Lifetime prevalence estimates of major depression: An indirect estimation method and a quantification of recall bias

The measurement of lifetime prevalence of depression in cross-sectional surveys is biased by recall problems. We estimated it indirectly for two countries using modelling, and quantified the underestimation in the empirical estimate for one. A microsimulation model was used to generate population-based epidemiological measures of depression. We fitted the model to 1-and 12-month prevalence data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) and the Australian Adult Mental Health and Wellbeing Survey. The lowest proportion of cases ever having an episode in their life is 30% of men and 40% of women, for both countries. This corresponds to a lifetime prevalence of 20 and 30%, respectively, in a cross-sectional setting (aged 15-65). The NEMESIS data were 38% lower than these estimates. We conclude that modelling enabled us to estimate lifetime prevalence of depression indirectly. This method is useful in the absence of direct measurement, but also showed that direct estimates are underestimated by recall bias and by the cross-sectional setting.

Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study

Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

VISSIM Calibration for Urban Freeways, 2015

In urban areas, interchange spacing and the adequacy of design for weaving, merge, and diverge areas can significantly influence available capacity. Traffic microsimulation tools allow detailed analyses of these critical areas in complex locations that often yield results that differ from the generalized approach of the Highway Capacity Manual. In order to obtain valid results, various inputs should be calibrated to local conditions. This project investigated basic calibration factors for the simulation of traffic conditions within an urban freeway merge/diverge environment. By collecting and analyzing urban freeway traffic data from multiple sources, specific Iowa-based calibration factors for use in VISSIM were developed. In particular, a repeatable methodology for collecting standstill distance and headway/time gap data on urban freeways was applied to locations throughout the state of Iowa. This collection process relies on the manual processing of video for standstill distances and individual vehicle data from radar detectors to measure the headways/time gaps. By comparing the data collected from different locations, it was found that standstill distances vary by location and lead-follow vehicle types. Headways and time gaps were found to be consistent within the same driver population and across different driver populations when the conditions were similar. Both standstill distance and headway/time gap were found to follow fairly dispersed and skewed distributions. Therefore, it is recommended that microsimulation models be modified to include the option for standstill distance and headway/time gap to follow distributions as well as be set separately for different vehicle classes. In addition, for the driving behavior parameters that cannot be easily collected, a sensitivity analysis was conducted to examine the impact of these parameters on the capacity of the facility. The sensitivity analysis results can be used as a reference to manually adjust parameters to match the simulation results to the observed traffic conditions. A well-calibrated microsimulation model can enable a higher level of fidelity in modeling traffic behavior and serve to improve decision making in balancing need with investment.

Transportation and spatial development : an overview and a future direction