Quantifying uncertainty in cost effectiveness analyses

This study compared four alternative approaches (Taylor, Fieller, percentile bootstrap, and bias-corrected bootstrap methods) to estimating confidence intervals (CIs) around cost-effectiveness (CE) ratio. The study consisted of two components: (1) Monte Carlo simulation was conducted to identify characteristics of hypothetical cost-effectiveness data sets which might lead one CI estimation technique to outperform another. These results were matched to the characteristics of an (2) extant data set derived from the National AIDS Demonstration Research (NADR) project. The methods were used to calculate (CIs) for data set. These results were then compared. The main performance criterion in the simulation study was the percentage of times the estimated (CIs) contained the “true” CE. A secondary criterion was the average width of the confidence intervals. For the bootstrap methods, bias was estimated. ^ Simulation results for Taylor and Fieller methods indicated that the CIs estimated using the Taylor series method contained the true CE more often than did those obtained using the Fieller method, but the opposite was true when the correlation was positive and the CV of effectiveness was high for each value of CV of costs. Similarly, the CIs obtained by applying the Taylor series method to the NADR data set were wider than those obtained using the Fieller method for positive correlation values and for values for which the CV of effectiveness were not equal to 30% for each value of the CV of costs. ^ The general trend for the bootstrap methods was that the percentage of times the true CE ratio was contained in CIs was higher for the percentile method for higher values of the CV of effectiveness, given the correlation between average costs and effects and the CV of effectiveness. The results for the data set indicated that the bias corrected CIs were wider than the percentile method CIs. This result was in accordance with the prediction derived from the simulation experiment. ^ Generally, the bootstrap methods are more favorable for parameter specifications investigated in this study. However, the Taylor method is preferred for low CV of effect, and the percentile method is more favorable for higher CV of effect. ^

Advances in understanding energy consumption behavior and the governance of its change - Outline of an integrated framework

Transforming today’s energy systems in industrialized countries requires a substantial reduction of the total energy consumption at the individual level. Selected instruments have been found to be effective in changing people’s behavior in single domains. However, the so far weak success story on reducing overall energy consumption indicates that our understanding of the determining factors of individual energy consumption as well as of its change is far from being conclusive. Among others, the scientific state of the art is dominated by analyzing single domains of consumption and by neglecting embodied energy. It also displays strong disciplinary splits and the literature often fails to distinguish between explaining behavior and explaining change of behavior. Moreover, there are knowledge gaps regarding the legitimacy and effectiveness of the governance of individual consumption behavior and its change. Against this backdrop, the aim of this paper is to establish an integrated interdisciplinary framework that offers a systematic basis for linking the different aspects in research on energy related consumption behavior, thus paving the way for establishing a better evidence base to inform societal actions. The framework connects the three relevant analytical aspects of the topic in question: (1) It systematically and conceptually frames the objects, i.e. the energy consumption behavior and its change (explananda); (2) it structures the factors that potentially explain the energy consumption behavior and its change (explanantia); (3) it provides a differentiated understanding of change inducing interventions in terms of governance. Based on the existing states of the art approaches from different disciplines within the social sciences the proposed framework is supposed to guide interdisciplinary empirical research.

Theory of uncertainty in illness in patients with cancer of unknown primary origin: Structure providers as antecedents of uncertainty in a population of cancer patients with an unknown primary diagnosis

Uncertainty has been found to be a major component of the cancer experience and can dramatically affect psychosocial adaptation and outcomes of a patient's disease state (McCormick, 2002). Patients with a diagnosis of Carcinoma of Unknown Primary (CUP) may experience higher levels of uncertainty due to the unpredictability of current and future symptoms, limited treatment options and an undetermined life expectancy. To date, only one study has touched upon uncertainty and its' effects on those with CUP but no information exists concerning the effects of uncertainty regarding diagnosis and treatment on the distress level and psychosocial adjustment of this population (Parker & Lenzi, 2003). ^ Mishel's Uncertainty in Illness Theory (1984) proposes that uncertainty is preceded by three variables, one of which being Structure Providers. Structure Providers include credible authority, the degree of trust and confidence the patient has with their doctor, education and social support. It was the goal of this study to examine the relationship between uncertainty and Structure Providers to support the following hypotheses: (1) There will be a negative association between credible authority and uncertainty, (2) There will be a negative association between education level and uncertainty, and (3) There will be a negative association between social support and uncertainty. ^ This cross-sectional analysis utilized data from 219 patients following their initial consultation with their oncologist. Data included the Mishel Uncertainty in Illness Scale (MUIS) which was used to determine patients' uncertainty levels, the Medical Outcomes Study-Social Support Scale (MOSS-SSS) to assess patients, levels of social support, the Patient Satisfaction Questionnaire (PSQ-18) and the Cancer Diagnostic Interview Scale (CDIS) to measure credible authority and general demographic information to assess age, education, marital status and ethnicity. ^ In this study we found that uncertainty levels were generally higher in this sample as compared to other types of cancer populations. And while our results seemed to support most of our hypothesis, we were only able to show significant associations between two. The analyses indicated that credible authority measured by both the CDIS and the PSQ was a significant predictor of uncertainty as was social support measured by the MOSS-SS. Education has shown to have an inconsistent pattern of effect in relation to uncertainty and in the current study there was not enough data to significantly support our hypothesis. ^ The results of this study generally support Mishel's Theory of Uncertainty in Illness and highlight the importance of taking into consideration patients, psychosocial factors as well as employing proper communication practices between physicians and their patients.^

Scintillation efficiency of liquid argon in low energy neutron-argon scattering

Experiments searching for weak interacting massive particles with noble gases such as liquid argon require very low detection thresholds for nuclear recoils. A determination of the scintillation efficiency is crucial to quantify the response of the detector at low energy. We report the results obtained with a small liquid argon cell using a monoenergetic neutron beam produced by a deuterium-deuterium fusion source. The light yield relative to electrons was measured for six argon recoil energies between 11 and 120 keV at zero electric drift field.

A Comparison of different Uncertainty Activation Cross-Section Data Libraries: Application to the Prediction Uncertainty in Tritium Production

T actitivity in LiPb LiPb mock-up material irradiated in Frascati: measurement and MCNP results

Traffic uncertainty in toll motorway concessions in Spain

This study assessed the inaccuracy of the traffic estimates for toll motorway concessions in Spain. It was found that the estimates conducted by both the government and the concessionaire showed a significant bias towards overestimating traffic. The level of overestimation in Spain is even greater than that reported by other studies based on worldwide data. The notorious levels of overestimation entail severe burdens to the economics of the concessionaires that often prompt renegotiations of the contracts, which are often accepted by the government. These renegotiations usually end up with toll changes or extension of the concession terms, which have to be ultimately borne by future motorway users. It is postulated herein that the bias towards overestimating traffic in toll motorways in Spain is mostly caused by strategic issues rather than by modelling errors.

Calculus of the uncertainty in acoustic field measurements: comparative study between the uncertainty propagation method and the distribution propagation method

The new Spanish Regulation in Building Acoustic establishes values and limits for the different acoustic magnitudes whose fulfillment can be verify by means field measurements. In this sense, an essential aspect of a field measurement is to give the measured magnitude and the uncertainty associated to such a magnitude. In the calculus of the uncertainty it is very usual to follow the uncertainty propagation method as described in the Guide to the expression of Uncertainty in Measurements (GUM). Other option is the numerical calculus based on the distribution propagation method by means of Monte Carlo simulation. In fact, at this stage, it is possible to find several publications developing this last method by using different software programs. In the present work, we used Excel for the Monte Carlo simulation for the calculus of the uncertainty associated to the different magnitudes derived from the field measurements following ISO 140-4, 140-5 and 140-7. We compare the results with the ones obtained by the uncertainty propagation method. Although both methods give similar values, some small differences have been observed. Some arguments to explain such differences are the asymmetry of the probability distributions associated to the entry magnitudes,the overestimation of the uncertainty following the GUM

Uncertainty in ellipse fitting using a flatbed scanner: development and experimental verification

In the field of dimensional metrology, the use of optical measuring machines requires the handling of a large number of measurement points, or scanning points, taken from the image of the measurand. The presence of correlation between these measurement points has a significant influence on the uncertainty of the result. The aim of this work is the development of an estimation procedure for the uncertainty of measurement in a geometrically elliptical shape, taking into account the correlation between the scanning points. These points are obtained from an image produced using a commercial flat bed scanner. The characteristic parameters of the ellipse (coordinates of the center, semi-axes and the angle of the semi-major axis with regard to the horizontal) are determined using a least squares fit and orthogonal distance regression. The uncertainty is estimated using the information from the auto-correlation function of the residuals and is propagated through the fitting algorithm according to the rules described in Evaluation of Measurement Data—Supplement 2 to the ‘Guide to the Expression of Uncertainty in Measurement’—Extension to any number of output quantities. By introducing the concept of cut-off length, it can be observed how it is possible to take into account the presence of the correlation in the estimation of uncertainty in a very simple way while avoiding underestimation.