A methodological framework for assessing agreement between cost-effectiveness outcomes estimated using alternative sources of data on treatment costs and effects for trial-based economic evaluations

A new methodological framework for assessing agreement between cost-effectiveness endpoints generated using alternative sources of data on treatment costs and effects for trial-based economic evaluations is proposed. The framework can be used to validate cost-effectiveness endpoints generated from routine data sources when comparable data is available directly from trial case report forms or from another source. We illustrate application of the framework using data from a recent trial-based economic evaluation of the probiotic Bifidobacterium breve strain BBG administered to babies less than 31 weeks of gestation. Cost-effectiveness endpoints are compared using two sources of information; trial case report forms and data extracted from the National Neonatal Research Database (NNRD), a clinical database created through collaborative efforts of UK neonatal services. Focusing on mean incremental net benefits at £30,000 per episode of sepsis averted, the study revealed no evidence of discrepancy between the data sources (two-sided p values >0.4), low probability estimates of miscoverage (ranging from 0.039 to 0.060) and concordance correlation coefficients greater than 0.86. We conclude that the NNRD could potentially serve as a reliable source of data for future trial-based economic evaluations of neonatal interventions. We also discuss the potential implications of increasing opportunity to utilize routinely available data for the conduct of trial-based economic evaluations

Surface reconstruction of wear in carpets by using a wavelet edge detector

Carpet manufacturers have wear labels assigned to their products by human experts who evaluate carpet samples subjected to accelerated wear in a test device. There is considerable industrial and academic interest in going from human to automated evaluation, which should be less cumbersome and more objective. In this paper, we present image analysis research on videos of carpet surfaces scanned with a 3D laser. The purpose is obtaining good depth Images for an automated system that should have a high percentage of correct assessments for a wide variety of carpets. The innovation is the use of a wavelet edge detector to obtain a more continuously defined surface shape. The evaluation is based on how well the algorithms allow a good linear ranking and a good discriminance of consecutive wear labels. The results show an improved linear ranking for most carpet types, for two carpet types the results are quite significant

Robust Magnetic Polarons in Type-II (Zn,Mn)Te Quantum Dots

We present evidence of magnetic ordering in type-II (Zn, Mn) Te quantum dots. This ordering is attributed to the formation of bound magnetic polarons caused by the exchange interaction between the strongly localized holes and Mn within the dots. In our photoluminescence studies, the magnetic polarons are detected at temperatures up to ~ 200 K, with a binding energy of ~ 40 meV. In addition, these dots display an unusually small Zeeman shift with applied field (2 meV at 10 T). This behavior is explained by a small and weakly temperature-dependent magnetic susceptibility due to anti-ferromagnetic coupling of the Mn spins

Anatomical and functional visual network patterns in progressive multiple sclerosis

The gradual accrual of disability over time in progressive multiple sclerosis is believed to be driven by widespread degeneration. Yet another facet of the problem may reside in the loss of the brain's ability to adapt to the damage incurred as the disease progresses. In this study, we attempted to examine whether changes associated with optic neuritis in the structural and functional visual networks can still be discerned in progressive patients even years after the acute insult. Forty-eight progressive multiple sclerosis patients, 21 with and 27 without prior optic neuritis, underwent structural and functional MRI, including DTI and resting state fMRI. Anatomical and functional visual networks were analyzed using graph theory-based methods. While no functional metrics were significantly different between the two groups, anatomical global efficiency and density were significantly lower in the optic neuritis group, despite no significant difference in lesion load between the groups. We conclude that long-standing distal damage to the optic nerve causes trans-synaptic effects and the early ability of the cortex to adapt may be altered, or possibly nullified. We suggest that this limited ability of the brain to compensate should be considered when attempting to explain the accumulation of disability in progressive multiple sclerosis patients

Physical activity and health related quality of life

Copyright @ 2012 Anokye et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: Research on the relationship between Health Related Quality of Life (HRQoL) and physical activity (PA), to date, have rarely investigated how this relationship differ across objective and subjective measures of PA. The aim of this paper is to explore the relationship between HRQoL and PA, and examine how this relationship differs across objective and subjective measures of PA, within the context of a large representative national survey from England. METHODS: Using a sample of 5,537 adults (40–60 years) from a representative national survey in England (Health Survey for England 2008), Tobit regressions with upper censoring was employed to model the association between HRQoL and objective, and subjective measures of PA controlling for potential confounders. We tested the robustness of this relationship across specific types of PA. HRQoL was assessed using the summary measure of health state utility value derived from the EuroQol-5 Dimensions (EQ-5D) whilst PA was assessed via subjective measure (questionnaire) and objective measure (accelerometer- actigraph model GT1M). The actigraph was worn (at the waist) for 7 days (during waking hours) by a randomly selected sub-sample of the HSE 2008 respondents (4,507 adults – 16 plus years), with a valid day constituting 10 hours. Analysis was conducted in 2010. RESULTS: Findings suggest that higher levels of PA are associated with better HRQoL (regression coefficient: 0.026 to 0.072). This relationship is consistent across different measures and types of PA although differences in the magnitude of HRQoL benefit associated with objective and subjective (regression coefficient: 0.047) measures of PA are noticeable, with the former measure being associated with a relatively better HRQoL (regression coefficient: 0.072). CONCLUSION: Higher levels of PA are associated with better HRQoL. Using an objective measure of PA compared with subjective shows a relatively better HRQoL.This project was funded by the NIHR Health Technology Assessment programme (project number 08/72/01)

Axon initial segment dysfunction in a mouse model of human genetic epilepsy with febrile seizures plus

Febrile seizures are a common childhood seizure disorder and a defining feature of genetic epilepsy with febrile seizures plus (GEFS+), a syndrome frequently associated with Na+ channel mutations. Here, we describe the creation of a knockin mouse heterozygous for the C121W mutation of the ß1 Na+ channel accessory subunit seen in patients with GEFS+. Heterozygous mice with increased core temperature displayed behavioral arrest and were more susceptible to thermal challenge than wild-type mice. Wild-type ß1 was most concentrated in the membrane of axon initial segments (AIS) of pyramidal neurons, while the ß1(C121W) mutant subunit was excluded from AIS membranes. In addition, AIS function, an indicator of neuronal excitability, was substantially enhanced in hippocampal pyramidal neurons of the heterozygous mouse specifically at higher temperatures. Computational modeling predicted that this enhanced excitability was caused by hyperpolarized voltage activation of AIS Na+ channels. This heat-sensitive increased neuronal excitability presumably contributed to the heightened thermal seizure susceptibility and epileptiform discharges seen in patients and mice with ß1(C121W) subunits. We therefore conclude that Na+ channel ß1 subunits modulate AIS excitability and that epilepsy can arise if this modulation is impaired

The Shape and Figure Rotation of NGC 2915's Dark Halo

NGC 2915 is a blue compact dwarf galaxy with a very extended HI disk showing a short central bar and extended spiral arms, both reaching far beyond the optical component. We use Tremaine & Weinberg (1984) method to measure the pattern speed of the bar from HI radio synthesis data. Our measurements yield a pattern speed of 0.21+/-0.06 km/s/arcsec (8.0+/-2.4 km/s/kpc for D=5.3 Mpc), in disagreement with the general view that corotation in barred disks lies just outside the end of the bar, but consistent with recent models of barred galaxies with dense dark matter halos. Our adopted bar semi-length puts corotation at more than 1.7 bar radii. The existence of the pattern is also problematic. Because NGC 2915 is isolated, interactions cannot account for the structure observed in the HI disk. We also demonstrate that the low observed disk surface density and the location of the pseudo-rings make it unlikely that swing amplification or bar-driven spiral arms could explain the bar and spiral pattern. Based on the similarity of the dark matter and HI surface density profiles, we discuss the possibility of dark matter distributed in a disk and following closely the HI distribution. The disk then becomes unstable and can naturally form a bar and spiral pattern. However, this explanation is hard to reconcile with some properties of NGC 2915. We also consider the effect of a massive and extended triaxial dark matter halo with a rotating figure. The existence of such halos is supported by CDM simulations showing strongly triaxial dark halos with slow figure rotation. The observed structure of the HI disk can then arise through forcing by the rotating triaxial figure. We associate the measured pattern speed in NGC 2915 with the figure rotation of its dark halo.Comment: 37 pages, including 8 figures and 2 tables (AASTeX, aaspp4.sty). Fig.1 and 2 available as jpg. Accepted for publication in The Astronomical Journal. Online manuscript with PostScript figures available at: http://www.strw.leidenuniv.nl/~bureau/pub_list.htm

Health-state utilities in a prisoner population : a cross-sectional survey

Background: Health-state utilities for prisoners have not been described. Methods: We used data from a 1996 cross-sectional survey of Australian prisoners (n = 734). Respondent-level SF-36 data was transformed into utility scores by both the SF-6D and Nichol's method. Socio-demographic and clinical predictors of SF-6D utility were assessed in univariate analyses and a multivariate general linear model. Results: The overall mean SF-6D utility was 0.725 (SD 0.119). When subdivided by various medical conditions, prisoner SF-6D utilities ranged from 0.620 for angina to 0.764 for those with none/mild depressive symptoms. Utilities derived by the Nichol's method were higher than SF-6D scores, often by more than 0.1. In multivariate analysis, significant independent predictors of worse utility included female gender, increasing age, increasing number of comorbidities and more severe depressive symptoms. Conclusion: The utilities presented may prove useful for future economic and decision models evaluating prison-based health programs

The development and application of a new tool to assess the adequacy of the content and timing of antenatal care

Abstract Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care. Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from ‘Inadequate’ (both tools) to ‘Adequate plus’ (APNCU) or ‘Appropriate’ (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools. Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as ‘Adequate’ or ‘Adequate plus’ by the APNCU were deemed ‘Inadequate’ by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care. Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as ‘Inappropriate’. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure