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A note on the nature of utility in time and health and implications for cost utility analysis
Time Trade-Off valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rests on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature - yet the issues appear not to be widely appreciated by those using and applying TTO. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that is demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in Cost Utility Analysis. In essence, it is extremely unwise to assume that the current "tariffs" of TTO values, such as those routinely used by NICE and other organisations, can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We suggest a number of solutions, including the provision of multiple value sets, for a range of durations
Some integer formula-encodings and related algorithms
We investigate the special class of formulas made up of arbitrary but finite
com- binations of addition, multiplication, and exponentiation gates. The
inputs to these formulas are restricted to the integral unit 1. In connection
with such formulas, we describe two essen- tially distinct families of
canonical formula-encodings for integers, respectively deduced from the decimal
encoding and the fundamental theorem of arithmetic. Our main contribution is
the de- tailed description of two algorithms which efficiently determine the
canonical formula-encodings associated with relatively large sets of
consecutive integers
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A theoretical framework for TTO valuations and a taxonomy of TTO approaches: results from a pilot study
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Does the value of quality of life depend on duration?
The aims of this study are to investigate the feasibility of eliciting Time Trade Off (TTO) valuations using short durations; to determine the effect of contrasting durations on individuals’ responses to the TTO; to examine variations within and between respondents’ values with respect to duration; and to consider the insights provided by participants’ comments and explanations regarding their reaction to duration in the valuation task. 27 participants provided TTO values using short and long durations for three EQ-5D states. Feedback was sought using a series of open ended questions. Of the 81 opportunities to observe it, strict constant proportionality was satisfied twice. 11 participants had no systematic relationship between duration and value; 11 provided consistently lower valuations in long durations, while 5 had higher valuations in long durations. Comments provided by participants were consistent with the values they provided. Mean TTO values did not differ markedly between alternative durations. We conclude that it is feasible to elicit TTO values for short durations. There is considerable heterogeneity in individuals’ responses to the time frames used to elicit values. Further research is required to ensure that the values used in cost effectiveness analysis adequately represent preferences about quality and length of life
Protocols for TTO valuations of health states worse than dead: A literature review and framework for systematic analysis
Developing language skills in second language learners through literature discussions
This study analyzed book discussions of primary aged ESL students and their teacher to examine the benefits to language development. Collected over one school year, data included transcribed audiotapes of the book discussions, class interviews, and personal journal entries of the teacher which described classroom events and interactions. Analysis of the transcripts resulted in the identification of seven categories which illustrated the diversity of types of talk. In addition, changes in the amount of student and teacher talk over time were noted, with student talk increasing, and teacher talk becoming less pronounced. Four students were highlighted to illustrate the benefits of picture book discussions for different English proficiency levels. Finally, the role of the teacher in these discussions was explored. Several benefits of discussing picture books with ESL students are suggested in terms of their importance for language development
Gauge invariance of color confinement due to the dual Meissner effect caused by Abelian monopoles
The mechanism of non-Abelian color confinement is studied in SU(2) lattice
gauge theory in terms of the Abelian fields and monopoles extracted from
non-Abelian link variables without adopting gauge fixing.
Firstly, the static quark-antiquark potential and force are computed with the
Abelian and monopole Polyakov loop correlators, and the resulting string
tensions are found to be identical to the non-Abelian string tension. These
potentials also show the scaling behavior with respect to the change of lattice
spacing.
Secondly, the profile of the color-electric field between a quark and an
antiquark is investigated with the Abelian and monopole Wilson loops. The
color-electric field is squeezed into a flux tube due to monopole supercurrent
with the same Abelian color direction. The parameters corresponding to the
penetration and coherence lengths show the scaling behavior, and the ratio of
these lengths, i.e, the Ginzburg-Landau parameter, indicates that the vacuum
type is near the border of the type1 and type2 (dual) superconductor.
These results are summarized that the Abelian fundamental charge defined in
an arbitrary color direction is confined inside a hadronic state by the dual
Meissner effect. As the color-neutral state in any Abelian color direction
corresponds to the physical color-singlet state, this effect explains
non-Abelian color confinement and supports the existence of a gauge-invariant
mechanism of color confinement due to the dual Meissner effect caused by
Abelian monopoles.Comment: 11 pages, 14 figure
Socioeconomic deprivation and age are barriers to the online collection of patient reported outcome measures in orthopaedic patients
Introduction:
Questionnaires are used commonly to assess functional outcome and satisfaction in surgical patients. Although these have in the past been administered through written forms, there is increasing interest in the use of new technology to improve the efficiency of collection. The aim of this study was to assess the availability of internet access for a group of orthopaedic patients and the acceptability of online survey completion.
Methods:
A total of 497 patients attending orthopaedic outpatient clinics were surveyed to assess access to the internet and their preferred means for completing follow-up questionnaires.
Results:
Overall, 358 patients (72%) reported having internet access. Lack of access was associated with socioeconomic deprivation and older age. Multivariable regression confirmed increased age and greater deprivation to be independently associated with lack of internet access. Out of the total group, 198 (40%) indicated a preference for assessment of outcomes via email and the internet.
Conclusions:
Internet access was not universal among the patients in our orthopaedic clinic. Reliance on internet collection of PROMs may introduce bias by not including results from patients in older age groups and those from the more deprived socioeconomic groups
Curriculum for Excellence Draft Experiences and Outcomes: Collection, analysis and reporting of data. Interim report.
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