Is quality of life measurement likely to be a proxy for health needs assessment in patients with coronary artery disease?

BACKGROUND: The identification of patients' health needs is pivotal in optimising the quality of health care, increasing patient satisfaction and directing resource allocation. Health needs are complex and not so easily evaluated as health-related quality of life (HRQL), which is becoming increasingly accepted as a means of providing a more global, patient-orientated assessment of the outcome of health care interventions than the simple medical model. The potential of HRQL as a surrogate measure of healthcare needs has not been evaluated. OBJECTIVES AND METHOD: A generic (Short Form-12; SF-12) and a disease-specific questionnaire (Seattle Angina Questionnaire; SAQ) were tested for their potential to predict health needs in patients with acute coronary disease. A wide range of healthcare needs were determined using a questionnaire specifically developed for this purpose. RESULTS: With the exception of information needs, healthcare needs were highly correlated with health-related quality of life. Patients with limited enjoyment of personal interests, weak financial situation, greater dependency on others to access health services, and dissatisfaction with accommodation reported poorer HRQL (SF-12: p < 0.001; SAQ: p < 0.01). Difficulties with mobility, aids to daily living and activities requiring assistance from someone else were strongly associated with both generic and disease-specific questionnaires (SF-12: r = 0.46-0.55, p < 0.01; SAQ: r = 0.53-0.65, p < 0.001). Variables relating to quality of care and health services were more highly correlated with SAQ components (r = 0.33-0.59) than with SF-12 (r = 0.07-0.33). Overall, the disease-specific Seattle Angina Questionnaire was superior to the generic Short Form-12 in detecting healthcare needs in patients with coronary disease. Receiver-operator curves supported the sensitivity of HRQL tools in detecting health needs. CONCLUSION: Healthcare needs are complex and developing suitable questionnaires to measure these is difficult and time-consuming. Without a satisfactory means of measuring these needs, the extent to which disease impacts on health will continue to be underestimated. Further investigation on larger populations is warranted but HRQL tools appear to be a reasonable proxy for healthcare needs, as they identify the majority of needs in patients with coronary disease, an observation not previously reported in this patient group

Algol 68 Dialect Conversion -- a Syntactic Approach

A syntax directed package for converting Revised Algol 68 programs into Algol 68-R form, (where possible) is being developed at Nottingham. The package makes use of J.M. Foster's Syntax Improving Device (SID) [1]. The experience gained has underlined the value of a syntactic approach to problems of this sort. A far wider range of constructs can be translated than would ever be possible by using ad hoc methods. In many respects the difficulties encountered are those of conventional compiler writing, but some intriguing new problems arise when, as in this case, the source language and target language differ relatively little in philosophy and appearance.

Compiling Exceptions Correctly

Exceptions are an important feature of modern programming languages, but their compilation has traditionally been viewed as an advanced topic. In this article we show that the basic method of compiling exceptions using stack unwinding can be explained and verified both simply and precisely, using elementary functional programming techniques. In particular, we develop a compiler for a small language with exceptions, together with a proof of its correctness.

Calculating an Exceptional Machine

In previous work we showed how to verify a compiler for a small language with exceptions. In this article we show how to calculate, as opposed to verify, an abstract machine for this language. The key step is the use of Reynold's defunctionalization, an old program transformation technique that has recently been rejuvenated by the work of Danvy et al.

A Pyramidal Genetic Algorithm for Multiple-Choice Problems

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence, higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes amongst the agents on solution quality are examined for two multiple-choice optimisation problems. It is shown that partnering strategies that exploit problem-specific knowledge are superior and can counter inappropriate (sub-) fitness measurements.

Partnering Strategies for Fitness Evaluation in a Pyramidal Evolutionary Algorithm

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes for (sub-)fitness evaluation purposes are examined for two multiple-choice optimisation problems. It is shown that random partnering strategies perform best by providing better sampling and more diversity.

'On the Application of Hierarchical Coevolutionary Genetic Algorithms: Recombination and Evaluation Partners'

This paper examines the use of a hierarchical coevolutionary genetic algorithm under different partnering strategies. Cascading clusters of sub-populations are built from the bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations potentially search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes amongst the sub-populations on solution quality are examined for two constrained optimisation problems. We examine a number of recombination partnering strategies in the construction of higher-level individuals and a number of related schemes for evaluating sub-solutions. It is shown that partnering strategies that exploit problem-specific knowledge are superior and can counter inappropriate (sub-) fitness measurements.

The OPIT system part I.

The OPIT program is briefly described. OPIT is a basis-set-optimising, self-consistent field, molecular orbital program for calculating properties of closed-shell ground states of atoms and molecules. A file handling technique is then put forward which enables core storage to be used efficiently in large FORTRAN scientific applications programs. Hashing and list processing techniques, of the type frequently used in writing system software and computer operating systems, are here applied to the creation of data files (integral label and value lists etc.). Files consist of a chained series of blocks which may exist in core or on backing store or both. Efficient use of core store is achieved and the processes of file deletion, file re-writing and garbage collection of unused blocks can be easily arranged. The scheme is exemplified with reference to the OPIT program. A subsequent paper will describe a job scheduling scheme for large programs of this sort.

A Pyramidal Evolutionary Algorithm with Different Inter-Agent Partnering Strategies for Scheduling Problems

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes amongst the agents on solution quality are examined for two multiple-choice optimisation problems. It is shown that partnering strategies that exploit problem-specific knowledge are superior and can counter inappropriate (sub-) fitness measurements.

Noise Reduction Technique for a Simulation Optimisation Study

This paper reports on an attempt to apply Genetic Algorithms to the problem of optimising a complex system, through discrete event simulation (Simulation Optimisation), with a view to reducing the noise associated with such a procedure. We are applying this proposed solution approach to our application test bed, a Crossdocking distribution centre, because it provides a good representative of the random and unpredictable behaviour of complex systems i.e. automated machine random failure and the variability of manual order picker skill. It is known that there is noise in the output of discrete event simulation modelling. However, our interest focuses on the effect of noise on the evaluation of the fitness of candidate solutions within the search space, and the development of techniques to handle this noise. The unique quality of our proposed solution approach is we intend to embed a noise reduction technique in our Genetic Algorithm based optimisation procedure, in order for it to be robust enough to handle noise, efficiently estimate suitable fitness function, and produce good quality solutions with minimal computational effort.

Partnering Strategies for Fitness Evaluation in a Pyramidal Evolutionary Algorithm

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes for (sub-)fitness evaluation purposes are examined for two multiple-choice optimisation problems. It is shown that random partnering strategies perform best by providing better sampling and more diversity.

A Pyramidal Evolutionary Algorithm with Different Inter-Agent Partnering Strategies for Scheduling Problems

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes amongst the agents on solution quality are examined for two multiple-choice optimisation problems. It is shown that partnering strategies that exploit problem-specific knowledge are superior and can counter inappropriate (sub-) fitness measurements.

A Pyramidal Genetic Algorithm for Multiple-Choice Problems

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence, higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes amongst the agents on solution quality are examined for two multiple-choice optimisation problems. It is shown that partnering strategies that exploit problem-specific knowledge are superior and can counter inappropriate (sub-) fitness measurements.

Multi-Agent Simulation and Management Practices

Intelligent agents offer a new and exciting way of understanding the world of work. Agent-Based Simulation (ABS), one way of using intelligent agents, carries great potential for progressing our understanding of management practices and how they link to retail performance. We have developed simulation models based on research by a multi-disciplinary team of economists, work psychologists and computer scientists. We will discuss our experiences of implementing these concepts working with a well-known retail department store. There is no doubt that management practices are linked to the performance of an organisation (Reynolds et al., 2005; Wall & Wood, 2005). Best practices have been developed, but when it comes down to the actual application of these guidelines considerable ambiguity remains regarding their effectiveness within particular contexts (Siebers et al., forthcoming a). Most Operational Research (OR) methods can only be used as analysis tools once management practices have been implemented. Often they are not very useful for giving answers to speculative ‘what-if’ questions, particularly when one is interested in the development of the system over time rather than just the state of the system at a certain point in time. Simulation can be used to analyse the operation of dynamic and stochastic systems. ABS is particularly useful when complex interactions between system entities exist, such as autonomous decision making or negotiation. In an ABS model the researcher explicitly describes the decision process of simulated actors at the micro level. Structures emerge at the macro level as a result of the actions of the agents and their interactions with other agents and the environment. We will show how ABS experiments can deal with testing and optimising management practices such as training, empowerment or teamwork. Hence, questions such as “will staff setting their own break times improve performance?” can be investigated.

Calculation of sample size for stroke trials assessing functional outcome: comparison of binary and ordinal approaches

Background Many acute stroke trials have given neutral results. Sub-optimal statistical analyses may be failing to detect efficacy. Methods which take account of the ordinal nature of functional outcome data are more efficient. We compare sample size calculations for dichotomous and ordinal outcomes for use in stroke trials. Methods Data from stroke trials studying the effects of interventions known to positively or negatively alter functional outcome – Rankin Scale and Barthel Index – were assessed. Sample size was calculated using comparisons of proportions, means, medians (according to Payne), and ordinal data (according to Whitehead). The sample sizes gained from each method were compared using Friedman 2 way ANOVA. Results Fifty-five comparisons (54 173 patients) of active vs. control treatment were assessed. Estimated sample sizes differed significantly depending on the method of calculation (Po00001). The ordering of the methods showed that the ordinal method of Whitehead and comparison of means produced significantly lower sample sizes than the other methods. The ordinal data method on average reduced sample size by 28% (inter-quartile range 14–53%) compared with the comparison of proportions; however, a 22% increase in sample size was seen with the ordinal method for trials assessing thrombolysis. The comparison of medians method of Payne gave the largest sample sizes. Conclusions Choosing an ordinal rather than binary method of analysis allows most trials to be, on average, smaller by approximately 28% for a given statistical power. Smaller trial sample sizes may help by reducing time to completion, complexity, and financial expense. However, ordinal methods may not be optimal for interventions which both improve functional outcome