Efficiency, equity, and NICE clinical guidelines

The stated purpose of clinical guidelines from the United Kingdom's National Institute for Clinical Excellence (NICE) is to "help healthcare professionals and patients make the right decisions about healthcare in specific clinical circumstances." However, what constitutes "the right decisions" depends on your point of view. For individual patients the right decision is that which maximises their wellbeing, and this is properly the concern of the clinician. Yet in resource constrained healthcare systems this will not always coincide with the right decisions for patients in general or society as a whole, thereby leading to some understandable tensions. NICE is a national policy making body whose responsibility is clearly broader than the individual patient. This wider viewpoint is reflected in NICE's technology appraisals by the central role afforded to cost effectiveness. We argue that the methods currently used by the NICE clinical guideline programme confuse these two viewpoints

An Algebraic Duality Theory for Multiplicative Unitaries

Multiplicative Unitaries are described in terms of a pair of commuting shifts of relative depth two. They can be generated from ambidextrous Hilbert spaces in a tensor C*-category. The algebraic analogue of the Takesaki-Tatsuuma Duality Theorem characterizes abstractly C*-algebras acted on by unital endomorphisms that are intrinsically related to the regular representation of a multiplicative unitary. The relevant C*-algebras turn out to be simple and indeed separable if the corresponding multiplicative unitaries act on a separable Hilbert space. A categorical analogue provides internal characterizations of minimal representation categories of a multiplicative unitary. Endomorphisms of the Cuntz algebra related algebraically to the grading are discussed as is the notion of braided symmetry in a tensor C*-category.Comment: one reference adde

Wavelet-based voice morphing

This paper presents a new multi-scale voice morphing algorithm. This algorithm enables a user to transform one person's speech pattern into another person's pattern with distinct characteristics, giving it a new identity, while preserving the original content. The voice morphing algorithm performs the morphing at different subbands by using the theory of wavelets and models the spectral conversion using the theory of Radial Basis Function Neural Networks. The results obtained on the TIMIT speech database demonstrate effective transformation of the speaker identity

The threatened status of restricted-range coral reef fish species

Coral reefs are the most diverse ecosystem in the sea. Throughout the world they are being overfished, polluted and destroyed, placing biodiversity at risk. To date, much of the concern over biodiversity loss has centred on local losses and the possibility of global extinction has largely been discounted. However, recent research has shown that 24% of reef fish species have restricted ranges (< 800 000 km(2)), with 9% highly restricted (< 50 000 km(2)). Restricted-range species are thought to face a greater risk of extinction than more widespread species since local impacts could cause global loss. We searched for information on status in the wild and characteristics of 397 restricted-range reef fish species. Fish body size, habitat requirements and usefulness to people were compared with those of a taxonomically-matched sample of more widespread species. We found that on average species with restricted ranges were significantly smaller (mean total length 19.1 cm versus 24.4 cm), tended to have narrower habitat requirements and were less used by people. Greater habitat specificity will tend to increase extinction risk while, if real, more limited usefulness (equivalent to exploitation) may reduce risk. Fifty-eight percent of restricted-range species were considered common/abundant in the wild and 42% uncommon/rare. Population status and threats to 319 species for which data were available were assessed according to the categories and criteria of the IUCN red list of threatened animals. A number of species were found to be rare, were exploited and had highly restricted ranges overlapping areas where reef degradation is particularly severe, placing them at a high risk of extinction. Five species were listed as Critically Endangered, two of them possibly already extinct in the wild, one as Endangered and 172 as Vulnerable. A further 126 species fell into Lower Risk categories and 11 were considered Data Deficient. Given the intensity of impacts to reefs, the broad geographical areas affected and the large numbers of restricted-range species, global extinctions seem likely. Urgent management action is now crucial for the survival of several species of reef fishes

Voice morphing using the generative topographic mapping

In this paper we address the problem of Voice Morphing. We attempt to transform the spectral characteristics of a source speaker's speech signal so that the listener would believe that the speech was uttered by a target speaker. The voice morphing system transforms the spectral envelope as represented by a Linear Prediction model. The transformation is achieved by codebook mapping using the Generative Topographic Mapping, a non-linear, latent variable, parametrically constrained, Gaussian Mixture Model

The worldwide costs of marine protected areas

Declines in marine harvests, wildlife, and habitats have prompted calls at both the 2002 World Summit on Sustainable Development and the 2003 World Parks Congress for the establishment of a global system of marine protected areas (MPAs). MPAs that restrict fishing and other human activities conserve habitats and populations and, by exporting biomass, may sustain or increase yields of nearby fisheries. Here we provide an estimate of the costs of a global MPA network, based on a survey of the running costs of 83 MPAs worldwide. Annual running costs per unit area spanned six orders of magnitude, and were higher in MPAs that were smaller, closer to coasts, and in high-cost, developed countries. Models extrapolating these findings suggest that a global MPA network meeting the World Parks Congress target of conserving 20–30% of the world’s seas might cost between $5 billion and$19 billion annually to run and would probably create around one million jobs. Although substantial, gross network costs are less than current government expenditures on harmful subsidies to industrial fisheries. They also ignore potential private gains from improved fisheries and tourism and are dwarfed by likely social gains from increasing the sustainability of fisheries and securing vital ecosystem services

Health State Values for the HUI 2 descriptive system: results from a UK survey

This paper reports the results of a study to estimate a statistical health state valuation model for a revised version of the Health Utilities Index Mark 2, using Standard Gamble health state preference data. A sample of 51 health states were valued by a sample of the 198 members of the UK general population. Models are estimated for predicting health state valuations for all 8,000 states defined by the revised HUI2. The recommended model produces logical and significant coefficients for all levels of all dimensions in the HUI2. These coefficients appear to be robust across model specifications. This model performs well in predicting the observed health state values within the valuation sample and for a separate validation sample of health states. However, there are concerns over large prediction errors for two health states in the valuation sample. These problems must be balanced against concerns over the validity of using the VAS based health state valuation data of the original HUI2 valuation model

Improving water utilization from a catchment perspective

Water management / Water scarcity / Water use efficiency / Catchment areas / Calibrations / Hydrology / Models / River basins / Participatory management / Water balance / Case studies / Asia / Africa / South Africa / Zimbabwe