Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010

BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.

Design, modelling and measurement of a hybrid powerplant for unmanned aerial systems

Hybrid powerplants combining internal combustion engines and electric motor prime movers have been extensively developed for land- and marine-based transport systems. The use of such powerplants in airborne applications has been historically impractical due to energy and power density constraints. Improvements in battery and electric motor technology make aircraft hybrid powerplants feasible. This paper presents a technique for determining the feasibility and mechanical effectiveness of powerplant hybridisation. In this work, a prototype aircraft hybrid powerplant was designed, constructed and tested. It is shown that an additional 35% power can be supplied from the hybrid system with an overall weight penalty of 5%, for a given unmanned aerial system. A flight dynamic model was developed using the AeroSim Blockset in MATLAB Simulink. The results have shown that climb rates can be improved by 56% and endurance increased by 13% when using the hybrid powerplant concept.

FaceXpress : an integrated software suite for facial emotion stimulus manipulation and facial measurement

The characterisation of facial expression through landmark-based analysis methods such as FACEM (Pilowsky & Katsikitis, 1994) has a variety of uses in psychiatric and psychological research. In these systems, important structural relationships are extracted from images of facial expressions by the analysis of a pre-defined set of feature points. These relationship measures may then be used, for instance, to assess the degree of variability and similarity between different facial expressions of emotion. FaceXpress is a multimedia software suite that provides a generalised workbench for landmark-based facial emotion analysis and stimulus manipulation. It is a flexible tool that is designed to be specialised at runtime by the user. While FaceXpress has been used to implement the FACEM process, it can also be configured to support any other similar, arbitrary system for quantifying human facial emotion. FaceXpress also implements an integrated set of image processing tools and specialised tools for facial expression stimulus production including facial morphing routines and the generation of expression-representative line drawings from photographs.

Perturbed Lignification Impacts Tree Growth in Hybrid Poplar-A Function of Sink Strength, Vascular Integrity, and Photosynthetic Assimilation

The effects of reductions in cell wall lignin content, manifested by RNA interference suppression of coumaroyl 3'-hydroxylase, on plant growth, water transport, gas exchange, and photosynthesis were evaluated in hybrid poplar trees (Populus alba 3 grandidentata). The growth characteristics of the reduced lignin trees were significantly impaired, resulting in smaller stems and reduced root biomass when compared to wild-type trees, as well as altered leaf morphology and architecture. The severe inhibition of cell wall lignification produced trees with a collapsed xylem phenotype, resulting in compromised vascular integrity, and displayed reduced hydraulic conductivity and a greater susceptibility to wall failure and cavitation. In the reduced lignin trees, photosynthetic carbon assimilation and stomatal conductance were also greatly reduced, however, shoot xylem pressure potential and carbon isotope discrimination were higher and water-use efficiency was lower, inconsistent with water stress. Reductions in assimilation rate could not be ascribed to increased stomatal limitation. Starch and soluble sugars analysis of leaves revealed that photosynthate was accumulating to high levels, suggesting that the trees with substantially reduced cell wall lignin were not carbon limited and that reductions in sink strength were, instead, limiting photosynthesis.

Neurobiological correlates of encoding strength of Pavlovian fear conditioned memory

Emotionally significant memories, especially those induced in conjunction with physical and mental trauma, are frequently retained for an individual’s lifetime. How these memories are organized and encoded within neural networks is a fundamental question. The lateral amygdala (LA) is a key nucleus for acquisition and maintenance of associative emotional memories. We used Pavlovian fear conditioning to study how ‘weaker’ and ‘stronger’ memories are encoded in neural networks of the LA. In Pavlovian fear conditioning a neutral stimulus, in this case a tone, is temporally paired with an aversive unconditioned stimulus (US), such as a foot shock. The previously neutral stimulus becomes a conditioned stimulus (CS) capable of eliciting defensive responses. We used time spent freezing when the CS is presented in a neutral context as a dependent variable measure of memory ‘strength’.

Measurement of actual efficacy of compact fluorescent lamps (CFLs)

The use of compact fluorescent lamps (CFLs) in domestic residences has increased rapidly due to their higher energy efficiency and longer life expectancy when compared with traditional incandescent light bulbs. Through measurement of illuminance, actual power and apparent power, the actual efficacy and associated power factor of CFLs are studied in this paper. It is found that for an individual CFL, although its power consumption and lighting output (i.e. luminous flux) may be higher or lower than the stated values provided by the lighting manufacturers, the actual efficacy would most likely be equal to or better than the efficacy calculated from the given rated power and lumen from the manufacturers. The typical power factor for CFLs was 0.63.

Exploring variation in measurement as a foundation for statistical thinking in the elementary school

This study was based on the premise that variation is the foundation of statistics and statistical investigations. The study followed the development of fourth-grade students' understanding of variation through participation in a sequence of two lessons based on measurement. In the first lesson all students measured the arm span of one student, revealing pathways students follow in developing understanding of variation and linear measurement (related to research question 1). In the second lesson each student's arm span was measured once, introducing a different aspect of variation for students to observe and contrast. From this second lesson, students' development of the ability to compare their representations for the two scenarios and explain differences in terms of variation was explored (research question 2). Students' documentation, in both workbook and software formats, enabled us to monitor their engagement and identify their increasing appreciation of the need to observe, represent, and contrast the variation in the data. Following the lessons, a written student assessment was used for judging retention of understanding of variation developed through the lessons and the degree of transfer of understanding to a different scenario (research question 3).

Direct measurement as a tool for assessing the accuracy of inverse dynamics

The understanding of the loads generated within the prosthetic leg can aid engineers in the design of components and clinicians in the process of rehabilitation. Traditional methods to assess these loads have relied on inverse dynamics. This indirect method estimates the applied load using video recordings and force-plates located at a distance from the region of interest, such as the base of the residuum. The well-known limitations of this method are related to the accuracy of this recursive model and the experimental conditions required (Frossard et al., 2003). Recent developments in sensors (Frossard et al., 2003) and prosthetic fixation (Brånemark et al., 2000) permit the direct measurement of the loads applied on the residuum of transfemoral amputees. In principle, direct measurement should be an appropriate tool for assessing the accuracy of inverse dynamics. The purpose of this paper is to determine the validity of this assumption. The comparative variable used in this study is the velocity of the relative body center of mass (VCOM(t)). The relativity is used to align the static (w.r.t. position) force plate measurement with the dynamic load cell measurement.

Review of direct measurement of inner prosthesis loading in transfemoral amputation: Potential benefits for evidence-based practice

The understanding of the load applied on the residuum through the prosthesis of individuals with transfemoral amputation (TFA) is essential to address a number of concerns that could strongly reduce their quality of life (e.g., residuum skin lesion, prosthesis fitting, alignment). This inner prosthesis loading could be estimated using a typical gait laboratory relying on inverse dynamics equations. Alternative, technological advances proposed over the last decade enabled direct measurement of this kinetic information in a broad variety of situations that could potentially be more relevant in clinical settings. The purposes of this presentation are (A) to review the literature about recent developments in measure and analyses of inner prosthesis loading of TFA, and (B) to extract information that could potentially contribute to a better evidence-based practice.

Strength properties of composite clay balls containing additives from industry wastes as new filter media in water treatment

Pebble matrix filtration (PMF) is a water treatment technology that can remove suspended solids in highly turbid surface water during heavy storms. PMF typically uses sand and natural pebbles as filter media. Hand-made clay pebbles (balls) can be used as alternatives to natural pebbles in PMF treatment plants, where natural pebbles are not readily available. Since the high turbidity is a seasonal problem that occurs during heavy rains, the use of newly developed composite clay balls instead of pure clay balls have the advantage of removing other pollutants such as natural organic matter (NOM) during other times. Only the strength properties of composite clay balls are described here as the pollutant removal is beyond the scope of this paper. These new composite clay balls must be able to withstand dead and live loads under dry and saturated conditions in a filter assembly. Absence of a standard ball preparation process and expected strength properties of composite clay balls were the main reasons behind the present study. Five different raw materials from industry wastes: Red Mud (RM), Water Treatment Alum Sludge (S), Shredded Paper (SP), Saw Dust (SD), and Sugar Mulch (SM) were added to common clay brick mix (BM) in different proportions. In an effort to minimize costs, in this study clay balls were fired to 1100 0C at a local brick factory together with their bricks. A comprehensive experimental program was performed to evaluate crushing strength of composite hand-made clay balls, using uniaxial compression test to establish the best material combination on the basis of strength properties for designing sustainable filter media for water treatment plants. Performance at both construction and operating stages were considered by analyzing both strength properties under fully dry conditions and strength degradation after saturation in a water bath. The BM-75% as the main component produced optimum combination in terms of workability and strength. With the material combination of BM-75% and additives-25%, the use of Red Mud and water treatment sludge as additives produced the highest and lowest strength of composite clay balls, with a failure load of 5.4 kN and 1.4 kN respectively. However, this lower value of 1.4 kN is much higher than the effective load on each clay ball of 0.04 kN in a typical filter assembly (safety factor of 35), therefore, can still be used as a suitable filter material for enhanced pollutant removal.

Flight-training effect on the cervical muscle isometric strength of trainee pilots

External stimulus/loading initiates adaptations within skeletal muscle. It has been previously found that the cervical area has the highest loading while performing flying maneuvers under +Gz. The first purpose of this study was to examine the neck muscle response to the physical environment associated with flight training, incorporating limited exposure to +Gz force, in a Pilatus PC-9 aircraft. The second purpose was to examine the short-term range of movement (ROM) response to flight training. Isometric cervical muscle strength and ROM was monitored in 9 RAAF pilots completing an 8-mo flight-training course at Pearce Airbase in Western Australia, and in 10 controls matched for gender, age, height, and weight. Isometric cervical muscle strength and ROM were measured at baseline and at 8 mo using the multi-cervical rehabilitation unit (Hanoun Medical, Downsview, Ontario, Canada). Results indicated that an increase in pilot neck strength was limited to flexion while in a neutral position. No strength changes were recorded in any other site in the pilots or for the controls. These findings suggest that short-term exposure to the physical environment associated with flight training had a limited significant effect on increasing isometric cervical muscle strength. No significant changes were observed in pilot ROM, indicating that short-term exposure to flight does not effect ROM.