The Implications of Linking Questions within the SG and TTO Methods

We consider the impact of introducing intermediate stages, chained together, into the Standard Gamble (SG) and Time Trade-Off (TTO) methods. We broadly replicate the patterns of responses observed in other SG studies. Less is known about the impact of intermediate stages, chained together, in the TTO method. We find that the TTO responses do not replicate the patterns found in the SG responses. We discuss additional issues that are brought to bear in the TTO responses compared to the SG responses and consider whether these can account for the different results.Standard Gamble, Time Trade-Off, Chaining

The Time Trade-Off Method: An Exploratory Study

In a pilot study we investigate whether the inferences we draw about people's preferences towards health care treatments are altered if we vary the procedure that is used to elicit these preferences. In a conventional Time Trade-Off question, respondents express their preferences towards treatment by comparing a period of ill-health with a shorter period in a higher quality of life. In our less conventional TTO question, we vary the procedure by asking respondents their preferences towards treatment by comparing a period of ill-health with a longer period in a lower quality of life. The quantitative data is equivocal about whether preferences for treatment differ between the conventional and unconventional questions. The qualitative data support the notion of contrasting issues in questions that involve prolonging time in a more severe quality of life and appear to account for a failure to find quantitative differences in all of the questions.Time Trade-Off, Procedural invariance

Aztec elements in 20th century Mexican drama

Dissertation (Ph.D.)--University of Kansas, Spanish and Portuguese, 1974

Are Some Deaths Worse Than Others? The Effect of 'Labelling' on People's Perceptions

This paper sets out to explore the extent to which perceptions regarding the 'badness' of different types of deaths differ according to how those deaths are 'labelled' in the elicitation procedure. In particular, we are interested in whether responses to 'contextual' questions - where the specific context in which the deaths occur is known - differ from 'generic' questions - where the context is unknown. Further, we set out to test whether sensitivity to the numbers of deaths differs across the 'generic' and 'contextual' versions of the questions. We uncover evidence to suggest that both the perceived 'badness' of different types of deaths and sensitivity to the numbers of deaths may differ according to whether 'generic' or 'contextual' descriptions are used. Qualitative data suggested two reasons why responses to 'generic' and 'contextual' questions differed: firstly, some influential variables were omitted from the 'generic' descriptions and secondly, certain variables were interpreted somewhat differently once the context had been identified. The implications of our findings for 'generic' questions, such as those commonly used in health economics (for example, the EQ 5D), are discussed.Preferences, Context effects, Affect heuristic

The role of psychological variables in pain report in children undergoing fixed appliance orthodontic treatment

The present study aimed to 1) examine the relationship between psychological factors (self esteem, child and parental anxiety, locus of control, family environment, expectation of pain, motivation to receive treatment) and pain report in children undergoing fixed appliance orthodontic therapy; 2)identify the specific factors which help to predict pain report; 3) to investigate the use and value of enhancing children's control/coping with pain when they are having fixed appliance orthodontic therapy. This research was considered to be clinically relevant as pain due to the appliance has been found to be a one of the major causes of discontinuation of treatment. This results in a lack of gain for the individual in addition to unnecessary cost to the health service. It was anticipated that knowledge gained from this research may help dentists to target individuals who are at increased risk of suffering more distress or of discontinuing their treatment. Over forty parents and children participated in the study. Questionnaires examining the various psychological factors were given to children and their parents. In addition children were asked to keep a diary of their experience of wearing their brace until they no longer felt any discomfort.Results indicate that psychological factors which may influence the acute dental pain reported in the first few days of wearing the appliance are different to those influencing longer lasting pain.Pain report over the initial few days appeared to be influenced by factors internal to the child (self esteem , locus of control, child trait anxiety and expectation of pain), however as time went on external factors became more important (family environment and parental state and trait anxiety). Three subscales from the Harter Self Esteem Questionnaire were found to account for a substantial amount of the variance in pain report over the first few days of wearing the appliance. The extent to which an individual attributed orthodontic status and treatment to chance also contributed significantly to the variance of pain reported over this time. Parental anxiety and cultural-intellectual orientation of the family as a whole contributed significantly to the variation in how long pain was reported for.Children who were given additional information about ways to cope with pain reported no less pain that children who were not given this information. Results were discussed with reference to possible future research

Speech intelligibility in the classroom: effects of listener age and teacher voice

The purpose of this study was to determine if listener age (graduate students vs. third graders) and teacher voice (three teachers) affected word recognition in atypical classroom. For the graduate students, word recognition scores were uniformly good at all locations within the classroom and for all three teachers.For the third graders, word recognition scores were significantly poorer than for the graduate students. The word recognition scores depended complexly on the teacher\u27s speaking voice and her ability to control the noise in the classroom. It Also depended on the classroom row, with word recognition being poorest in the lastrow. The results of the present study provide evidence that acquisition of listening skills is not complete by third grade and that the lack of maturation/ability combines with factors related to the teacher\u27s voice and the classroom acoustics to reduce word recognition.The acoustic characteristics of the classroom did not meet ASHA criteria,however the characteristics of the classroom were good in comparison to classrooms described by other investigators. The results suggest that if classrooms,such as the test classroom, are to be used in the future, there is the need to understand the interaction of acoustic characteristics with talker and listener factors.An alternative approach would be to improve the listening environment with classroom amplification systems or FM systems to overcome the problems created by talker and listener factors in poor acoustic environments

Alexithymia and facial emotion recognition ability: An embodied hot and cold simulation perspective

Difficulty with knowing or identifying one’s internal feeling states is considered the hallmark feature of the personality construct of alexithymia. It is currently unclear, however, whether alexithymia also involves difficulty recognising external emotion cues, such as facial expressions of emotion. Facial expressions provide salient cues about one’s feelings, intentions and motivations that allow us to navigate our social contexts. Better facial emotion recognition is associated with positive outcomes across psychological, social and physical health domains. Typically, the ability to recognise facial emotions has been assessed using cognitive tests underpinned by the traditional cognitive science perspective which postulates that our conceptual knowledge of emotion is stored as symbolic representations within the semantic memory network. Yet, the neuroscientific discovery of sensory-motor mirror neurons has led to embodied accounts of cognition that assume motor and somatosensory systems within the brain are also involved in recognising others’ emotion, with mirror neuron activity producing a re-experiencing or simulation of the observed emotion of the other in one’s self. The primary aim of this dissertation was to examine facial emotion recognition and alexithymia from a broad theoretical perspective. As the small number of previous studies on facial emotion recognition and alexithymia are mostly derived from the cognitive science perspective, this thesis included the embodied cognition theoretical viewpoint. In a series of six experiments, university students were assigned to three groups based on their scores on the Toronto Alexithymia Scale (TAS-20). Participants with TAS-20 scores above the clinical cut-off were divided into two groups, a ‘High Alexithymia’ group (HA) and a ‘Moderate Alexithymia’ group (MA), using median split for a comparison of mean scores. A control group comprised students with TAS-20 scores in the normal range. To reduce the confounding of results due to variables known to impair facial emotion recognition performance, all participants with clinical range scores on the Depression and Anxiety Scales (DASS) were excluded from participation. Significant differences were found between the HA and MA groups on various measures of performance in most of these experiments, using a different sample of participants for each experiment. Experiment 1(a) examined the ability to accurately and rapidly identify dynamic facial expressions. Performance on this task is assumed to depend upon explicit access to schematic representations of emotion, which are proposed to be impoverished or unavailable to consciousness in individuals with alexithymia. While previous studies have typically utilised static stimuli, dynamic stimuli were used to provide ecological validity and to increase the level of task difficulty. Experiment 1(a) found that the HA and MA groups combined were significantly less accurate and slower to recognise facial expressions than controls. An unexpected finding was that the HA group were faster (but as accurate) on the task than the MA group. It was thought that addressing the question of how groups perform under dynamic and static conditions might help to clarify this unusual pattern of results. This assumption was based on prior research findings suggesting that static faces are processed using motor simulation and dynamic faces using emotion simulation. Experiment 1(b) presented the same task as Experiment 1(a) under Static and Dynamic conditions. The results of Experiment 1(a) were replicated in the Dynamic condition of Experiment 1(b), with a different group of participants. Importantly, while the HA group were significantly faster to recognise facial expressions than the MA group under Dynamic conditions, these groups performed with equivalent speed under Static conditions. It was argued that this result is consistent with the idea that the HA group relied on the recruitment of motor-simulation processes to improve their performance in Experiments 1(a) and 1(b). A difficulty in interpreting the above studies is that the task itself relies upon linguistic processes. To reduce the possibility of a verbal deficit accounting for the results, Experiment 2 (a and b) required participants to make ‘same’ or ‘different’ discriminations of two static facial expression stimuli of high or low intensity of expression. No differences were found between groups in Experiment 2(a). Experiment 2(b) then increased the level of task difficulty by employing low intensity of expression stimuli. This was done to address the potential issue of using shallow information-processing strategies to perform the discrimination task. Results showed that while the HA group was less accurate than the MA group and controls, the MA group was slower than the HA group and controls. It was argued that the difficult task conditions of Experiment 2(b) involving degraded stimuli may have prompted the use of a compensatory motor-based strategy among the HA group, resulting in the facilitation of their speed, but not accuracy, to discriminate facial expressions, relative to the MA group. Experiment 3 (a and b) examined facial emotion recognition from an embodied cognition perspective that allowed the examination of facial mimicry, which refers to congruent ‘micro-expressions’ of facial muscle activity that putatively support the recognition of others’ emotions. In Experiment 3(a), controls produced a greater amount of facial mimicry than the groups with clinical range TAS-20 scores and the HA group produced more mimicry the MA group. In addition, while the HA group and controls produced greater amounts of mimicry in the Happy condition than the Anger condition, the MA group produced equivalently low amounts of smile and frown facial reactions in both Expression conditions. It has been suggested that facial mimicry may not be an exclusively automatic reaction but rather depends on a number of goal-directed or top-down factors. Experiment 3(b) thus sought to further our understanding of these factors by exploring differences in performance following manipulation of the instruction given to participants. Within group comparisons showed that while controls produced a significant increase in frown facial mimicry when asked to adopt the observed emotion (Emotion Simulation condition) than when they passively viewed dynamic faces, the HA group produced similar levels of facial mimicry across the instruction conditions, while the MA group produced less frown facial mimicry in the Emotion Simulation condition than the Passive Viewing condition. It was argued this pattern of results is also consistent with the idea that the HA group employ a compensatory strategy involving the enhanced recruitment of action relevant simulation. It was also argued that the decrease in frown facial mimicry by the MA group only in response to the instruction to simulate anger may indicate that they rely instead on context dependent implicit learning of facial mimicry responses. A potential limitation of these experiments is the allocation of participants to categorical groups based on extreme TAS-20 total scores. On-going investigation of potential subtypes in alexithymia is clearly an important issue for future research. This series of experiments confirm that facial emotion recognition, discrimination and facial mimicry processes are detrimentally affected in alexithymia. This thesis also demonstrates the importance and utility of integrating notions of embodied forms of emotional processing into the conceptual framework of alexithymia and acts as a basis to prompt new treatment strategies for alexithymia based on simulation principles

Testing the Additive Independence Assumption in the QALY Model

Quality-Adjusted Life Years (QALYs) estimate the utility derived from health states by taking account of life expectancy and quality of life. In applying QALYs to situations where health varies over time, it is usual to assume that we can add the utilities from constituent health states. This assumption of additive independence has been challenged by research suggesting that people's preferences for health states are affected by the sequence in which health states occur. This paper investigates two tests of additive independence as well as a test of the consistency of preferences over time. The main test of additive independence is based on a new method using stylised health profiles of deteriorating, improving or temporarily-improving health. The advantage of this new method is that the test relies only on a comparison of health states occurring in the same time period and therefore controls for the effects of time preference. The other test of additive independence determines whether people strictly prefer one type of health profile over another and collects qualitative data on the issues considered by people in these choices. In the main test of additive independence, only one of the two cases considered detected a statistical difference. In the other test of additive independence, the sample was split almost equally between those strictly preferring one or other of the choices. The qualitative data revealed contrasting viewpoints about the benefits derived from such choices which led to this split. The paper also found that preferences were consistent over time. The tests of additive independence were, therefore, unable to conclusively reject additive independence.Utility measurement, Additive independence, Health profiles

Tests of Utility Independence When Health Varies over Time

In the conventional QALY model, people's preferences are assumed to satisfy utility independence. When health varies over time, utility independence implies that the value attached to a health state is independent of the health state that arise before or after it. In this paper we set out to test the extent to which utility independence is undermined by sequence and duration effects. Two separate studies were conducted involving a total of 155 respondents. In study one, we conducted 5 tests of utility independence using a standard gamble question. Three of the tests of utility independence were repeated in study two after randomisation was introduced in order to take account of possible ordering effects. Utility independence holds in the majority of cases examined here and so our work generally supports the use of utility independence to derive more tractable models.Utility independence, QALY

The use of risk-based discrete choice experiments to capture preferences over health states

Discrete choice experiments (DCEs) allow a number of characteristics to be traded-off against one another. An overriding methodological challenge faced is how best to apply DCEs to questions involving those attributes commonly used in value elicitation exercises such as risk, time (Bansback et al. 2012) and numbers treated (Robinson et al, 2010). Flynn (2010) concluded that in developing the methods, it was important to understand more fully the preferences of individual respondents. The study reported here sets out to provide such insights by enhancing a DCE design with additional questions that allow utility values to be derived at the individual level also. The DCE presented respondents with eight pairwise risky choices to estimate aggregate utility values for three EQ-5D health states, ranging from mild to severe. The design allowed the elicitation of utility values for worse-than-dead states. Risk was represented using the stimulus used by EuroVaQ (http://research.ncl.ac.uk/eurovaq/). Three main devices were used to collect additional individual level data. Firstly we included six additional DCE questions that were not used to estimate the aggregate DCE model but allowed the utility value of one health state to be estimated at the level of the individual. These six questions provided more extensive tests of the internal consistency of the pairwise choices undertaken in the DCE. Secondly, respondents were asked three questions where the risk in one of the two treatments was fixed, and they set the risk of the other treatment (a modified SG question). These questions then allowed us to estimate utility values for all three health states. Finally, we collected respondents risk attitudes using Kuilen and Wakker's 2011 measure. We collected data on a convenient sample of 59 students studying Economics or Geography at the University of London and Exeter in 2011/12. Preliminary results show that 22 of the 59 respondents gave a series of DCE responses that were internally inconsistent. We report here the implications of the results for the inclusion of risk as an attribute in DCEs and for preference elicitation more broadly