Predicting individual patient outcomes using prognostic models in economic evaluations

Objective When estimating incremental quality adjusted life years (QALYs) and costs in economic evaluations, prognostic models can be applied to predict survival times. However, these models do not themselves estimate whether the event, e.g. death or survival, would actually occur or not. When this projection is needed it is important to fully incorporate the uncertainty around it. Study Design and Setting This paper compares two methods for estimating patient specific outcomes. The average probability method uses the mean estimated proportion of survivors at a particular time point and assumes the patients with the longest survival times are the survivors. The second method uses probabilistic sensitivity analysis (PSA) to simulate individual patient outcomes. The two methods are illustrated using a prognostic model for estimating survival in the absence of liver transplantation. Results The mean survival, QALYs, costs and incremental cost-effectiveness ratio (ICER) were similar for the two methods. 95% confidence intervals were slightly wider for survival and QALY estimates and substantially wider for cost and ICER estimates when using PSA to estimate patient outcomes, thus capturing outcome uncertainty at the individual level. Conclusion PSA gives more realistic confidence intervals representing uncertainty than an average probability method and is the recommended method when estimating individual patient outcomes from prognostic models

Engineering Civil Society

Papers originally presented at a conference and workshop

A study of the large-scale infrared emission from a selected dark cloud

An investigation of the infrared emission energetics and embedded population in the rho Ophiuchi dark cloud is summarized. With a distance of approximately 140 pc, the rho Ophiuchi cloud is one of the closest regions of recent star formation. It is also one of the best studied such regions with numerous observations at all wavelengths. The IRAS data of the cloud provided a new glimpse of the overall structure of the cloud. In particular, the interaction of radiation from the Sco-Oph OB Association on the external heating of the cloud was very evident on Skyflux and Survey Co-Add images produced by IRAS. The infrared survey also revealed a number of new embedded sources in the cloud which have subsequently been observed from the ground. An earlier study explored the overall energetics of the cloud using the IRAS data. The main conclusions of that work were: (1) the overall luminosity of the cloud is well explained by the emission of the known B-stars, HD 147889, SR-3, and S1, along with a 15 percent contribution from the external radiation field; (2) the dust physical temperatures were significantly lower than the observed CO gas temperatures; and (3) dust grains are heated to only 10 percent to 20 percent of the total depth into the cloud. This analysis is extended by drawing on data from large-scale CO maps and from near-infrared surveys of the embedded population

Comments on "Venus' spectroscopic phase variation: Implications of the Mariner 10 photographs

From a misinterpretation of Mariner 10 pictures, Chamberlain (1974) constructed a model in which he used horizontal variations in the Venus atmosphere to explain the phase-variation of CO2 absorption at small phase angles. Published observations of spatial variations in CO2 absorption on Venus show that they are too small to explain the phase effect. The question of uniqueness that is, if more than one model can explain the phase-effect observations is discussed. Before this question can be answered, a realistic model that does account for the data must be constructed. No such calculations exist

Improvements to photometry. Part 1: Better estimation of derivatives in extinction and transformation equations

Atmospheric extinction in wideband photometry is examined both analytically and through numerical simulations. If the derivatives that appear in the Stromgren-King theory are estimated carefully, it appears that wideband measurements can be transformed to outside the atmosphere with errors no greater than a millimagnitude. A numerical analysis approach is used to estimate derivatives of both the stellar and atmospheric extinction spectra, avoiding previous assumptions that the extinction follows a power law. However, it is essential to satify the requirements of the sampling theorem to keep aliasing errors small. Typically, this means that band separations cannot exceed half of the full width at half-peak response. Further work is needed to examine higher order effects, which may well be significant

Scintillations during occultations by planets. 1. An approximate theory

Scintillations observed during occultations of both stars and spacecraft by planetary atmospheres are discussed theoretically. The effects of severe flattening of the Fresnel zone or source image by defocusing on occultations are presented, along with temporal power spectra. Other topics discussed include atmospheric turbulence, saturation of scintillation, effects of saturation on occultation curves, and some methods for a more accurate determination of atmospheric structure

Telescience Testbed Program: A study of software for SIRTF instrument control

As a continued element in the Telescience Testbed Program (TTP), the University of Arizona Steward Observatory and the Electrical and Computer Engineering Department (ECE) jointly developed a testbed to evaluate the Operations and Science Instrument System (OASIS) software package for remote control of an instrument for the Space Infrared Telescope Facility (SIRTF). SIRTF is a cryogenically-cooled telescope with three focal plane instruments that will be the infrared element of NASA's Great Observatory series. The anticipated launch date for SIRTF is currently 2001. Because of the complexity of the SIRTF mission, it was not expected that the OASIS package would be suitable for instrument control in the flight situation, however, its possible use as a common interface during the early development and ground test phases of the project was considered. The OASIS package, developed at the University of Colorado for control of the Solar Mesosphere Explorer (SME) satellite, serves as an interface between the operator and the remote instrument which is connected via a network. OASIS provides a rudimentary windowing system as well as support for standard spacecraft communications protocols. The experiment performed all of the functions required of the MIPS simulation program. Remote control of the instrument was demonstrated but found to be inappropriate for SIRTF at this time for the following reasons: (1) programming interface is too difficult; (2) significant computer resources were required to run OASIS; (3) the communications interface is too complicated; (4) response time was slow; and (5) quicklook of image data was not possible

Primordial black holes in non-Gaussian regimes

Primordial black holes (PBHs) can form in the early Universe from the collapse of rare, large density fluctuations. They have never been observed, but this fact is enough to constrain the amplitude of fluctuations on very small scales which cannot be otherwise probed. Because PBHs form only in very rare large fluctuations, the number of PBHs formed is extremely sensitive to changes in the shape of the tail of the fluctuation distribution - which depends on the amount of non-Gaussianity present. We first study how local non-Gaussianity of arbitrary size up to fifth order affects the abundance and constraints from PBHs, finding that they depend strongly on even small amounts of non-Gaussianity and the upper bound on the allowed amplitude of the power spectrum can vary by several orders of magnitude. The sign of the non-linearity parameters (f_{NL}, g_{NL}, etc) are particularly important. We also study the abundance and constraints from PBHs in the curvaton scenario, in which case the complete non-linear probability distribution is known, and find that truncating to any given order (i.e. to order f_{NL} or g_{NL}, etc) does not give accurate results

The clouds of Venus

The physical and chemical properties of the clouds of Venus are reviewed, with special emphasis on data that are related to cloud dynamics. None of the currently-popular interpretations of cloud phenomena on Venus is consistent with all the data. Either a considerable fraction of the observational evidence is faulty or has been misinterpreted, or the clouds of Venus are much more complex than the current simplistic models. Several lines of attack are suggested to resolve some of the contradictions. A sound understanding of the clouds appears to be several years in the future