A field study on the validity of the Quadri-Track Zone Comparison Technique

This field study tested and demonstrated the validity and reliability of the Quadri-Track Zone Comparison Technique designed for specific Single-Issue Psychophysiological Veracity (PV) examinations using the polygraph, using one hundred and forty confirmed real-life cases from a private polygraph firm under contract with a metropolitan police department. The Quadri-Track Zone Comparison Technique's unique Inside Track accurately increased the scores for the innocent by 43.6% and the guilty by 37.1% thereby reducing the overall inconclusive rate from 19.5% to 1.4%, which effectively remedies the major cause (Fear/Hope of Error) of inconclusive results in single-issue polygraph tests. The Quadri-Track Zone Comparison Technique correctly identified 100% of the innocent as truthful with no inconclusives and no errors. It further correctly identified 97.8% of the guilty as deceptive and 2.2% as inconclusive, with no errors. Inconclusives excluded, the Quadri-Track Zone Comparison Technique was 100% accurate in the identification of the innocent and the guilty. Inconclusives included, the utility rate was 98.6%. Blind scoring of polygraph charts showed extremely high correlations for the individual and total scores with a combined accuracy of 98.3%.     

Rebuttal to objections by Iacono and Verschuere et al.

The arguments presented by Iacono and Verschuere et al. against the publication of the Mangan et al. field study of the Quadri-Track Zone Comparison Technique in Physiology & Behavior , are based largely on dated articles that examined control question polygraph techniques whose psychological test structures, physiological analyses, and scoring systems are significantly different than those of the Quadri-Track ZCT. Iacono and Verschuere et al. alleged that the Quadri-Track ZCT is biased against the innocent and can be defeated with the use of countermeasures without considering the technique's unique "remedial inside track" that quantifies the innocent examinee's fear of error-and the guilty examinee's hope of error-which are factored into the overall score, thus avoiding false positive and false negative errors. Their objection to the use of confessions as the criterion for ground truth presumes that the polygraph examinations conducted in this field study were conducted in a vacuum. They ignored the various methods of post-test confirmation and research studies that support the use of confessions as ground truth. Verschuere et al. cited the National Research Council's 2003 report to support their conviction that the accuracy of polygraph tests is well below perfection and errors often occur. However, they failed to mention that the accuracy range values of the seven field studies which met the National Research Council's scientific criteria were from 0.711 to 0.999 with a median value of 0.89, and that the field study with the highest accuracy (0.999) was from a published 1989 field study on the Quadri-Track Zone Comparison Technique.     

An elicitation of utility for quality of life under prospect theory

This paper performs several tests of decision analysis applied to the health domain. First, we conduct a test of the normative expected utility theory. Second, we investigate the possibility to elicit the more general prospect theory. We observe risk aversion for gains and losses and violations of expected utility. These results imply that mechanisms governing decisions in the health domain are similar to those in the monetary domain. However, we also report one important deviation: utility is universally concave for the health outcomes used in this study, in contrast to the commonly found S-shaped utility for monetary outcomes, with concave utility for gains and convex utility for losses.     

Early clinical esophageal adenocarcinoma (cT1): Utility of CT in regional nodal metastasis detection and can the clinical accuracy be improved?

IntroductionTreatment of early esophageal cancer depends on the extent of the primary tumor and presence of regional lymph node metastasis.(RNM). Short axis diameter >10 mm is typically used to detect RNM. However, clinical determination of RNM is inaccurate and can result in inappropriate treatment. Purpose of this study is to evaluate the accuracy of a single linear measurement (short axis > 10 mm) of regional nodes on CT in predicting nodal metastasis, in patients with early esophageal cancer and whether using a mean diameter value (short axis + long axis/2) as well as nodal shape improves cN designation.MethodsCTs of 49 patients with cT1 adenocarcinoma treated with surgical resection alone were reviewed retrospectively. Regional nodes were considered positive for malignancy when round or ovoid and mean size >5 mm adjacent to the primary tumor and >7 mm when not adjacent. Results were compared with pN status after esophagectomy.Results18/49 patients had pN+ at resection. Using a single short axis diameter >10 mm on CT, nodal metastasis (cN) was positive in 7/49. Only 1 of these patients was pN+ at resection (sensitivity 5%, specificity 80%, accuracy 53%). Using mean size and morphologic criteria, cN was positive in 28/49. 11 of these patients were pN+ at resection (sensitivity 61%, specificity 45%, accuracy 51%). EUS with limited FNA of regional nodes resulted in 16/49 patients with pN+ being inappropriately designated as cN0.ConclusionsEvaluation of size, shape and location of regional lymph nodes on CT improves the sensitivity of cN determination compared with a short axis measurement alone in patients with cT1 esophageal cancer, although clinical utility is limited.     

The time trade-off: a note on the effect of lifetime reallocation of consumption and discounting

This paper considers the extent to which responses to time trade-off (TTO) questions can provide unbiased estimates of ratios of individual marginal rates of substitution (MRS) of wealth for risk of various health state impairments relative to the corresponding MRS for risk of death. It is shown that if there is reallocation of lifetime consumption and/or discounting of future utilities, then a TTO response that is not adjusted for these effects will unambiguously overestimate the ratios of individual MRS. While the effect of reallocation is likely to be very small, discounting can lead to significant overestimation, the magnitude of which depends in part upon the severity of the health state impairment.     

A data recipient centered de-identification method to retain statistical attributes

Privacy has always been a great concern of patients and medical service providers. As a result of the recent advances in information technology and the government’s push for the use of Electronic Health Record (EHR) systems, a large amount of medical data is collected and stored electronically. This data needs to be made available for analysis but at the same time patient privacy has to be protected through de-identification. Although biomedical researchers often describe their research plans when they request anonymized data, most existing anonymization methods do not use this information when de-identifying the data. As a result, the anonymized data may not be useful for the planned research project. This paper proposes a data recipient centered approach to tailor the de-identification method based on input from the recipient of the data. We demonstrate our approach through an anonymization project for biomedical researchers with specific goals to improve the utility of the anonymized data for statistical models used for their research project. The selected algorithm improves a privacy protection method called Condensation by Aggarwal et al. Our methods were tested and validated on real cancer surveillance data provided by the Kentucky Cancer Registry.     

Comparison between different health state utility instruments in patients with fibromyalgia

BackgroundCost-utility analysis uses utility indexes to assess treatment effects. Some discrepancies between different utility indexes instruments are suggested and need to be identified in health conditions not yet investigated.ObjectiveTo compare different utility indexes instruments in Brazilian patients with fibromyalgia and identify variables associated with these instruments.MethodsImpact of fibromyalgia (Fibromyalgia Impact Questionnaire [FIQ]) and utility indexes (Short-Form 6 Dimensions [SF-6D], EuroQol 5 Dimensions [EQ-5D], and EuroQol - Visual Analogue Scale [EQ-VAS]) were assessed in 97 patients with fibromyalgia at baseline, 8-week (after an exercise-based intervention), and 6- and 12-month follow-up. Construct validity and responsiveness of the utility indexes instruments were compared. Multiple regression models were used to verify the variables associated with the utility indexes instruments.ResultsConstruct validity analysis showed that FIQ presented moderate correlation with the SF-6D, the EQ-5D, and the EQ-VAS (r=-0.43, -0.41, -0.30, respectively, all p < .01). There was a moderate correlation between the SF-6D and the EQ-5D (r = 0.51, p < .001), moderate correlation between the SF-6D and the EQ-VAS (r = 0.41, p < .001), and no correlation between the EQ-VAS and the EQ-5D. The EQ-5D was responsive at the 8-week and 6-month follow-up, the SF-6D was responsive only at 6-month follow-up and the EQ-VAS was not responsive. The FIQ was associated with the EQ-5D and the SF-6D indexes, and symptom duration and depression with the EQ-VAS index.ConclusionThe EQ-5D better assessed the clinical change in patients with fibromyalgia. Furthermore, impact of fibromyalgia, symptom duration, and depression seem to be associated with the utility indexes.     

The burden of neuropathic pain: A systematic review and meta-analysis of health utilities

Patients with neuropathic pain (NeuP) experience substantially lower health-related quality of life (HRQoL) than the general population. The aim of this systematic review and meta-analysis is to test the hypothesis that NeuP is associated with low levels of health utility. A structured search of electronic databases (MEDLINE, EMBASE, Cochrane Library and CINAHL) was undertaken. Reference lists of retrieved reports were also reviewed. Studies reporting utility single-index measures (preference based) in NeuP were included. Random effects meta-analysis was used to pool EQ-5D index utility estimates across NeuP conditions. The association of utilities and pre-defined factors (NeuP condition, patient age, sex, duration and severity of pain and method of utility scoring) was examined using meta-regression. Twenty-four studies reporting health utility values in patients with NeuP were included in the review. Weighted pooled utility score across the studies varied from a mean of 0.15 for failed back surgery syndrome to 0.61 for post-herpetic neuralgia and diabetic neuropathy. Although there was substantial heterogeneity (P < 0.0001) across studies, we found little variation in utility as a function of patient and study characteristics. The single exception was a significant relationship (P < 0.0001) between increasing neuropathic pain severity and a reduction in utility. This study confirms the hypothesis that patients with NeuP experience low utilities and therefore low HRQoL. However, the contribution of non-NeuP co-morbidity remains unclear. Neuropathic pain severity emerged as a primary predictor of the negative health impact of NeuP.     

内蒙古自治区结核病控制项目经济学评价

目的通过对内蒙古自治区结核病控制项目的卫生经济学评价,为卫生资源投入与合理使用提供科学依据。方法采用成本一效果分析、成本一效用分析、成本一效益分析方法对2005—2012年内蒙古自治区结核病控制项目资金的投入与效果进行卫生经济学评价。结果2005—2012年内蒙古自治区结核病控制项目实施DOTS策略后共挽回DALY1555672．3年,共获得22003个完整生命;减少新发传染性肺结核病人73805110708例,避免了新发病例DALY损失777836．16～1166751．61年。DOTS策略每治愈1例结核病人需花费1825．72元,节省费用4574．28元,总计节省费用67521．28万元。结论DOTS策略减轻了肺结核患者的经济负担,是一项低投入高效益、高效果的策略。