The relationship between EQ-5D, HAQ and pain in patients with rheumatoid arthritis: further validation and development of the limited dependent variable, mixture model approach

Objective To provide robust estimates of EQ-5D as a function of the Health Assessment Questionnaire (HAQ) and pain in patients with rheumatoid arthritis. Method Repeated observations of patients diagnosed with RA in a US observational cohort (n=100,398 observations) who provided data on HAQ, pain on a visual analogue scale and the EQ-5D questionnaire. We use a bespoke mixture modelling approach to appropriately reflect the characteristics of the EQ-5D instrument and compare this to results from linear regression. Results The addition of pain alongside HAQ as an explanatory variable substantially improves explanatory power. The preferred model is a four component mixture. Unlike the linear regression it exhibits very good fit to the data, does not suffer from problems of bias or predict values outside the feasible range. Conclusions It is appropriate to model the relationship between HAQ and EQ-5D but only if suitable statistical methods are applied. Linear models underestimate the QALY benefits, and therefore the cost effectiveness, of therapies. The bespoke mixture model approach outlined here overcomes this problem. The addition of pain as an explanatory variable greatly improves the estimates

A comparison of direct and indirect methods for the estimation of health utilities from clinical outcomes

Background: Analysts often need to estimate health state utility values as a function of other outcome measures. Utility values like EQ-5D have several unusual characteristics that make standard statistical methods inappropriate. We have developed a bespoke approach based on mixture models to directly estimate EQ-5D. An indirect method, “response mapping”, first estimates the level on each of the five dimensions of the EQ-5D descriptive system and then calculates the expected tariff score. These methods have never previously been compared. Methods: We use a large observational database of patients diagnosed with Rheumatoid Arthritis (n=100,398 observations). Direct estimation of UK EQ-5D scores as a function of Health Assessment Questionnaire (HAQ), pain and age was performed using a limited dependent variable mixture model. Indirect modelling was undertaken using a set of generalized ordered probit models with expected tariff scores calculated mathematically. Linear regression was reported for comparison purposes. Results: The linear model fits poorly, particularly at the extremes of the distribution. Both the bespoke mixture model and the generalized ordered probit approach offer improvements in fit over the entire range of EQ-5D. Mean average error is 10% and 5% lower compared to the linear model respectively. Root mean squared error is 3% and 2% lower. The mixture model demonstrates superior performance to the indirect method across almost the entire range of pain and HAQ. Limitations: There is limited data from patients in the most extreme HAQ health states. Conclusions: Modelling of EQ-5D from clinical measures is best performed directly using the bespoke mixture model. This substantially outperforms the indirect method in this example. Linear models are inappropriate, suffer from systematic bias and generate values outside the feasible range

Developing collaborative partnerships with culturally and linguistically diverse families during the IEP process

Family participation in the special education process has been federally mandated for 40 years, and educators recognize that effective collaboration with their students’ families leads to improved academic and social outcomes for students. However, while some family-school relationships are positive and collaborative, many are not, particularly for culturally and linguistically diverse (CLD) families. This article provides practice guidelines based in research for teachers who seek to improve their practices when working with CLD families who have children served by special education

Separating the Effects of Hemodialysis Dose and Nutrition: In Search of the Optimal Dialysis Dose

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73859/1/j.1525-139X.1999.90218.x.pd

How Will the Results of the HEMO Study Impact Dialysis Practice?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71984/1/j.1525-139X.2003.03003_3.x.pd

Costs Associated with Voluntary Speed Reduction Requests In Central California Marine Sanctuaries To Protect Endangered Whales

International trade is vital to the U.S. economy. As waterborne traffic accounts for about 40 percent of all international cargo value and 70 percent of international tonnage, regulatory changes involving waterborne transportation may significantly impact the United States (US) economy on both local and national levels. A Voluntary Speed Reduction (VSR) program reduces vessel speeds off the central coast of California for vessels 300 gross tons and larger from May 1st to November 15th to protect whales and other marine mammals. This study investigates the magnitude of changes in vessel costs associated with VSR requests. This analysis contributes to the literature through more comprehensive estimation of the private and societal impacts that include vessel main propulsion fuel use, vessel auxiliary power fuel use, vessel capital cost, vessel administrative and overhead cost, container capital cost, inventory carrying cost and societal cost from emissions from main propulsion fuel and auxiliary fuel use. Calculations suggest full compliance with NOAA 10-knot speed limitations for all vessel types in VSR zones results in an annual increase of costs to vessel operators and a concurrent reduction in societal costs due to lowered emissions. Net annual costs are estimated to increase about $3.5 million. This represents a 1.3 percent increase in total annual costs within the VSR. If container vessels were allowed a minimum 12-knot speed, added annual cost increases of$2.1 million would be expected, representing about a 0.8 percent increase. Average vessel transit distances within the VSR represent only a minor portion of overall transit distances. With total trip distances between San Francisco and Vancouver, BC (695 miles), Hawaii (2,500 miles), Shanghai (5,337 miles), Singapore (7,337 miles), added trip cost within the VSR amortized across the entire length of the voyage would result in de minimis increases

Plasmas in Saturn's magnetosphere

The solar wind plasma analyzer on board Pioneer 2 provides first observations of low-energy positive ions in the magnetosphere of Saturn. Measurable intensities of ions within the energy-per-unit charge (E/Q) range 100 eV to 8 keV are present over the planetocentric radial distance range about 4 to 16 R sub S in the dayside magnetosphere. The plasmas are found to be rigidly corotating with the planet out to distances of at least 10 R sub S. At radial distances beyond 10 R sub S, the bulk flows appear to be in the corotation direction but with lesser speeds than those expected from rigid corotation. At radial distances beyond the orbit of Rhea at 8.8 R sub S, the dominant ions are most likely protons and the corresponding typical densities and temperatures are 0.5/cu cm and 1,000,000 K, respectively, with substantial fluctuations. It is concluded that the most likely source of these plasmas in the photodissociation of water frost on the surface of the ring material with subsequent ionization of the products and radially outward diffusion. The presence of this plasma torus is expected to have a large influence on the dynamics of Saturn's magnetosphere since the pressure ratio beta of these plasmas approaches unity at radial distances as close to the planet as 6.5 R sub S. On the basis of these observational evidences it is anticipated that quasi-periodic outward flows of plasma, accompanied with a reconfiguration of the magnetosphere beyond about 6.5 R sub S, will occur in the local night sector in order to relieve the plasma pressure from accretion of plasma from the rings

Genomic prediction and quantitative trait locus discovery in a cassava training population constructed from multiple breeding stages

Open Access Article; Published online: 11 Dec 2019Assembly of a training population (TP) is an important component of effective genomic selection‐based breeding programs. In this study, we examined the power of diverse germplasm assembled from two cassava (Manihot esculenta Crantz) breeding programs in Tanzania at different breeding stages to predict traits and discover quantitative trait loci (QTL). This is the first genomic selection and genome‐wide association study (GWAS) on Tanzanian cassava data. We detected QTL associated with cassava mosaic disease (CMD) resistance on chromosomes 12 and 16; QTL conferring resistance to cassava brown streak disease (CBSD) on chromosomes 9 and 11; and QTL on chromosomes 2, 3, 8, and 10 associated with resistance to CBSD for root necrosis. We detected a QTL on chromosome 4 and two QTL on chromosome 12 conferring dual resistance to CMD and CBSD. The use of clones in the same stage to construct TPs provided higher trait prediction accuracy than TPs with a mixture of clones from multiple breeding stages. Moreover, clones in the early breeding stage provided more reliable trait prediction accuracy and are better candidates for constructing a TP. Although larger TP sizes have been associated with improved accuracy, in this study, adding clones from Kibaha to those from Ukiriguru and vice versa did not improve the prediction accuracy of either population. Including the Ugandan TP in either population did not improve trait prediction accuracy. This study applied genomic prediction to understand the implications of constructing TP from clones at different breeding stages pooled from different locations on trait accuracy