were chosen and developed, and in how the research projects were commissioned. The ideological and methodological debates associated with these decisions have continued among those working in this field. The need for an effective communication strategy for the programme as a whole was particularly important. However, such a strategy was never developed, making it difficult to establish the general influence of the IMP as a programme. Conclusion: Our findings about the impact of the work funded, and the difficulties faced by those developing the IMP, have implications for the development of strategic programmes of research in general, as well as for the development of more effective research in this field

A Local Moment Approach to magnetic impurities in gapless Fermi systems

A local moment approach is developed for the single-particle excitations of a symmetric Anderson impurity model (AIM), with a soft-gap hybridization vanishing at the Fermi level with a power law r > 0. Local moments are introduced explicitly from the outset, and a two-self-energy description is employed in which the single-particle excitations are coupled dynamically to low-energy transverse spin fluctuations. The resultant theory is applicable on all energy scales, and captures both the spin-fluctuation regime of strong coupling (large-U), as well as the weak coupling regime. While the primary emphasis is on single particle dynamics, the quantum phase transition between strong coupling (SC) and (LM) phases can also be addressed directly; for the spin-fluctuation regime in particular a number of asymptotically exact results are thereby obtained. Results for both single-particle spectra and SC/LM phase boundaries are found to agree well with recent numerical renormalization group (NRG) studies. A number of further testable predictions are made; in particular, for r < 1/2, spectra characteristic of the SC state are predicted to exhibit an r-dependent universal scaling form as the SC/LM phase boundary is approached and the Kondo scale vanishes. Results for the `normal' r = 0 AIM are moreover recovered smoothly from the limit r -> 0, where the resultant description of single-particle dynamics includes recovery of Doniach-Sunjic tails in the Kondo resonance, as well as characteristic low-energy Fermi liquid behaviour.Comment: 52 pages, 19 figures, submitted to Journal of Physics: Condensed Matte

Local quantum phase transition in the pseudogap Anderson model: scales, scaling and quantum critical dynamics

The pseudogap Anderson impurity model provides a paradigm for understanding local quantum phase transitions, in this case between generalised fermi liquid and degenerate local moment phases. Here we develop a non-perturbative local moment approach to the generic asymmetric model, encompassing all energy scales and interaction strengths and leading thereby to a rich description of the problem. We investigate in particular underlying phase boundaries, the critical behaviour of relevant low-energy scales, and single-particle dynamics embodied in the local spectrum. Particular attention is given to the resultant universal scaling behaviour of dynamics close to the transition in both the GFL and LM phases, the scale-free physics characteristic of the quantum critical point itself, and the relation between the two.Comment: 39 pages, 19 figure

Tracing the jet contribution to the mid-IR over the 2005 outburst of GRO J1655-40 via broadband spectral modeling

We present new results from a multi-wavelength (radio/infrared/optical/X-ray) study of the black hole X-ray binary GRO J1655-40 during its 2005 outburst. We detected, for the first time, mid-infrared emission at 24 um from the compact jet of a black hole X-ray binary during its hard state, when the source shows emission from a radio compact jet as well as a strong non-thermal hard X-ray component. These detections strongly constrain the optically thick part of the synchrotron spectrum of the compact jet, which is consistent with being flat over four orders of magnitude in frequency. Moreover, using this unprecedented coverage, and especially thanks to the new Spitzer observations, we can test broadband disk and jet models during the hard state. Two of the hard state broadband spectra are reasonably well fitted using a jet model with parameters overall similar to those previously found for Cyg X-1 and GX 339-4. Differences are also present; most notably, the jet power in GRO J1655-40 appears to be a factor of at least ~3-5 higher (depending on the distance) than that of Cyg X-1 and GX 339-4 at comparable disk luminosities. Furthermore, a few discrepancies between the model and the data, previously not found for the other two black hole systems for which there was no mid-IR/IR and optical coverage, are evident, and will help to constrain and refine theoretical models.Comment: accepted for publication in Ap

Multi-Wavelength Coverage of State Transitions in the New Black Hole X-Ray Binary Swift J1910.2-0546

Understanding how black holes accrete and supply feedback to their environment is one of the outstanding challenges of modern astrophysics. Swift J1910.2-0546 is a candidate black hole low-mass X-ray binary that was discovered in 2012 when it entered an accretion outburst. To investigate the binary configuration and the accretion morphology we monitored the evolution of the outburst for ~3 months at X-ray, UV, optical (B,V,R,I), and near-infrared (J,H,K) wavelengths using Swift and SMARTS. The source evolved from a hard to a soft X-ray spectral state with a relatively cold accretion disk that peaked at ~0.5 keV. A Chandra/HETG spectrum obtained during this soft state did not reveal signatures of an ionized disk wind. Both the low disk temperature and the absence of a detectable wind could indicate that the system is viewed at relatively low inclination. The multi-wavelength light curves revealed two notable features that appear to be related to X-ray state changes. Firstly, a prominent flux decrease was observed in all wavebands ~1-2 weeks before the source entered the soft state. This dip occurred in (0.6-10 keV) X-rays ~6 days later than at longer wavelengths, which could possibly reflect the viscous time scale of the disk. Secondly, about two weeks after the source transitioned back into the hard state, the UV emission significantly increased while the X-rays steadily decayed. We discuss how these observations may reflect changes in the accretion flow morphology, perhaps related to the quenching/launch of a jet or the collapse/recovery of a hot flow.Comment: 8 pages, 5 figures, 1 table. To be published in Ap

Anderson impurities in gapless hosts: comparison of renormalization group and local moment approaches

The symmetric Anderson impurity model, with a soft-gap hybridization vanishing at the Fermi level with power law r > 0, is studied via the numerical renormalization group (NRG). Detailed comparison is made with predictions arising from the local moment approach (LMA), a recently developed many-body theory which is found to provide a remarkably successful description of the problem. Results for the `normal' (r = 0) impurity model are obtained as a specific case. Particular emphasis is given both to single-particle excitation dynamics, and to the transition between the strong coupling (SC) and local moment (LM) phases of the model. Scaling characteristics and asymptotic behaviour of the SC/LM phase boundaries are considered. Single-particle spectra are investigated in some detail, for the SC phase in particular. Here, the modified spectral functions are found to contain a generalized Kondo resonance that is ubiquitously pinned at the Fermi level; and which exhibits a characteristic low-energy Kondo scale that narrows progressively upon approach to the SC->LM transition, where it vanishes. Universal scaling of the spectra as the transition is approached thus results. The scaling spectrum characteristic of the normal Anderson model is recovered as a particular case, and is captured quantitatively by the LMA. In all cases the r-dependent scaling spectra are found to possess characteristic low-energy asymptotics, but to be dominated by generalized Doniach-Sunjic tails, in agreement with LMA predictions.Comment: 26 pages, 14 figures, submitted for publicatio

X-Ray Observations of V4641 SGR (= SAX J1819.3-2525) During the Brief and Violent Outburst of 2003

We present the results of detailed analysis of pointed X-ray observations by RXTE PCA/HEXTE of the black hole X-ray binary (BHXRB) system V4641 Sgr (= SAX J1819.3-2525) during its outburst of August 2003. Soft X-ray (3-20 keV) flux variations by factors of 10 or more on timescales of minutes or shorter were seen. The rapid and strong variability of this source sets it apart from typical XRBs. In spite of large luminosity fluctuations, the spectral state of the source did not change significantly during the dwells which suggests that the physical emission processes did not change much during the observations. The energy spectra during the dwells were dominated by a hard Comptonized powerlaw component, indicative of the canonical low/hard state observed in other BHXRBs. No soft thermal component was found in three out of the four RXTE pointings. However spectral deconvolution of the observation with largest average luminosity suggests an obscured, hot accretion disk. During one of the observations we detected a short term (about 100s) soft X-ray dropout which is apparently due to variability in the observed column density. Strong Fe K$\alpha$ fluorescent emisssion line near 6.5 keV was detected with large equivalent widths in the range of 700 - 1000eV. In the temporal domain, the Fourier power spectra were dominated by red noise below a few Hz. Poisson noise dominated at higher frequencies and no high frequency features were detected. The strong Comptonized spectra, broad iron emission line, absence of disk component in the spectra, absence of any timing variability above few Hz and occasional large changes in the column density along the line-of-sight, all support an enshrouded black hole with occasional outflow and a very dynamic environment.Comment: 27 pages, 10 figures (1 color figure), accepted for publication in the Astrophysical Journal. It is tentatively scheduled for the ApJ 01 February 2006, v637, 2 issu