Using the EQ-5D as a performance measurement tool in the NHS

In a landmark move, the UK Department of Health (DH) is introducing the routine use of Patient Reported Outcome Measures (PROMs) as a means of measuring the performance of health care providers in improving patient health. From April 2009 all patients will be asked to complete both generic (EQ-5D) and condition specific PROMs before and after surgery for four elective procedures; the intention is to extend this to a wide range of other NHS services. The aim of this paper is to report analysis of the EQ-5D data generated from a pilot study commissioned by the DH, and to consider the implications of the results for their use as performance indicators and measures of patient benefit. The EQ-5D has the potential advantage in the context of PROMs of enabling comparisons of performance across services as well as between providers; and in facilitating assessments of the cost effectiveness of NHS services. We present two new methods we have developed for analysing and displaying EQ-5D profile data: a Paretian Classification of Health Change, and a Health Profile Grid. Using these methods, we show that EQ-5D data can readily be used to generate useful insights into differences between providers in improving overall changes in health; results are also suggestive of striking differences in changes in health between surgical procedures. We conclude by noting a number of issues that remain to be addressed in the use of PROMs data as a basis for performance indicators

Deriving preference-based single indices from non-preference based condition-specific instruments: Converting AQLQ into EQ5D indices

Suppose that one has a clinical dataset with only non-preference-based QOL data, and that one nevertheless would like to perform a cost/QALY analysis. This study reports on some efforts to establish a "mapping" relationship between AQLQ (a non-preference-based QOL instrument for asthma) and EQ5D (a preference-based generic instrument). Various methods are described in terms of associated assumptions regarding the measurement properties of the instruments. This is followed by empirical mapping, based on regressing EQ5D on AQLQ. Six main regression models and two supplementary models are identified, and the regressions carried out. Performance of each model is explored in terms of goodness of fit between observed and predicted values, and of robustness of predictions on external data. The results show that it is possible to predict mean EQ5D indices given AQLQ data. The general implications for methods of mapping non-preference-based instruments onto preference-based measures are discussed

The Knowledge of the Grid: A Grid Ontology

This paper presents a knowledge architecture and set of ontologies that can be used as the foundation to facilitate the matching of abstract resource requests to services and resources, to determine the functional equivalence of Grid middle wares and deployments and to allow the description of ‘hybrid’ compound Grids composed of individual heterogeneous Grids. This is necessary as in all these cases what is required is mediation between different views or descriptions of Grids, which requires a formal reference vocabulary. We present a framework and ontologies for achieving this

Deriving preference-based single indices from non-preference based condition-specific instruments: converting AQLQ into EQ5D indices

Suppose that one has a clinical dataset with only non-preference-based QOL data, and that one nevertheless would like to perform a cost/QALY analysis. This study reports on some efforts to establish a “mapping” relationship between AQLQ (a non-preference-based QOL instrument for asthma) and EQ5D (a preference-based generic instrument). Various methods are described in terms of associated assumptions regarding the measurement properties of the instruments. This is followed by empirical mapping, based on regressing EQ5D on AQLQ. Six main regression models and two supplementary models are identified, and the regressions carried out. Performance of each model is explored in terms of goodness of fit between observed and predicted values, and of robustness of predictions on external data. The results show that it is possible to predict mean EQ5D indices given AQLQ data. The general implications for methods of mapping non-preference-based instruments onto preference-based measures are discussed.EQ5D; AQLQ; mapping

Measurement of Synchrotron x-ray energies and line shapes using diffraction markers

Standard reference markers for accurate, reproducible synchrotron x-ray energies are obtained using a three Si crystal spectrometer. The first two crystals are in the monochromator and the third is used to obtain diffraction markers which monitor the energy. Then for any value of the glancing angle on the reference Si crystal the energy for the (333) diffraction must occur at 3/4 that of the (444) and 3/5 of that for the (555). This establishes for the first time an absolute synchrotron energy scale. Higher-order diffractions are used to determine excitation line profiles. We conclude that the use of reference diffractions is necessary to measure reproducible x-ray energies and to analyze the incident photons\u27 line profile. The detection of diffractions near the edge of measurement and near the Cu edge will provide a fast secondary standard which will allow comparison of edge data between different laboratories. The diffraction profiles will allow the proper analysis of spectral line widths

Temperature- and Bias-dependence of magnetoresistance in doped manganite thin film trilayer junctions

Thin film trilayer junction of La$$Sr$_{0.33}$MnO$_3$ - SrTiO$_3$ - La$_{0.67}$Sr$_{0.33}$MnO$_3$ shows a factor of 9.7 change in resistance, in a magnetic field around 100 Oe at 14K. The junction magnetoresistance is bias and temperature dependent. The energy scales associated with bias and temperature dependence are an order of magnitude apart. The same set of energies also determine the bias and temperature dependence of the differential conductance of the junction. We discuss these results in terms of metallic cluster inclusions at the junction-barrier interface.Comment: 3 pages, 4 figure

Trust economics feasibility study

We believe that enterprises and other organisations currently lack sophisticated methods and tools to determine if and how IT changes should be introduced in an organisation, such that objective, measurable goals are met. This is especially true when dealing with security-related IT decisions. We report on a feasibility study, Trust Economics, conducted to demonstrate that such methodology can be developed. Assuming a deep understanding of the IT involved, the main components of our trust economics approach are: (i) assess the economic or financial impact of IT security solutions; (ii) determine how humans interact with or respond to IT security solutions; (iii) based on above, use probabilistic and stochastic modelling tools to analyse the consequences of IT security decisions. In the feasibility study we apply the trust economics methodology to address how enterprises should protect themselves against accidental or malicious misuse of USB memory sticks, an acute problem in many industries

Magnetoresistance due to Domain Walls in Micron Scale Fe Wires with Stripe Domains

The magnetoresistance (MR) associated with domain boundaries has been investigated in microfabricated bcc Fe (0.65 to 20 $\mu$m linewidth) wires with controlled stripe domains. Domain configurations have been characterized using magnetic force microscopy. MR measurements as a function of field angle, temperature and domain configuration are used to estimate MR contributions due to resistivity anisotropy and domain walls. Evidence is presented that domain boundaries enhance the conductivity in such microstructures over a broad range of temperatures (1.5 K to 80 K).Comment: 8 pages, 3 postscript figures, and 2 jpg images (Fig 1 and 2) to appear in IEEE Transactions on Magnetics (Fall 1998

The 2.35 year itch of Cyg OB2 #9. II. Radio monitoring

Cyg OB2 #9 is one of a small set of non-thermal radio emitting massive O-star binaries. The non-thermal radiation is due to synchrotron emission in the colliding-wind region. Cyg OB2 #9 was only recently discovered to be a binary system and a multi-wavelength campaign was organized to study its 2011 periastron passage. We report here on the results of the radio observations obtained in this monitoring campaign. We used the Expanded Very Large Array (EVLA) radio interferometer to obtain 6 and 20 cm continuum fluxes. The observed radio light curve shows a steep drop in flux sometime before periastron. The fluxes drop to a level that is comparable to the expected free-free emission from the stellar winds, suggesting that the non-thermal emitting region is completely hidden at that time. After periastron passage, the fluxes slowly increase. We introduce a simple model to solve the radiative transfer in the stellar winds and the colliding-wind region, and thus determine the expected behaviour of the radio light curve. From the asymmetry of the light curve, we show that the primary has the stronger wind. This is somewhat unexpected if we use the astrophysical parameters based on theoretical calibrations. But it becomes entirely feasible if we take into account that a given spectral type - luminosity class combination covers a range of astrophysical parameters. The colliding-wind region also contributes to the free-free emission, which can help to explain the high values of the spectral index seen after periastron passage. Combining our data with older Very Large Array (VLA) data allows us to derive a period P = 860.0 +- 3.7 days for this system. With this period, we update the orbital parameters that were derived in the first paper of this series.Comment: 10 pages, 4 figures, accepted for publication in A&