Development of low density rigid polyurethane foam for use of s-1c flight vehicles final report

Compression testing of low density rigid polyurethane foam for S-1DC flight vehicle

A review and meta analysis of health state utility values in breast cancer

Background and purpose: Health-related quality of life is an important issue in the treatment of breast cancer, and health-state utilities are essential for cost-utility analysis. This paper identifies and summarises published utilities for common health-related quality of life outcomes for breast cancer, considers the impact of variation in study designs used, and pools utilities for some breast cancer health states. Data sources and study selection: 13 databases were searched using key words relating to breast cancer and utility measurement. Articles were included if specified empirical methods for deriving utility values were used and details of the method, including number of respondents, were given. Articles were excluded if values were based on expert opinion or were not unique. Data extraction and synthesis: The authors identified 49 articles which met their inclusion criteria, providing 476 unique utilities for breast cancer health states. Where possible, mean utility estimates were pooled using ordinary least squares with utilities clustered within study group and weighted by both number of respondents and inverse of the variance of each utility. Regressions included controls for disease state, utility assessment method and other features of study design. Results: Utility values found in the review are summarised for six categories: 1) screening related states, 2) preventative states, 3) adverse events in breast cancer and its treatment, 4) non-specific breast cancer, 5) metastatic breast cancer states and 6) early breast cancer states. Pooled utility values for the latter two categories are estimated, showing base state utility values of between 0.668 and 0.782 for early breast cancer and 0.721 and 0.806 metastatic breast cancer depending upon which model is used. Utilities were found to vary significantly by valuation method, and who conducted the valuation. Conclusions: A large number of utility values for breast cancer are available in the literature; the states that these refer to are often complex, making pooling of values problematic

How do individuals value health states? A qualitative investigation.

Despite the importance of health state values in informing resource allocation in health care, there is arguably little known about how individuals value health. Previous studies have shown that a variety of non-health factors and beliefs are important in valuing health, but there is less evidence in the literature about how individuals' beliefs affect their preferences or what role non-health factors play in the process of forming preferences. This study investigated the thought processes of 21 U.K. based participants in March 2013 who valued health states using semi-structured interviews and a think-aloud protocol, with the aim to better understand the relationship between health states, the individual's underlying beliefs, and the individual's preferences. Participants followed several stages in valuing health. First, participants interpreted the health states more concretely, relying on their imagination and their experience of ill health. Participants judged how the concrete health problems combined with their personal interests, circumstances, and environment would affect them personally. Ultimately, participants valued health by estimating and weighing the non-health consequences of the health states. Six consequences were most frequently mentioned: activities, enjoyment, independence, relationships, dignity, and avoiding being a burden. At each stage participants encountered difficulties and expressed concerns. The findings have implications for methods of describing health, for example, whether the focus should be on health or a broader notion of well-being and capability. This is because the consequences are similar to the domains of broader measures such as the ICECAP measures for adults and older people, and the Warwick-Edinburgh Mental Wellbeing Scale. The findings suggest the need for testing whether individuals are informed about the health states they are valuing. Participants valued health by estimating the non-health consequences of health states and these estimates relied on individuals' beliefs about the interaction of the health state and their personal and social circumstances

Proceed with caution: an economic perspective on the UK's value based pricing proposals

The shift from the Pharmaceutical Pricing Regulation Scheme to Value Based Pricing (VBP) is an important change in the way that medicines will be priced, and consequently, reimbursed in the United Kingdom. Whilst the opportunity to purchase new medicines based on value to society is one that should be welcomed, we should proceed with caution. We highlight ten issues that should be considered relating to innovation, the role and meaning of funding threshold and the adjustments to reflect burden of illness, therapeutic innovation and improvement and wider societal factors. Most importantly, the assessment of value should continue to be based on the characteristics of the displaced activities (e.g. the health produced). To a large extent, all that is changing under VBP are the characteristics being considered; weighted health rather than unweighted health. In addition, we should not totally abandon a cost-utility framework for appraisal just because its current formulation does not match the wider perspective now desired by government

Chasing the second gamma-ray bright isolated neutron star: 3EG J1835+5918/RX J1836.2+5925

The EGRET telescope aboard NASAs Compton GRO has repeatedly detected 3EG J1835+5918, a bright and steady source of high-energy gamma-ray emission with no identification suggested until recently. The long absence of any likely counterpart for a bright gamma-ray source located 25 degrees off the Galactic plane initiated several attempts of deep observations at other wavelengths. We report on counterparts in X-rays on a basis of a 60 ksec ROSAT HRI image. In order to conclude on the plausibility of the X-ray counterparts, we reanalyzed data from EGRET at energies above 100 MeV and above 1 GeV, including data up to CGRO observation cycle 7. The gamma-ray source location represents the latest and probably the final positional assessment based on EGRET data. The X-ray counterparts were studied during follow-up optical identification campaigns, leaving only one object to be likely associated with the gamma-ray source 3EG J1835+5918. This object, RX J1836.2+5925, has the characteristics of an isolated neutron star and possibly of a radio-quiet pulsar.Comment: 5 pages, 3 figures. To appear in the Proceedings of the 270. WE-Heraeus Seminar on Neutron Stars, Pulsars and Supernova Remnants, Jan. 21-25, 2002, Physikzentrum Bad Honnef, eds W. Becker, H. Lesch & J. Truemper. Proceedings are available as MPE-Report 27

Lower extremity stiffness: considerations for testing, performance enhancement and injury risk

Force-deformation characteristics of the lower limb have been associated with athletic performance and may modulate the risk of injury. In-spite of these known associations, measurements of lower extremity stiffness are not commonly administered by strength and conditioning coaches. This review provides an overview of the available literature pertaining to the effects of lower extremity stiffness on physical performance and injury risk. Practical methods of monitoring and training stiffness are also discussed. The cumulative body of evidence indicates that increases in lower extremity stiffness are associated with heightened performance in athletic tasks such as hopping, jumping, throwing, endurance running, sprinting and changing direction. Relationships with injury are less conclusive as both excessive and insufficient limb stiffness have been postulated to increase risk. Thus, the ‘optimal’ level of stiffness appears to be dependent on the anthropometry, and physical capabilities of the athlete, in addition to sport-specific activity demands. Training interventions can positively enhance lower extremity stiffness, including isometric, eccentric and isotonic strength training and plyometrics. Complex training also appears to provide a potent stimulus and may be more effective than the use of singular training modes. For plyometric activities, it is recommended that coaches use a developmental sequence of exercises with increasing eccentric demand to provide an appropriate stimulus based on the training age and technical competency of the athlete

EQ-5D in skin conditions: an assessment of validity and responsiveness

Aims and objectives This systematic literature review aims to assess the reliability, validity and responsiveness of three widely used generic preference-based measures of health-related quality of life (HRQL), i.e., EQ-5D, Health Utility Index 3 (HUI3) and SF-6D in patients with skin conditions. Methods A systematic search was conducted to identify studies reporting health state utility values obtained using EQ-5D, SF-6D, or HUI3 alongside other HRQL measures or clinical indices for patients with skin conditions. Data on test-retest analysis for reliability, known group differences or correlation and regression analyses for validity, and change over time or responsiveness indices analysis were extracted and reviewed. Results A total of 16 papers reporting EQ-5D utilities in people with skin conditions were included in the final review. No papers for SF-6D and HUI3 were found. Evidence of reliability was not found for any of these measures. The majority of studies included in the review (12 out of 16) examined patients with plaque psoriasis or psoriatic arthritis and the remaining four studies examined patients with either acne, hidradenitis suppurativa, hand eczema, or venous leg ulcers. The findings were generally positive in terms of performance of EQ-5D. Six studies showed that EQ-5D was able to reflect differences between severity groups and only one reported differences that were not statistically significant. Four studies found that EQ-5D detected differences between patients and the general population, and differences were statistically different for three of them. Further, moderate-to-strong correlation coefficients were found between EQ-5D and other skin-specific HRQL measures in four studies. Eight studies showed that EQ-5D was able to detect change in HRQL appropriately over time and the changes were statistically significant in seven studies. Conclusions Overall, the validity and responsiveness of the EQ-5D was found to be good in people with skin diseases, especially plaque psoriasis or psoriatic arthritis. No evidence on SF-6D and HUI3 was available to enable any judgments to be made on their performance

ASCA observations of the young rotation-powered pulsars PSR B1046-58 and PSR B1610-50

We present X-ray observations of two young energetic radio pulsars, PSRs B1046-58 and B1610-50, and their surroundings, using archival data from the Advanced Satellite for Cosmology and Astrophysics (ASCA). The energetic pulsar PSR B1046-58 is detected in X-rays with a significance of 4.5 sigma. The unabsorbed flux, estimated assuming a power-law spectrum and a neutral hydrogen column density N_H of 5E21 cm^-2 is (2.5 +/- 0.3) x 10E-13 ergs/cm^2/s in the 2-10 keV band. Pulsed emission is not detected; the pulsed fraction is less than 31% at the 90% confidence level for a 50% duty cycle. We argue that the emission is best explained as originating from a pulsar-powered synchrotron nebula. The X-ray counterpart of the pulsar is the only hard source within the 95% error region of the previously unidentified gamma-ray source 3EG J1048-5840. This evidence supports the results of Kaspi et al. (1999), who in a companion paper, suggest that PSR B1046-58 is the counterpart to 3EG J1048-5840. X-ray emission from PSR B1610-50 is not detected. Using similar assumptions as above, the derived 3 sigma upper limit for the unabsorbed 2-10 keV X-ray flux is 1.5E-13 ergs/cm^2/s. We use the flux limit to estimate the pulsar's velocity to be less than ~170 km/s, casting doubt on a previously reported association between PSR B1610-50 and supernova remnant Kes 32. Kes 32 is detected, as is evident from the correlation between X-ray and radio emission. The ASCA images of PSR B1610-50 are dominated by mirror-scattered emission from the X-ray-bright supernova remnant RCW 103, located 33' away. We find no evidence for extended emission around either pulsar, in contrast to previous reports of large nebulae surrounding both pulsars.Comment: Accepted for publication in the ApJ (v.528, pp.436-444) Correcting typo in abstract of .tex fil