Outcome measurement and service evaluation - a note on research design.

The purpose of this research note is to demonstrate how an individualised quality of life instrument could be adapted to provide a more accurate estimate of the impact of a social service on a person’s quality of life. An increase in quality of life between the start and end of a service is often taken as an indication that the service impacted positively on quality of life. The modifications to the quality of life instrument suggested in this paper show that this assumption is not always accurate and should be questioned directly.

Measuring the health-related quality of life of people with ischaemic heart disease.

Objectives—To inform researchers and clinicians about the most appropriate generic and disease specific measures of health related quality of life for use among people with ischaemic heart disease. Methods—MEDLINE and BIDS were searched for research papers which contained a report of at least one of the three most common generic instruments or at least one of the five disease specific instruments used with ischaemic heart disease patients. Evidence for the validity, reliability, and sensitivity of these instruments was critically appraised. Results—Of the three generic measures—the Nottingham health profile, sickness impact profile, and short form 36 (SF-36)—the SF-36 appears to offer the most reliable, valid, and sensitive assessment of quality of life. However, a few of the SF-36 subscales lack a sufficient degree of sensitivity to detect change in a patient’s clinical condition. According to the best available evidence, the quality of life after myocardial infarction questionnaire should be preferred to the Seattle angina questionnaire, the quality of life index cardiac version, the angina pectoris quality of life questionnaire, and the summary index. Overall, research on disease specific measures is sparse compared to the number of studies which have investigated generic measures. Conclusions—An assessment of the quality of life of people with ischaemic heart disease should comprise a disease specific measure in addition to a generic measure. The SF-36 and the quality of life after myocardial infarction questionnaire (version 2) are the most appropriate currently available generic and disease specific measures of health related quality of life, respectively. Further research into the measurement of health related quality of life of people with ischaemic heart disease is required in order to address the problems (such as lack of sensitivity to detect change) identified by the review.

Selecting a measure of health-related quality of life.

Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.

The adaptations of a quality of life questionnaire for routine use in clinical practice: the Chronic Respiratory Disease Questionnaire in Cystic Fibrosis.

The assessment of quality of life (QOL) is necessary to monitor the course of disease and to assess the effect of new and existing interventions in clinical practice. This will only be achieved if QOL can be measured accurately and routinely. The aim of this study was to demonstrate the methodology involved in the adaptation and shortening of the Chronic Respiratory Disease Questionnaire (CRDQ) in a population of adults with cystic fibrosis (CF). A single interviewer administered the CRDQ to a sample of 45 adult patients (32 males) with CF prior to assessment of spirometric measures of lung function. Those patients whose lung function was stable at the time of study, and who could attend for a retest within 14 days, were asked to complete the questionnaire at a subsequent visit (n=10). The average interval between visits was 7 days (range 5-14 days). Correlations between spirometry and CRDQ dimensions ranged from -0.003 to 0.426. The fatigue, emotion and mastery dimensions showed high internal consistency, and adequate construct validity. In the small number of patients suitable for retest, the results indicated that the dimensions exhibited adequate test retest reliability. In contrast low internal consistency was demonstrated for the dyspnoea dimension. The fatigue, emotion and mastery dimensions could be reduced, in terms of their number of items without a substantial loss in explanatory power. This study suggests that QOL measurement can be made convenient, and so more easily accessible for routine clinical assessment.

Generic, disease-specific and individualised approaches to measuring health-related quality of life among people with heart disease - a comparative analysis.

Increasing emphasis is being placed on the evaluation of health-related quality of life. However, there is no consensus on the definition of this concept and as a result there are a plethora of existing measurement instruments. Head-to-head comparisons of the psychometric properties of existing instruments are necessary to facilitate evidence-based decisions about which instrument should be chosen for routine use. Therefore, an individualised instrument (the modified Patient Generated Index), a generic instrument (the Short Form 36) and a disease-specific instrument (the Quality of Life after Myocardial Infarction questionnaire) were administered to patients with ischaemic heart disease (n=117) and the evidence for the validity, reliability and sensitivity of each instrument was examined and compared. The modified Patient Generated Index compared favourably with the other instruments but none of the instruments examined provided sound evidence for sensitivity to change. Therefore, any recommendation for the use of the individualised approach in the routine collection of health-related quality of life data in clinical practice must be conditional upon the submission of further evidence to support the sensitivity of such instruments.

Proton Probing Measurement of Electric and Magnetic Fields Generated by ns and ps Laser-Matter Interactions

The use of laser-accelerated protons as a particle probe for the detection of electric fields in plasmas has led in recent years to a wealth of novel information regarding the ultrafast plasma dynamics following high intensity laser-matter interactions. The high spatial quality and short duration of these beams have been essential to this purpose. We will discuss some of the most recent results obtained with this diagnostic at the Rutherford Appleton Laboratory (UK) and at LULI - Ecole Polytechnique (France), also applied to conditions of interest to conventional Inertial Confinement Fusion. In particular, the technique has been used to measure electric fields responsible for proton acceleration from solid targets irradiated with ps pulses, magnetic fields formed by ns pulse irradiation of solid targets, and electric fields associated with the ponderomotive channelling of ps laser pulses in under-dense plasmas.

Lean principles and techniques for improving the quality and productivity of software development projects: a case study

Software product development is recognised as difficult due to the intangible nature of the product, requirements elicitation, effective progress measurement, and so forth. In this paper, we describe some of the challenges of software product development and how the challenges are being met by lean management principles and techniques. Specifically, we examine lean principles and techniques that were devised by Toyota and other manufacturers over the last 50 years. Applying lean principles to software development projects has been advocated for over ten years and it will be shown that the extensive lean literature is a valuable source of ideas for software development. A case study with a software development organisation, Timberline Inc., will demonstrate that lean principles and techniques can be successfully applied to software product development.

Production of a monoclonal antibody and its application in an optical biosensor based assay for the quantitative measurement of Pantothenic Acid (Vitamin B5) in foodstuffs

Pantothenicacid (PA), vitamin B5, is an essential B vitamin that may be fortified in food and as such requires robust and accurate methods of detection to meet compliance legislation. This study reports the production and characterisation of the first monoclonalantibody (MAb) specific for PA and the subsequent development of a surface plasmon resonance (SPR) biosensorassay for the quantification of PA. The developed assay was compared with an SPR based commercial kit which utilised a polyclonal antibody (PAb). Foodstuffs, including cereals (n = 43), infant formulas and baby food (n = 10) and fruit juices (n = 48) were analysed by both the MAb and PAb biosensorassays and comparison plots showed good correlation (R2 0.77–0.99). The results indicate that the MAb basedbiosensorassay is suitable for the measurement of PA in foodstuffs and has the added advantage of facilitating a constant, long term supply of identical antibody. Preliminary matrix studies suggest the MAb basedassay is an excellent candidate for further validation studies and routine quality assurance based analysis.

Measurement of permeability using a bench-top centrifuge

The commonly used British Standard constant head triaxial permeability test for testing of fine-grained soils is relatively time consuming. A reduction in the required time for soil permeability testing would provide potential cost savings to the construction industry, particularly in the construction quality assurance of landfill clay liners. The purpose of this paper is to evaluate an alternative approach of measuring permeability of fine-grained soils benefiting from accelerated time scaling for seepage flow when testing specimens in elevated gravity conditions provided by a centrifuge. As part of the investigation, an apparatus was designed and produced to measure water flow through soil samples under conditions of elevated gravitational acceleration using a small desktop laboratory centrifuge. A membrane was used to hydrostatically confine the test sample. A miniature data acquisition system was designed and incorporated in the apparatus to monitor and record changes in head and flow throughout the tests. Under enhanced gravity in the centrifuge, the flow through the sample was under ‘variable head' conditions as opposed to ‘constant head' conditions as in the classic constant head permeability tests conducted at 1 g . A mathematical model was developed for analysis of Darcy's coefficient of permeability under conditions of elevated gravitational acceleration and verified using the results obtained. The test data compare well with the results on analogous samples obtained using the classical British Standard constant head permeability tests.