62 research outputs found
The social value of a QALY : raising the bar or barring the raise?
Background: Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England,
there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether
QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY
(SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were
released during a time of considerable debate about the NICE threshold, and authors with differing perspectives
have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of
results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for
those who conducted the research to contribute to the debate as to its implications for NICE.
Discussion: The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the
current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and
age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents’
answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in
values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values
of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing
the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the
other that greater weight could be given to QALYs gained by some groups.
Summary: Although we conducted only a feasibility study and a modelling exercise, neither present compelling
evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be
moved up for some types of QALY and down for others. While many members of the public appear to be open to
the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have
any secure evidence base for introducing such a system
Dorsal hippocampal involvement in conditioned-response timing and maintenance of temporal information in the absence of the CS
Involvement of the dorsal hippocampus (DHPC) in conditioned-response timing and maintaining temporal information across time gaps was examined in an appetitive Pavlovian conditioning task, in which rats with sham and DHPC lesions were first conditioned to a 15-s visual cue. After acquisition, the subjects received a series of non-reinforced test trials, on which the visual cue was extended (45 s) and gaps of different duration, 0.5, 2.5, and 7.5 s, interrupted the early portion of the cue. Dorsal hippocampal-lesioned subjects underestimated the target duration of 15 s and showed broader response distributions than the control subjects on the no-gap trials in the first few blocks of test, but the accuracy and precision of their timing reached the level of that of the control subjects by the last block. On the gap trials, the DHPC-lesioned subjects showed greater rightward shifts in response distributions than the control subjects. We discussed these lesion effects in terms of temporal versus non-temporal processing (response inhibition, generalisation decrement, and inhibitory conditioning)
Search for Gravitational Waves from Primordial Black Hole Binary Coalescences in the Galactic Halo
We use data from the second science run of the LIGO gravitational-wave
detectors to search for the gravitational waves from primordial black hole
(PBH) binary coalescence with component masses in the range 0.2--.
The analysis requires a signal to be found in the data from both LIGO
observatories, according to a set of coincidence criteria. No inspiral signals
were found. Assuming a spherical halo with core radius 5 kpc extending to 50
kpc containing non-spinning black holes with masses in the range 0.2--, we place an observational upper limit on the rate of PBH coalescence
of 63 per year per Milky Way halo (MWH) with 90% confidence.Comment: 7 pages, 4 figures, to be submitted to Phys. Rev.
Multi-messenger observations of a binary neutron star merger
On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta
Workplace friendships between men: gay men's perspectives and experiences
Challenging the heteronormative bias in the current literature on men’s workplace friendships, this article uses qualitative interview data to explore how gay men understand and experience workplace friendships involving other gay and heterosexual men. Developing a Foucauldian approach, this study suggests that gay men’s experiences and perspectives on workplace friendships can supplant negative stereotypes of men’s friendships, by understanding them as relational sites for developing empowering organizational gay sexualities and genders. From a Foucauldian theoretical orientation, we can examine how gay men can(not) avoid falling into the trap of treating gender and sexuality in dichotomous and heterosexist terms, allowing them and their male work friends to explore new possibilities for workplace friendships that are more gender and sexually complex than is currently assumed. This article advocates future research on this matter as it could potentially enrich extant critical scholarship that has often bathed organizational masculinities in a negative light
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