Mapping the Paediatric Quality of Life Inventory (PedsQL™) Generic Core Scales onto the Child Health Utility Index–9 Dimension (CHU-9D) Score for Economic Evaluation in Children

Background: The Paediatric Quality of Life Inventory (PedsQL™) questionnaire is a widely used, generic instrument designed for measuring health-related quality of life (HRQoL); however, it is not preference-based and therefore not suitable for cost–utility analysis. The Child Health Utility Index–9 Dimension (CHU-9D), however, is a preference-based instrument that has been primarily developed to support cost–utility analysis. Objective: This paper presents a method for estimating CHU-9D index scores from responses to the PedsQL™ using data from a randomised controlled trial of prednisolone therapy for treatment of childhood corticosteroid-sensitive nephrotic syndrome. Methods: HRQoL data were collected from children at randomisation, week 16, and months 12, 18, 24, 36 and 48. Observations on children aged 5 years and older were pooled across all data collection timepoints and were then randomised into an estimation (n = 279) and validation (n = 284) sample. A number of models were developed using the estimation data before internal validation. The best model was chosen using multi-stage selection criteria. Results: Most of the models developed accurately predicted the CHU-9D mean index score. The best performing model was a generalised linear model (mean absolute error = 0.0408; mean square error = 0.0035). The proportion of index scores deviating from the observed scores by 13 years) or patient groups with particularly poor quality of life. ISRCTN Registry No: 1664524

Sustainable Fictions – Geographical, Literary and Cultural Intersections in J.R.R. Tolkien’s The Lord of the Rings

J. R. R. Tolkien s The Lord of the Rings (1954/1955), one of the founding texts of fantasy literature and the centrepiece of a number of writings about the geography, history and mythology of ‘Middle-earth’, has long become a cult phenomenon. We argue that in this influential text, Tolkien offers a fictional exploration of sustainability. Combining an application of Geographic Information System techniques with textual analysis and interpreting text and spatial data in conjunction, we show that there is a systematically varying distance between our real world and the physical features of Tolkien's ‘Secondary World’, as regards climate and vegetation patterns. There is an emphasis on land degeneration, a ‘missing forest problem’ which prompts a closer look at the role of woods and trees in Tolkien's work. It emerges that the preservation of trees is at the centre of Tolkien's sustainable fictions. For the author, it was a function of fantasy, which he sets against a dystopian and secular modernism as well as the destructive aspects of modernity, to provide (positive) ‘escape’, ‘consolation’ and ‘recovery’, which is achieved through a final vision of the successful preservation of the environment