An illustration of the modelling of cost and efficacy data from a clinical trial

Health care providers, purchasers and policy makers need to make informed decisions regarding the provision of cost-effective care. When a new health care intervention is to be compared with the current standard, an economic evaluation alongside an evaluation of health benefits provides useful information for the decision making process. We consider the information on cost-effectiveness which arises from an individual clinical trial comparing the two interventions. Recent methods for conducting a cost-effectiveness analysis for a clinical trial have focused on the net benefit parameter. The net benefit parameter, a function of costs and health benefits, is positive if the new intervention is cost-effective compared with the standard. In this paper we describe frequentist and Bayesian approaches to cost-effectiveness analysis which have been suggested in the literature and apply them to data from a clinical trial comparing laparoscopic surgery with open mesh surgery for the repair of inguinal hernias. We extend the Bayesian model to allow the total cost to be divided into a number of different components. The advantages and disadvantages of the different approaches are discussed. In January 2001, NICE issued guidance on the type of surgery to be used for inguinal hernia repair. We discuss our example in the light of this information. Copyright © 2003 John Wiley & Sons, Ltd.

A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures

Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.

Enhancing recovery rates: lessons from year one of IAPT

BACKGROUND: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. METHOD: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). RESULTS: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. CONCLUSIONS: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Wireless Sensor Networks: MAC protocols and real time applications

Wireless Senor Networks(WSNs) detect events using one or more sensors, then collect data from detected events using these sensors. This data is aggregated and forwarded to a base station(sink) through wireless communication to provide the required operations. Different kinds of MAC and routing protocols need to be designed for WSN in order to guarantee data delivery from the source nodes to the sink. Some of the proposed MAC protocols for WSN with their techniques, advantages and disadvantages in the terms of their suitability for real time applications are discussed in this paper. We have concluded that most of these protocols can not be applied to real time applications without improvement

Children’s and adults’ processing of syntactically ambiguous sentences during reading

While there has been a fair amount of research investigating children’s syntactic processing during spoken language comprehension, and a wealth of research examining adults’ syntactic processing during reading, as yet very little research has focused on syntactic processing during text reading in children. In two experiments, children and adults read sentences containing a temporary syntactic ambiguity while their eye movements were monitored. In Experiment 1, participants read sentences such as, ‘The boy poked the elephant with the long stick/trunk from outside the cage’ in which the attachment of a prepositional phrase was manipulated. In Experiment 2, participants read sentences such as, ‘I think I’ll wear the new skirt I bought tomorrow/yesterday. It’s really nice’ in which the attachment of an adverbial phrase was manipulated. Results showed that adults and children exhibited similar processing preferences, but that children were delayed relative to adults in their detection of initial syntactic misanalysis. It is concluded that children and adults have the same sentence-parsing mechanism in place, but that it operates with a slightly different time course. In addition, the data support the hypothesis that the visual processing system develops at a different rate than the linguistic processing system in children.

A unified view on lifetime distributions arising from selection mechanisms

In this paper, we formulate a flexible density function from the selection mechanism viewpoint (see, for example, Bayarri and DeGroot (1992) and Arellano-Valle et al. (2006)) which possesses nice biological and physical interpretations. The new density function contains as special cases many models that have been proposed recently in the literature. In constructing this model, we assume that the number of competing causes of the event of interest has a general discrete distribution characterized by its probability generating function. This function has an important role in the selection procedure as well as in computing the conditional personal cure rate. Finally, we illustrate how various models can be deduced as special cases of the proposed model. (C) 2011 Elsevier B.V. All rights reserved.

Bayesian nonlinear regression models with scale mixtures of skew-normal distributions: Estimation and case influence diagnostics

The purpose of this paper is to develop a Bayesian analysis for nonlinear regression models under scale mixtures of skew-normal distributions. This novel class of models provides a useful generalization of the symmetrical nonlinear regression models since the error distributions cover both skewness and heavy-tailed distributions such as the skew-t, skew-slash and the skew-contaminated normal distributions. The main advantage of these class of distributions is that they have a nice hierarchical representation that allows the implementation of Markov chain Monte Carlo (MCMC) methods to simulate samples from the joint posterior distribution. In order to examine the robust aspects of this flexible class, against outlying and influential observations, we present a Bayesian case deletion influence diagnostics based on the Kullback-Leibler divergence. Further, some discussions on the model selection criteria are given. The newly developed procedures are illustrated considering two simulations study, and a real data previously analyzed under normal and skew-normal nonlinear regression models. (C) 2010 Elsevier B.V. All rights reserved.

Multivariate measurement error models based on scale mixtures of the skew-normal distribution

Scale mixtures of the skew-normal (SMSN) distribution is a class of asymmetric thick-tailed distributions that includes the skew-normal (SN) distribution as a special case. The main advantage of these classes of distributions is that they are easy to simulate and have a nice hierarchical representation facilitating easy implementation of the expectation-maximization algorithm for the maximum-likelihood estimation. In this paper, we assume an SMSN distribution for the unobserved value of the covariates and a symmetric scale mixtures of the normal distribution for the error term of the model. This provides a robust alternative to parameter estimation in multivariate measurement error models. Specific distributions examined include univariate and multivariate versions of the SN, skew-t, skew-slash and skew-contaminated normal distributions. The results and methods are applied to a real data set.

Algebraic Bol loops

In this paper, we study the category of algebraic Bol loops over an algebraically closed field of definition. On the one hand, we apply techniques from the theory of algebraic groups in order to prove structural theorems for this category. On the other hand, we present some examples showing that these loops lack some nice properties of algebraic groups; for example, we construct local algebraic Bol loops which are not birationally equivalent to global algebraic loops.

A note on influence diagnostics in nonlinear mixed-effects elliptical models

This paper provides general matrix formulas for computing the score function, the (expected and observed) Fisher information and the A matrices (required for the assessment of local influence) for a quite general model which includes the one proposed by Russo et al. (2009). Additionally, we also present an expression for the generalized leverage on fixed and random effects. The matrix formulation has notational advantages, since despite the complexity of the postulated model, all general formulas are compact, clear and have nice forms. (C) 2010 Elsevier B.V. All rights reserved.

Prototype Generation from Ontology Charts

Semantic Analysis is a business analysis method designed to capture system requirements. While these requirements may be represented as text, the method also advocates the use of Ontology Charts to formally denote the system's required roles, relationships and forms of communication. Following model driven engineering techniques, Ontology Charts can be transformed to temporal Database schemas, class diagrams and component diagrams, which can then be used to produce software systems. A nice property of these transformations is that resulting system design models lend themselves to complicated extensions that do not require changes to the design models. For example, resulting databases can be extended with new types of data without the need to modify the database schema of the legacy system. Semantic Analysis is not widely used in software engineering, so there is a lack of experts in the field and no design patterns are available. This make it difficult for the analysts to pass organizational knowledge to the engineers. This study describes an implementation that is readily usable by engineers, which includes an automated technique that can produce a prototype from an Ontology Chart. The use of such tools should enable developers to make use of Semantic Analysis with minimal expertise of ontologies and MDA.

Um Modelo de replicação em ambientes que suportam mobilidade

Os estudos sobre mobilidade intensificaram-se com o uso em grande escala da Internet, pois esta trouxe a possibilidade de explorar mobilidade através de redes heterogêneas, conectadas por diferentes links de comunicação e distantes umas das outras. A replicação de componentes em sistemas distribuídos normalmente é utilizada para torná-los mais confiáveis e seguros ou para aumentar o desempenho da aplicação, uma vez que acessos remotos podem ser evitados através da localidade da réplica. Em qualquer um dos casos, a replicação implica a manutenção na consistência entre as múltiplas cópias, isto é, é preciso garantir que as cópias estejam com seus estados consistentes em um determinado momento. Em sistemas que permitem mobilidade e replicação, a principal preocupação é com a consistência e o gerenciamento das réplicas do objeto móvel. Isto é, dependendo da técnica de replicação utilizada, como gerenciar um objeto e suas réplicas se estes podem mudar sua localização? Como garantir um bom desempenho do sistema? Estas perguntas esta proposta procura responder. Este trabalho apresenta um modelo de replicação em ambientes de objetos distribuídos que permitem mobilidade chamado ReMMoS - Replication Model in Mobility Systems. O objetivo deste modelo é prover um ambiente de execução para suporte ao desenvolvimento de aplicações envolvendo mobilidade explicita e replicação implicita. Assim, o programador não necessita preocupar-se com o gerenciamento e a consistencia das cópias.