8,895 research outputs found
Cost-effectiveness analysis in R using a multi-state modelling survival analysis framework: a tutorial
This tutorial provides a step-by-step guide to performing cost-effectiveness analysis using a multi-state modelling approach. Alongside the tutorial we provide easy-to-use functions in the statistics package R. We argue this multi-state modelling approach using a package such as R has advantages over approaches where models are built in a spreadsheet package. In particular, using a syntax-based approach means there is a written record of what was done and the calculations are transparent. Reproducing the analysis is straightforward as the syntax just needs to be run again. The approach can be thought of as an alternative way to build a Markov decision analytic model, which also has the option to use a state-arrival extended approach if the Markov property does not hold. In the state-arrival extended multi-state model a covariate that represents patientsâ history is included allowing the Markov property to be tested. We illustrate the building of multi-state survival models, making predictions from the models and assessing fits. We then proceed to perform a cost-effectiveness analysis including deterministic and probabilistic sensitivity analyses. Finally, we show how to create two common methods of visualising the results, namely cost-effectiveness planes and cost-effectiveness acceptability curves. The analysis is implemented entirely within R. It is based on adaptions to functions in the existing R package mstate, to accommodate parametric multi-state modelling which facilitates extrapolation of survival curves
Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants
<b>Background:</b> The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.<p></p>
<b>Method:</b> We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score <4, and poor mental health as a GHQ score â„4. Logistic regression models were applied.
Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87â0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05â1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p < 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.<p></p>
<b>Conclusions:</b> The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.<p></p>
Estimating the Expected Value of Partial Perfect Information in Health Economic Evaluations using Integrated Nested Laplace Approximation
The Expected Value of Perfect Partial Information (EVPPI) is a
decision-theoretic measure of the "cost" of parametric uncertainty in decision
making used principally in health economic decision making. Despite this
decision-theoretic grounding, the uptake of EVPPI calculations in practice has
been slow. This is in part due to the prohibitive computational time required
to estimate the EVPPI via Monte Carlo simulations. However, recent developments
have demonstrated that the EVPPI can be estimated by non-parametric regression
methods, which have significantly decreased the computation time required to
approximate the EVPPI. Under certain circumstances, high-dimensional Gaussian
Process regression is suggested, but this can still be prohibitively expensive.
Applying fast computation methods developed in spatial statistics using
Integrated Nested Laplace Approximations (INLA) and projecting from a
high-dimensional into a low-dimensional input space allows us to decrease the
computation time for fitting these high-dimensional Gaussian Processes, often
substantially. We demonstrate that the EVPPI calculated using our method for
Gaussian Process regression is in line with the standard Gaussian Process
regression method and that despite the apparent methodological complexity of
this new method, R functions are available in the package BCEA to implement it
simply and efficiently
Universal diffusion near the golden chaos border
We study local diffusion rate in Chirikov standard map near the critical
golden curve. Numerical simulations confirm the predicted exponent
for the power law decay of as approaching the golden curve via principal
resonances with period (). The universal
self-similar structure of diffusion between principal resonances is
demonstrated and it is shown that resonances of other type play also an
important role.Comment: 4 pages Latex, revtex, 3 uuencoded postscript figure
Visual transients reveal the veridical position of a moving object
The position of a moving object is often mislocalised in the direction of movement. At the input stage of visual processing, the position of a moving object should still be represented veridically, whereas it should become closer to the mislocalised position at a later processing stage responsible for positional judgment. Here, we show that visual transients expose the veridical position of a moving object represented in early visual areas. For example, when a ring is flashed on a moving bar, the part of the bar within the ring is perceived at the veridical position, whereas the part outside the ring is perceived to be ahead of the ring as in the flash-lag effect. Our observations suggest that a filling-in process is triggered at the edges of the flash. This indicates that, in early cortical areas, moving objects are still represented at their veridical positions, and the perceived location is determined by the higher visual areas
A Renormalization Group for Hamiltonians: Numerical Results
We describe a renormalization group transformation that is related to the
breakup of golden invariant tori in Hamiltonian systems with two degrees of
freedom. This transformation applies to a large class of Hamiltonians, is
conceptually simple, and allows for accurate numerical computations. In a
numerical implementation, we find a nontrivial fixed point and determine the
corresponding critical index and scaling. Our computed values for various
universal constants are in good agreement with existing data for
area-preserving maps. We also discuss the flow associated with the nontrivial
fixed point.Comment: 11 Pages, 2 Figures. For future updates, check
ftp://ftp.ma.utexas.edu/pub/papers/koch
Robust and Efficient Sifting-Less Quantum Key Distribution Protocols
We show that replacing the usual sifting step of the standard
quantum-key-distribution protocol BB84 by a one-way reverse reconciliation
procedure increases its robustness against photon-number-splitting (PNS)
attacks to the level of the SARG04 protocol while keeping the raw key-rate of
BB84. This protocol, which uses the same state and detection than BB84, is the
m=4 member of a protocol-family using m polarization states which we introduce
here. We show that the robustness of these protocols against PNS attacks
increases exponentially with m, and that the effective keyrate of optimized
weak coherent pulses decreases with the transmission T like T^{1+1/(m-2)}
Information processing and signal integration in bacterial quorum sensing
Bacteria communicate using secreted chemical signaling molecules called
autoinducers in a process known as quorum sensing. The quorum-sensing network
of the marine bacterium {\it Vibrio harveyi} employs three autoinducers, each
known to encode distinct ecological information. Yet how cells integrate and
interpret the information contained within the three autoinducer signals
remains a mystery. Here, we develop a new framework for analyzing signal
integration based on Information Theory and use it to analyze quorum sensing in
{\it V. harveyi}. We quantify how much the cells can learn about individual
autoinducers and explain the experimentally observed input-output relation of
the {\it V. harveyi} quorum-sensing circuit. Our results suggest that the need
to limit interference between input signals places strong constraints on the
architecture of bacterial signal-integration networks, and that bacteria likely
have evolved active strategies for minimizing this interference. Here we
analyze two such strategies: manipulation of autoinducer production and
feedback on receptor number ratios.Comment: Supporting information is in appendi
Grass-Next â A Process-Based Model to Explore Nutrient and Carbon Dynamics in Topographically Complex Grazed Grasslands
Topographical features such as slope and aspect influence primary production, animal behavior and nutrient return to grazed grasslands. A new model was developed based on data collected during 40+ years of research in hill country landscapes, a long-term experiment on varying phosphorus (P) fertilizer rates and associated sheep stocking regimes. The Grass-NEXT model was able to simultaneously simulate total soil P (TSP), soil organic carbon (SOC) and total soil nitrogen (TSN) stock change and distribution in a topographically complex (hill country) landscape from 2003 to 2020. This model provided a basis for exploring, accounting, and reporting on changes in TSP, SOC and TSN stocks in response to current management practices (e.g., varying amounts of P fertilizer rates applied) in complex grazed systems. The model provided insights on both the combination of topographical features that provided the largest spatial and temporal variability across the landscape, and where more intensive sampling is required to detect a significant minimum change of 3% in total SOC stocks. Further work could improve the quantification of grazing activities and excreta deposition that would help to detect specific clusters of variation on topographical complex landscapes to facilitate soil sampling design
Early adoption of screening and the changing pattern of cervical cancer in UK Military women: evidence from the Scottish Veterans Health Study
Objective: To examine the risk of cervical cancer in a large national cohort of military veteran women followed up for up to 30â
years.
Methods: Retrospective cohort study of 5235 veteran women born between 1945 and 1985, and 20â
703 women with no record of service matched for age and area of residence, using Cox proportional hazard models to compare the overall risk of cervical cancer and by year of birth.
Results: During the follow-up period 1981â2012, there were 18 (0.34%) cases of cervical cancer in the veteran women compared with 81 (0.39%) in the non-veterans. The difference was not statistically significant overall (adjusted HR 0.95, 95% CI 0.57 to 1.59). When analysed by the year of birth, veteran women born in 1958 and earlier had a non-significantly higher risk than non-veterans (adjusted HR 1.24, 95% CI 0.68 to 2.26), while veteran women born after 1958 had a non-significant reduction in risk (adjusted HR 0.51, 95% CI 0.18 to 1.44).
Conclusions: Women born after 1958 who have served in the Armed Forces are at reduced risk of cervical cancer compared with women who have never served, and compared with older veteran women. Small numbers of cases precluded statistical significance. The change in risk pattern in veteran women coincided with the introduction of cervical screening in the Armed Forces, which predated the UK national programme, and provides evidence for the long-term effectiveness of the Armed Forcesâ sexual health strategy. The impact of recent changes in the screening age, and of human papillomavirus immunisation, should be monitored in the future
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