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Elección binaria Evaluación del estado de salud y modo de administración: Comparación directa de CAPI y en línea


Objetivo


Investigar si las respuestas a las preguntas de valoración del estado de salud de elección binaria difieren según el modo de administración: en línea versus cara a cara.


Métodos


Se realizaron encuestas idénticas que incluyeron el estado demográfico, el estado de salud auto-reportado y siete tipos de preguntas de valoración de la elección binaria en entornos de entrevista personal en línea y asistida por computadora (CAPI). Las muestras fueron reclutadas siguiendo los procedimientos empleados en estudios en línea típicos o CAPI. El análisis incluyó comparaciones descriptivas de la distribución de las respuestas a través de las opciones binarias y la regresión probit para explicar la propensión a elegir una opción a través de los modos de administración, el control de las características de fondo.


Resultados


En total, 422 encuestados (221 en línea, 201 CAPI) completaron una encuesta. No hubo diferencias generales en cuanto a edad ni sexo. Los encuestados en línea fueron educados a un nivel más alto que la muestra CAPI y la población en general, y la situación laboral difiere. Los encuestados de la CAPI reportaron una mejor salud general y mejor salud / satisfacción con la vida. CAPI tardó mucho más tiempo en completarse. No hubo efecto del modo de administración en las respuestas a las preguntas de valoración, y esto se replicó cuando se controlaron las diferencias demográficas.


Conclusiones


Los hallazgos sugieren que ambos modos pueden ser igualmente válidos para estudios de valoración del estado de salud usando métodos de elección binaria (por ejemplo, experimentos de selección discreta). Existen algunas diferencias entre las características observables de las muestras, y los grupos pueden diferir aún más en términos de características no observables. Al diseñar estudios de estado de salud de valoración, las ventajas y desventajas de ambos enfoques deben ser considerados.


Palabras clave: CAPI, valoración del estado de salud, en línea


Introducción


Para realizar estudios de valoración del estado de salud, se puede utilizar un rango de modos de administración. Estos incluyen entrevistas cara a cara usando métodos de papel y lápiz, entrevistas cara a cara usando entrevistas personales asistidas por computadora (CAPIs, en las que las encuestas son mostradas a través de una interfaz de computadora mientras un entrevistador está presente), y Estudios en línea. Hasta la fecha, las entrevistas cara a cara con métodos de papel y lápiz han sido el modo más utilizado para recolectar datos de valoración del estado de salud y se utilizaron para obtener pesos de preferencias para el cuestionario EuroQol de cinco dimensiones (EQ-5D) (TTO) técnica de elicitación de preferencias [1] y de seis dimensiones estado de salud de forma corta (derivado de SF-36) utilizando el juego estándar (SG) enfoque [2, 3]. TTO estudios que emplean métodos CAPI también se han utilizado para derivar EQ-5D cuestionario conjuntos de valores [4,5]. Una versión en línea del proceso TTO ha sido investigado, y algunas preocupaciones se han encontrado con el enfoque [6]. Las tareas de TTO y SG en estos estudios han sido: • TTO o SG de un estado de salud dado consiste en una serie de opciones, iteradas para diferentes valores hasta que se alcanza un punto de indiferencia para cada individuo estado. Sin embargo, las técnicas basadas en la elección binaria pueden significar que cada elección hecha por el entrevistado es independiente de la anterior. Un experimento de elección discreta (DCE) es un ejemplo de una técnica de elección binaria y se ha utilizado en un entorno cara a cara [7] y en la configuración en línea [8].


Cada modo tiene ventajas y desventajas que pueden afectar los datos generados y, por lo tanto, deben considerarse en el diseño de los estudios de valoración del estado de salud. Las entrevistas cara a cara pueden proporcionar datos de alta calidad con buenas tasas de finalización y fiabilidad [9], pero son caras y requieren mucho tiempo para llevar a cabo. El uso de CAPI significa que algunas de las ventajas de las encuestas en línea pueden ser explotadas en entornos cara a cara. Por ejemplo, los CAPIs permiten el enrutamiento complejo de preguntas, la ordenación aleatoria de preguntas, el registro del tiempo tomado y la minimización de errores asociados con la entrada de datos (que se completa automáticamente). Los métodos de valoración en línea tienen las ventajas relacionadas con el CAPI pero también son más baratos de realizar, permiten obtener grandes muestras en un corto espacio de tiempo, tienen un marco de muestreo flexible y permiten obtener una gama de características de fondo de los no respondientes. Las dos principales desventajas de las encuestas en línea se relacionan con la representatividad de la muestra y la calidad de los datos. Las personas que tienen acceso a Internet pueden no ser representativas de la población en general, y responder a una encuesta sin supervisión puede conducir a una participación de bajo nivel o una mala comprensión.


Los estudios han comparado la administración en línea y CAPI de los ejercicios de valoración del estado de salud. Las comparaciones de la administración en línea y cara a cara de tareas iterativas de intercambio de personas (PTO) han encontrado resultados ampliamente similares a través de los modos [10,11]. Robinson et al [10]. Sin embargo, encontró que un mayor número de encuestados en línea dio equivalencia & # x0201; Respuestas, que proporcionaron la manera más rápida de terminar cada tarea de PTO. Norman et al [6] compararon la administración en línea y cara a cara (pero no basada en CAPI) de una tarea iterativa de TTO y encontraron que las respuestas diferían por modo de administración, con aquellos que completaron la encuesta en línea mostrando más variación en la respuesta. Cuando los resultados fueron modelados para generar un valor establecido para el cuestionario EQ-5D, 100 de los 243 valores de estado de salud fueron más altos en el grupo en línea en al menos 0,1. Por lo tanto, las tareas iterativas de valoración del estado de salud administradas en línea pueden generar diferentes resultados de CAPI, pero no está claro si la diferencia se debe al modo de administración utilizado o diferencias en la percepción y terminación de una tarea iterativa cuando se administran usando diferentes modos de administración.


Además, no se ha establecido si las respuestas a preguntas de valoración de estado de salud de elección binaria son comparables entre modos de administración. Preguntas de elección binaria como DCE TTO. Donde la duración se incluye como una dimensión junto con el sistema de clasificación del estado de salud, se puede utilizar para valorar los estados de salud a nivel agregado [8]. Las preguntas de elección binaria como DCE sin duración se pueden usar para valorar estados de salud en híbridos & # x0201; Con TTO [12, 13]. Debido a que las preguntas de valoración de estado de salud convencionales tales como SG o TTO basadas en la iteración para identificar la indiferencia son efectivamente hechas de una serie de preguntas de elección binaria, un conjunto de instantáneas independientes & # x0201; Las preguntas de elección binaria se puede utilizar para valorar los estados de salud a nivel agregado [14]. La comparación de la administración en línea versus CAPI de preguntas de elección binaria para investigar el nivel de equivalencia entre los modos de administración tiene implicaciones directas para la mejor comprensión de estos métodos y el diseño de futuros estudios estatales de valoración usando técnicas de elección binaria.


La recogida de datos en línea plantea preocupaciones sobre la representatividad de la muestra y la comparabilidad con los datos recogidos mediante el uso de otros métodos. Las muestras reclutadas en línea pueden estar sesgadas en términos de características no observadas [15]. También hay preocupaciones sobre el motivo de la participación, el nivel de no respuesta y desgaste [16]. La confiabilidad y la validez de los datos generados [17 & # x02013; 19]. Y el nivel de participación de los encuestados. Sin embargo, otros estudios han encontrado la comparabilidad entre las muestras [20, 21]. Además de la comparabilidad en términos de la fiabilidad y validez de los datos generados [22].


Este estudio tuvo como objetivo comparar las respuestas a las versiones de elección binaria de las preguntas de valoración del estado de salud a través de los modos de administración en línea y CAPI. Esto se hizo mediante la administración de encuestas idénticas, donde la única diferencia era el modo de administración utilizado para recoger los datos. Hemos planteado la hipótesis de que las respuestas a diferentes tipos de preguntas de valoración de elección binaria no difieren entre los modos. Para investigar cuestiones relacionadas con la representatividad de las muestras reclutadas para los estudios cara a cara y en línea, también comparamos las características demográficas y el estado de salud autodeclarado de las muestras y las de la población en general.


Métodos


Encuesta


Los conjuntos de datos de encuestas en línea y CAPI utilizados en este estudio contenían idénticas preguntas de elección demográfica y binaria en el mismo orden. Ambos conjuntos de datos formaban parte de un proyecto de investigación más amplio en el que se utilizaron preguntas de selección binaria para investigar cuestiones metodológicas relacionadas con la valoración del estado de salud. Siete tipos diferentes y # x0201d; De las preguntas de elección binaria se incluyeron en la encuesta en línea, y el formato básico de las preguntas se describe en la Figura 1. Las preguntas incluyeron una serie de atributos experimentales que pueden ser variados a través de hipotéticos estados de salud. Estos incluyen el estado de salud experimentado (H), el tiempo pasado en el estado de salud (T), el tiempo transcurrido en plena salud antes del estado de salud (L), la perspectiva de la persona que experimenta el estado de salud (P) y el nivel de satisfacción Con salud mientras experimenta el estado de salud (S). Los siete tipos de preguntas fueron diseñados para examinar una serie de cuestiones metodológicas típicamente involucradas en las evaluaciones del estado de salud, a saber, que las preferencias del estado de salud son independientes de 1) la duración del estado, 2) cuya salud es (perspectiva) La longitud de & # x0201c; tiempo de entrega & # x0201d; (Un mecanismo para valorar todos los estados de la misma escala incluyendo aquellos que son peores que estar muertos), 4) cuando se producen estados de salud, y 5) la satisfacción asociada con el estado. Otros temas abordados fueron: 6) el valor de estado de salud más bajo que se puede valorar usando el tiempo de ejecución y 7) la valoración del estado de salud utilizando DCE con duración como atributo (DCE TTO). No todos los atributos anteriores varían a través de cada pregunta (véase Tabla 1 para las combinaciones de atributos utilizados en cada tipo de pregunta y Tsuchiya y Mulhern [23] para más detalles).


Formato de pregunta de la opción binaria básica utilizada en la encuesta.


Las 12 preguntas experimentales utilizadas para la encuesta.


La encuesta en línea tenía 15 versiones, la mayoría de las cuales contenían sólo tres de los siete tipos de preguntas. Una versión, sin embargo, contenía los siete tipos de preguntas, y esto se utiliza en el estudio que se informa aquí. La encuesta CAPI coincide con esta versión online en particular en términos de preguntas y tamaño de la muestra. En otras palabras, los datos utilizados en este estudio de comparación tienen una amplia cobertura del tipo de pregunta, pero no se pretende que se utilicen para abordar cualquiera de los problemas metodológicos propios. En esta versión, se administraron 12 preguntas a través de tres módulos de preguntas (se registró el tiempo necesario para completar cada módulo). El Módulo 1 incluyó cinco preguntas de tipo I, el módulo 2 incluyó uno de los tipos de pregunta II (cinco preguntas en total) y el módulo 3 incluyó dos preguntas TCE del DCE (tipo VII), se incluyeron dos subversiones del módulo 3 para ambos La encuesta en línea y la encuesta CAPI de manera que se utilizaron cuatro preguntas diferentes de este tipo en general). Los estados de salud utilizados se basan en el EQ-5D-5L [24]. La EQ-5D-5L describe el estado de salud a través de cinco dimensiones: movilidad, autocuidado, actividades habituales, dolor / malestar y ansiedad / depresión, cada una con cinco niveles de respuesta, leve, moderado, severo , Y extremo / incapaz.


Cada encuesta comenzó proporcionando información sobre el estudio, seguida de una página de consentimiento informado obligatorio. A los encuestados se les hizo una serie de preguntas demográficas y completaron el estado de salud auto-reportado (en una escala de 5 puntos, con puntajes que variaban de excelente a salud, salud y vida (En una escala de 10 puntos, con puntuaciones que van desde & # x0201; completamente satisfecho & # x0201d; totalmente insatisfecho & # x0201d;) y el EQ-5D-5L antes de completar las 12 preguntas de valoración de elección binaria .


Reclutamiento y la Muestra


Para lograr una comparación de los dos modos de administración como sucedería en el mundo real, el CAPI y muestras en línea fueron reclutados por separado siguiendo los procedimientos empleados en encuestas típicas.


Para la encuesta en línea, los encuestados fueron obtenidos de un panel de Internet existente y fueron seleccionados siguiendo cuotas establecidas basadas en la población general del Reino Unido en cinco grupos de edad 18 a 24, 25 a 34, 35 a 44, 45 a 54, 55 a 64 & # x02014; y el sexo. Las invitaciones se enviaron por correo electrónico. Antes de iniciar las preguntas experimentales, se retiró a los posibles entrevistados antes de comenzar las preguntas experimentales si la cuota correspondiente a la edad y el sexo ya estaba completa o después de la finalización si completaron la encuesta en menos de 5 minutos (que se eligió después de la inspección de la terminación Veces desde el lanzamiento inicial de la encuesta). La encuesta en línea descrita en este estudio fue una de 15 encuestas en línea diferentes que apuntaban a una muestra global alcanzada de 3000 (200 encuestados por versión). Las preguntas incluidas en la versión descrita aquí fueron idénticas a las utilizadas en la encuesta CAPI, por lo que un subconjunto de encuestados de la muestra general se considera en este estudio.


Para las CAPI, el reclutamiento siguió las cuotas fijadas para la edad y el sexo basadas en la población general del Reino Unido y reducida para una muestra alcanzada de 200. Esto intentó asegurar la comparabilidad total de las características de la muestra a través de los modos de la administración. Los participantes fueron reclutados llamando a 1 de cada 10 puertas en códigos postales seleccionados aleatoriamente en cinco áreas del Reino Unido. La encuesta fue presentada a los encuestados en una computadora portátil, y el entrevistador leyó todas las preguntas y el texto en la pantalla y registró la respuesta dada por el entrevistado. Esto se hizo en un ajuste uno a uno. Se impuso el mismo tiempo mínimo de finalización de 5 minutos y los participantes pudieron detener la encuesta en cualquier momento.


Análisis


Las características de los antecedentes, el estado de salud autoinformado y el tiempo empleado para completar la encuesta se compararon a través de las dos muestras mediante el análisis del chi-cuadrado, el análisis de Mann-Whitney U y el análisis de la varianza. Las características de los antecedentes de las muestras globales, CAPI y en línea también se compararon con la población general de Inglaterra y Gales mediante el uso de estadísticas extraídas del censo del Reino Unido de 2001 [25] para los 18 a 64 años de edad. Se realizaron comparaciones de la proporción de encuestados que eligieron el escenario B por muestra y por los siete tipos de preguntas de elección binaria, con significación estadística indicada por valores de P inferiores a 0,05.


También se investigaron las comparaciones de las proporciones de encuestados que eligieron el escenario B usando un intervalo de puntos de corte del tiempo de finalización (es decir, 5, 6, 7 y 8 minutos) usando análisis de chi cuadrado. También comparamos las respuestas para diferentes grupos de encuestados definidos por el tiempo que se tarda en completar cada uno de los tres módulos de preguntas de elección binaria. Se definieron dos grupos para cada módulo: el grupo 1 incluyó a los que completaron el módulo en menos de la mediana de tiempo para completar el módulo (y también la encuesta general en más de 5 minutos) y el grupo 2 incluyó aquellos que completaron el módulo en más de o Igual al tiempo medio empleado para completar el módulo (y la encuesta general en más de 5 minutos). El tiempo medio se utilizó como el punto de corte para permitir una división razonablemente igual entre los grupos.


Se usaron regresiones de Probit para explorar los determinantes de la propensión a escoger el escenario B para cada pregunta:


Pr (B = 1) = & # x003a6; (+) + (2) + (X + 3 + 2)


Donde Pr representa la probabilidad; & # X003b2; I = son los parámetros a estimar; D representa las características sociodemográficas de los encuestados; S representa satisfacción sanitaria del encuestado; X representa las propiedades del estado de salud utilizando estado de salud (H), duración (T), tiempo de espera en salud total (L), perspectiva de persona (P) y nivel de satisfacción (S) (ver Figura 1 y Tabla 1); M representa el modo de administración; Y Ti representa el tiempo necesario para completar el módulo de preguntas experimentales. La función & # x003a6; (& # x000b7;) es la función de distribución de la distribución normal estándar [26, 27]. Se reportan efectos marginales, ya que pueden interpretarse como porcentajes. Por ejemplo, un efecto marginal de & # x02212; 0.2 para un varón indica que ser un varón reduce la probabilidad de elegir el escenario B en un 20%. Para las regresiones, se reportan niveles de significación estadística de P menor que 0,05 y P menores de 0,01.


Resultados


Características del entrevistado y estado de salud auto-reportado


En total, 422 encuestados completaron la encuesta en línea o la versión CAPI. Para la encuesta en línea, 2326 miembros del panel fueron invitados a participar y 487 posibles encuestados (20,1%) accedieron a la encuesta. De estos, 266 (11,4% de los invitados y 54,6% de los encuestados) fueron excluidos porque pertenecían a una cuota de edad y sexo completa (n = 158, el 6,7% de los invitados y el 32,4% (N = 19, 0,8% de los invitados, 3,9% de los que accedieron) o completaron la encuesta en menos de 5 minutos (n = 108, 4,6% de los invitados y 22,2% de los que accedieron). Este grupo se definió como noncompleters. En total, 221 (el 9,5% de los invitados, el 46% de los que accedieron) completaron la encuesta en 5 minutos o más. No hubo diferencias significativas de edad o sexo entre las muestras respondedoras y no respondedoras.


La versión CAPI fue completada por 201 encuestados. La información sobre la tasa de respuesta para la encuesta no está disponible, ya que no fue registrada por la empresa de la encuesta, y por lo tanto, la tasa de respuesta no se puede calcular. Sin embargo, en un estudio similar de CAPI usando la misma metodología como parte del proyecto PRET, Mulhern et al [28] encontraron una tasa de respuesta global del 17,2%, y no hay razón para sugerir que la tasa de respuesta en este estudio sería sustancial Inferior o superior a éste. No se excluyó a los encuestados de la CAPI para completar la encuesta demasiado rápido, y no se pidió a los encuestados que interrumpieran la encuesta una vez que hubieran comenzado a responder a las preguntas.


No hubo diferencias significativas entre los grupos en línea y CAPI por edad y sexo, pero un número de variables demográficas significativamente diferente entre las muestras (Tabla 2]. Estos incluyen la situación laboral (con más jubilados y amas de casa en la muestra CAPI, pero más estudiantes en la muestra en línea), estado civil (con más encuestados CAPI casados ​​y más encuestados en línea) y nivel educativo Educado a un nivel superior). En comparación con la población general, las muestras en general, en línea y CAPI difieren en términos de la situación laboral, con más personas ocupadas en la población general (todos los P & # x0003c; 0,001). La muestra en línea es más similar a la población general en términos de estado civil que la muestra CAPI (con más de la muestra CAPI estar casado o con una pareja). Sin embargo, el nivel general de educación de la muestra CAPI es más similar al de la población general.


En cuanto a los tiempos medios de finalización, la muestra del CAPI tomó mucho más tiempo para completar la encuesta general, la pregunta de antecedentes y los componentes de salud autoinformados de la encuesta, así como el módulo experimental 1 (cinco preguntas de elección binaria de tipo I) y el módulo 2 (uno de los tipos II y # x02013; VI preguntas de elección binaria). La diferencia entre las muestras para el tiempo necesario para completar el módulo 3 (dos preguntas DCE TTO) no fue significativa. En todos los tres módulos, el SD del tiempo tomado es más largo para la muestra en línea que para la muestra CAPI. En cuanto a los tiempos de terminación medianos, la muestra de CAPI tomó mucho más tiempo para completar la encuesta general, las preguntas de fondo y los tres módulos de preguntas experimentales (ver Tabla 2).


Las respuestas a las preguntas generales de salud, salud y satisfacción de vida se muestran en la Figura 2. La muestra de CAPI es significativamente más probable reportar mejor salud (P & # x0003c; 0,001), mayores niveles de satisfacción de salud (P & # x0003c ; 0,001), y mayores niveles de satisfacción con la vida (P & # x0003c; 0,001). La media EQ-5D-5L puntuación del índice de la muestra en línea (cartografiado de la EQ-5D-3L utilizando el algoritmo producido por van Hout et al [29] fue 0,776 (0,25) y para la muestra CAPI fue de 0,874 (0,20 ). Esta diferencia fue significativa (F (1, 409) = 18,66, P & # x0003c; 0,001). Las respuestas de dimensión EQ-5D-5L también difieren significativamente por el modo de administración excepto la movilidad, con el grupo CAPI reportando menos problemas.


Estado de salud auto-reportado y satisfacción de salud y vida.


Preguntas de valoración de elección binaria


La proporción de la muestra que escoge el escenario B (es decir, elegir vivir por una duración más corta en plena salud, elegir la muerte inmediata o elegir el estado EQ-5D-5L y la duración asociada para las preguntas DCE TTO) no difieren significativamente por el modo de administración para Cualquiera de los siete tipos de preguntas de elección binaria (Tabla 3). Esto fue independiente de los atributos experimentales variados en el escenario. El resultado de la equivalencia a través de los escenarios es también consistente utilizando una gama de diferentes puntos de corte de tiempo mínimo para la encuesta general (5, 6, 7 y 8 minutos) y también al dividir la muestra en dos grupos en base al tiempo Para completar cada módulo experimental (el grupo 1 incluyó a aquellos que completaron el módulo en menos de la mediana de tiempo que tomó para completar el módulo, y el grupo 2 incluyó a aquellos que completaron el módulo en más o igual al tiempo mediano que tomaron).


Proporción de encuestados escogiendo el escenario B en diferentes preguntas de elección binaria usando el corte de 5 minutos y los valores de P usando otros puntos de corte generales y dentro del módulo.


Las regresiones de Probit para cada pregunta revelan que un rango de variables de atributo demográfico y experimental predice significativamente la probabilidad de escoger el escenario B para un número de preguntas de elección binaria al nivel de 0,05, pero no hay un patrón de los hallazgos (Tabla 4). El modo de administración, el tiempo que se tarda en completar el módulo de preguntas o la interacción entre el modo y el tiempo de finalización no predicen significativamente las respuestas a través de ninguno de los tipos de preguntas.


Coeficientes de efecto marginal de regresión de probit para la probabilidad de elegir el escenario B.


Para las preguntas de tipo I, la respuesta es significativamente pronosticada por el estado de salud y la duración utilizada en la pregunta, donde cuanto más grave es el estado de salud o mayor es la duración, el escenario B más probable es seleccionado. Estos resultados no se pueden probar entre los otros tipos de preguntas, ya que los tipos II a VI incluyen sólo un estado de salud y la duración asociada. Para las preguntas de tipo II, las mujeres son del 5% y aquellas con mayores niveles de satisfacción con la vida son 5% más propensas a elegir vivir en plena salud. Para el tipo IV, las mujeres son del 11% y los encuestados jubilados son 13% más propensos a escoger el escenario B. Para el tipo V, los varones son 12% y los que no están casados ​​o con pareja son 11% más propensos a elegir el escenario B Las respuestas a algunas de las preguntas del tipo VII se pronostican por estado matrimonial y laboral y satisfacción con la vida, pero estos resultados son difíciles de interpretar debido a la naturaleza de las preguntas tipo VII, que presenta dos estados de salud EQ-5D-5L completos. Las respuestas a los tipos de pregunta III y VI no están predichas por ninguna de las variables.


Discusión


Cuando se desarrollaron técnicas de valoración del estado de salud tales como TTO y SG, las entrevistas cara a cara fueron vistas como la mejor manera de administrar los ejercicios, y este es el modo utilizado para derivar preferencias por medidas genéricas basadas en las preferencias de salud, EQ-5D questionnaire [1] and the six-dimensional health state short form (derived from SF-36) [2,3]. as well as condition-specific instruments [30–32]. In recent years, there have been advances in communication technology and interest in the use of online health state valuation techniques is increasing. In parallel to this, health state valuation methods that are amenable to online administration, based on binary choice questions, have been developed [8,14,33]. There are issues, however, regarding the quality of data generated using online surveys. This article reports on a comparison between an identical set of binary choice questions designed to test issues related to health state valuation conducted in online and face-to-face environments. The results suggest that there is no difference between the responses to a range of binary choice valuation tasks across the administration modes. We also investigated the sample characteristics and found some differences between the groups. The finding of equivalence across the modes, however, remained robust after controlling for differences in the sample characteristics.


The responses to the main binary choice valuation questions were not statistically significantly different across the modes of administration, and this finding was not influenced by the severity or duration of the state used in the binary choice question. This is in comparison to a study comparing an iterative valuation technique (TTO) that found differences between online and face-to-face responses and concluded that this was due to the iterative nature of the process [6]. This is possibly because respondents who intend to complete the questions quickly may accept the first trade-off offered to avoid going through the process to reach indifference. Our study did not test an iterative process, but rather binary choice health state valuation tasks, which are amenable to online administration. The outcome has been that where a design that is suited to online and CAPI administration is used, comparable results are generated so that we cannot reject the hypothesis that the mode of administration does not affect the results. Furthermore, this result holds across different types of binary choice questions. The results, however, are based on a design where each type of question was asked only a handful of times. To infer from here that the outputs from online and CAPI versions of an actual valuation study where respondents are required to answer a larger number of questions of the same type will be no different, we would need to assume further that the effect of boredom caused by answering a larger number of similar questions is the same across the two modes of administration, which is something beyond the scope of this study. In other words, this study provides necessary but not sufficient evidence that the mode of administration may have little effect.


The finding of equivalence across modes of administration is valid for samples recruited following the standard procedures for CAPI (i. e. knocking on doors in selected postcode areas to produce a representative sample) and online (i. e. using participant panels) who were found to have similarities with the general population (the group targeted in most preference elicitation studies conducted in the world [1–5,8] ). This demonstrates the potential applicability of our results in the design of valuation studies using binary methods. Nevertheless, it is unclear how these findings relate to other preference elicitation tasks. Equivalence at the binary level is necessary for equivalence at the iterative level. Nevertheless, our results are not sufficient to make any claims about equivalence at the iterative level. It may be possible to extend our findings to other valuation methods, and further work should consider the stability of a range of both iterative and binary choice preference elicitation techniques across different administration modes.


We have also assessed the time taken to complete the survey. If an online respondent completes the survey too quickly or too slowly, this may suggest that they are not fully engaged. The results demonstrate that the CAPI sample took significantly longer to complete the overall survey and two of the experimental modules. This may be because an interviewer is present and reads out the questions, and it is unlikely for the respondent to complete the survey without some minimal level of engagement. The shorter completion time data indicate that it is possible that at least some respondents in the online sample completed the survey without fully paying attention or engaging in the task. To try to counter this, we imposed a minimum time limit of 5 minutes for online respondents to be classified as completers. Five minutes was chosen from inspecting the completion times from the initial launch of the survey. The finding of equivalence across the modes of administration is consistent by using a range of cutoff points higher than 5 minutes and also by splitting the sample using the time taken to complete each module (which allows us to compare those completing each module quickly and those completing each module more slowly). This suggests that our findings are relatively robust. We have been unable, however, to assess the consistency of the results by using overall time cutoff points below 5 minutes, and this limits the wider applicability of the findings to binary choice valuation studies conducted online that do not impose minimum completion times. Future research may investigate respondent engagement in the online environment in more detail, for example, by analyzing responses using a wider range of minimum time limits, recording the time taken to complete each task, or developing innovative methods for presenting the tasks.


There have been concerns about the representativeness of online samples and how this might affect the comparability of results across samples [15,20,21]. The two samples in our study were recruited against age and sex quotas and therefore do not differ in terms of these characteristics. The two samples, however, differ significantly in some observable characteristics, and this raises the issue of representativeness with respect to the UK general population. Compared with previous census data [25]. the CAPI samples are more representative in terms of educational attainment. The online sample overrepresents people educated to at least degree level, and this has also been found in other studies comparing online research groups with the general population [20]. Those who are educated to a higher level may be more computer literate, and this possibly explains their overrepresentation in the sample. In terms of health, it is possible that the online sample is genuinely less healthy than the CAPI sample. It has also been established, however, that individuals may answer face-to-face surveys in a socially desirable way, particularly when answering questions about sensitive issues such as mental health [34]. This may vary according to whether responses were public or anonymous [35]. In the CAPI sample, there may be a discrepancy between actual health and reported health status because of the presence of the interviewer, which may mean that, from the respondent’s perspective, responses are not completely anonymized. This did not, however, affect responses to the health state valuation questions.


We were not able to assess how the mode of administration affects the responses of those older than 65 years, because this group was not included in the sampling frame for the study. This potentially limits the applicability of our findings, as the Office of National Statistics predicts that approximately 59% of the adults 65 years or older use the Internet every day or almost every day (in comparison to ∼80% of those aged 18–54 years and 75% of those aged 55–64 years) [36]. Robinson et al. [10] included members of the population older than 65 years in their comparison of PTO tasks across different modes of administration and found that response to the Internet arm of the study was lower in this group. They did not, however, investigate differences in responses to the PTO task across different age groups. Further comparisons of valuation tasks across different modes of administration should investigate responses among those older than 65 years. This will establish the level of equivalence of health state valuation exercises across different modes of administration for the overall adult population.


It is in theory possible to make two samples agree in terms of any observable characteristic. Nevertheless, even with highly selective screening, the samples may differ in terms of further unobserved characteristics. The CAPI sample characteristics are influenced by who is at home when the interviewer visits, who agrees to take part, and who completes the interview. The online sample using an Internet panel is affected by who has access to the Internet, who is a member of the online panel, who in the panel agrees to take part, and who of those agreeing to take part completes the survey. It is not clear how the different selection mechanisms affect unobservable sample characteristics and therefore responses to health state valuation questions. Not everyone is equally likely to join an online panel and complete a particular survey or take part in a face-to-face interview. Typically, characteristics of nonresponders to interviews are not available, and one advantage of online surveys using existing Internet panels is that certain characteristics of nonresponders may be accessible. This allows for further insight into issues around nonresponse. A related issue is comparing the overall response rates for each mode of administration. Unfortunately, this study cannot inform this issue as the number of people who were invited to take part in the face-to-face CAPI study was not recorded by interviewers.


When designing health state valuation studies, the financial and time costs of the surveys are important and must be considered in light of the available preference elicitation methods and the modes available for administering the techniques. The cost of any survey has a fixed element and is not completely proportionate to the sample size. Nevertheless, even if generalized cost estimates cannot be given, it is generally the case that face-to-face interviews are substantially more costly per respondent and may take a much longer time to recruit sufficient numbers of participants. At the same time, any survey is only as good as the quality of the sample, and therefore the quality of the Internet panel needs to be scrutinized: one way to do this may be to look at how panel members are recruited and what incentives are offered. Overall, when the survey design is amenable to online administration, the incremental cost-effectiveness of conducting interview surveys must be examined.


This article discusses the findings from a head-to-head comparison of online and CAPI administrations of binary choice health state valuation questions. The two administrations have different advantages and disadvantages, and the two samples significantly differ across selected background characteristics, but the similarities with the general population indicate that the standard sampling frames used for face-to-face and online research studies are both valid. Responses to the main experimental binary choice questions, however, were not significantly different across the modes, and the mode of administration was not a significant factor explaining the responses. Therefore, both modes produce comparable data, and both can be used to administer health state valuation surveys including binary choice valuation questions such as DCE TTO [8]. The advantages and disadvantages of both modes must be considered when designing health state valuation studies.


Expresiones de gratitud


The wider PRET project team consists of Nick Bansback, John Brazier, Ken Buckingham, John Cairns, Nancy Devlin, Paul Dolan, Arne Risa Hole, Louise Longworth, Brendan Mulhern, Donna Rowen, and Aki Tsuchiya (the principal investigator). We are grateful to all respondents who took part, and the market research companies for carrying out the data collection. The study was approved by the ethics committee at the University of Sheffield School of Health and Related Research.


Source of financial support: This study was funded by the MRC Methodology Programme (reference no. G0901500; Project title: Preparatory Study for the Revaluation of the EQ-5D Tariff [PRÊT]).


The influence of contextual reward statistics on risk preference


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Wright N. D. Symmonds M. Hodgson K. Fitzgerald T. H. Crawford B. Dolan R. J. Approach–avoidance processes contribute to dissociable impacts of risk and loss on choice. J. Neurosci. 2012; 32 (20):7009–7020. [PubMed ]


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BACKGROUND: Health state valuation exercises can be conducted online, but the quality of data generated is unclear. OBJECTIVE: To investigate whether responses to binary choice health state valuation questions differ by administration mode: online versus face to face. METHODS: Identical surveys including demographic, self-reported health status, and seven types of binary choice valuation questions were administered in online and computer-assisted personal interview (CAPI) settings. Samples were recruited following procedures employed in typical online or CAPI studies. Analysis included descriptive comparisons of the distribution of responses across the binary options and probit regression to explain the propensity to choose one option across modes of administration, controlling for background characteristics. RESULTS: Overall, 422 (221 online; 201 CAPI) respondents completed a survey. There were no overall age or sex differences. Online respondents were educated to a higher level than were the CAPI sample and general population, and employment status differed. CAPI respondents reported significantly better general health and health/life satisfaction. CAPI took significantly longer to complete. There was no effect of the mode of administration on responses to the valuation questions, and this was replicated when demographic differences were controlled. CONCLUSIONS: The findings suggest that both modes may be equally valid for health state valuation studies using binary choice methods (e. g. discrete choice experiments). There are some differences between the observable characteristics of the samples, and the groups may differ further in terms of unobservable characteristics. When designing health state valuation studies, the advantages and disadvantages of both approaches must be considered.


Binary choice health state valuation and mode of administration: head-to-head comparison of online and CAPI.


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Value in Health


Valor Salud. 2013 January; 16(1): 104–113.


Binary Choice Health State Valuation and Mode of Administration: Head-to-Head Comparison of Online and CAPI


1 Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK


2 Health Economics Research Group, Brunel University, London, UK


3 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada


4 Office of Health Economics, London, UK


5 Department of Economics, University of Sheffield, Sheffield, UK


Address correspondence to . Brendan Mulhern, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Email: ku. ca. dleiffehs@nrehlum. b


Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.


Open Access under CC BY 3.0 license


This document was posted here by permission of the publisher. At the time of the deposit, it included all changes made during peer review, copy editing, and publishing. The U. S. National Library of Medicine is responsible for all links within the document and for incorporating any publisher-supplied amendments or retractions issued subsequently. The published journal article, guaranteed to be such by Elsevier, is available for free, on ScienceDirect, at: http://dx. doi. org/10.1016/j. jval.2012.09.001


Este artículo ha sido citado por otros artículos en PMC.


Abstracto


Fondo


Health state valuation exercises can be conducted online, but the quality of data generated is unclear.


Objetivo


To investigate whether responses to binary choice health state valuation questions differ by administration mode: online versus face to face.


Métodos


Identical surveys including demographic, self-reported health status, and seven types of binary choice valuation questions were administered in online and computer-assisted personal interview (CAPI) settings. Samples were recruited following procedures employed in typical online or CAPI studies. Analysis included descriptive comparisons of the distribution of responses across the binary options and probit regression to explain the propensity to choose one option across modes of administration, controlling for background characteristics.


Resultados


Overall, 422 (221 online; 201 CAPI) respondents completed a survey. There were no overall age or sex differences. Online respondents were educated to a higher level than were the CAPI sample and general population, and employment status differed. CAPI respondents reported significantly better general health and health/life satisfaction. CAPI took significantly longer to complete. There was no effect of the mode of administration on responses to the valuation questions, and this was replicated when demographic differences were controlled.


Conclusiones


The findings suggest that both modes may be equally valid for health state valuation studies using binary choice methods (e. g. discrete choice experiments). There are some differences between the observable characteristics of the samples, and the groups may differ further in terms of unobservable characteristics. When designing health state valuation studies, the advantages and disadvantages of both approaches must be considered.


Keywords: CAPI, health state valuation, online


Introducción


To conduct health state valuation studies, a range of administration modes can be used. These include face-to-face interviews using paper-and-pencil methods, face-to-face interviews using computer-assisted personal interviews (CAPIs—in which surveys are displayed via a computer interface while an interviewer is present), and online studies. To date, face-to-face interviews using paper-and-pencil methods have been the most widely used mode for collecting health state valuation data and were used to derive preference weights for EuroQol five-dimensional (EQ-5D) questionnaire using the time trade-off (TTO) preference elicitation technique [1] and six-dimensional health state short form (derived from SF-36) using the standard gamble (SG) approach [2,3]. TTO studies employing CAPI methods have also been used to derive EQ-5D questionnaire value sets [4,5]. An online version of the TTO process has been investigated, and some concerns have been found with the approach [6]. TTO and SG tasks in these studies have been “iterative”: TTO or SG of a given health state consists of a series of choices, iterated for different values until a point of indifference is reached for each individual respondent for the state. However, techniques based on binary choice can mean that each choice made by the respondent is independent of the one before. A discrete choice experiment (DCE) is an example of a binary choice technique and has been used in a face-to-face setting [7] and in online settings [8] .


Each mode has advantages and disadvantages that may affect the data generated and therefore need to be considered in the design of health state valuation studies. Face-to-face interviews may provide high-quality data with good completion rates and reliability [9] but are expensive and time-consuming to conduct. The use of CAPI means that some of the advantages of online surveys can be exploited in face-to-face environments. For example, CAPIs allow for complex routing of questions, question order randomization, recording of the time taken, and the minimization of errors associated with data entry (which is completed automatically). Online valuation methods have the advantages related to CAPI but are also cheaper to conduct, allow large samples to be achieved in a short space of time, have a flexible sampling frame, and enable a range of background characteristics of nonrespondents to be obtained. The two main disadvantages of online surveys relate to the representativeness of the sample and the quality of the data. People who have access to the Internet may not be representative of the wider population, and answering a survey unsupervised may lead to low-level engagement or poor understanding.


Studies have compared the online and CAPI administration of health state valuation exercises. Comparisons of the online and face-to-face administration of iterative person trade-off (PTO) tasks have found broadly similar results across modes [10,11]. Robinson et al [10]. however, found that a greater number of online respondents gave “equivalence” responses, which provided the quickest way to finish each PTO task. Norman et al [6] compared the online and face-to-face (but not CAPI-based) administration of an iterative TTO task and found that the responses differed by administration mode, with those completing the online survey displaying more variation in response. When the results were modeled to generate a value set for the EQ-5D questionnaire, 100 of the 243 health state values were higher in the online group by at least 0.1. Therefore, iterative health state valuation tasks administered online may generate different results from CAPI, but it is not clear whether the difference is due to the mode of administration used or differences in the perception and completion of an iterative task when administered by using different modes of administration.


In addition, it has not been established whether responses to binary choice health state valuation questions are comparable across administration modes. Binary choice questions such as DCE TTO . where duration is included as a dimension alongside the health state classification system, can be used to value health states at the aggregate level [8]. Binary choice questions such as DCE with no duration can be used to value health states in “hybrids” with TTO [12,13]. Because conventional health state valuation questions such as SG or TTO based on iteration to identify indifference are effectively made of a series of binary choice questions, a set of independent “snapshot” binary choice questions can be used to value health states at the aggregate level [14]. Comparing the online versus CAPI administration of binary choice questions to investigate the level of equivalence between the modes of administration has direct implications for the better understanding of these methods, and the design of future health state valuation studies using binary choice techniques.


Collecting data online raises concerns about the representativeness of the sample and comparability with data collected by using other methods. Samples recruited online may be biased in terms of unobserved characteristics [15]. There are also concerns about the motive of participation, the level of nonresponse and attrition [16]. the reliability and validity of the data generated [17–19]. and the level of engagement of respondents. Nevertheless, other studies have found comparability across samples [20,21]. in addition to comparability in terms of the reliability and validity of the data generated [22] .


This study aimed to compare responses to binary choice versions of health state valuation questions across online and CAPI modes of administration. This was done by administering identical surveys where the only difference was the mode of administration used to collect the data. We hypothesized that the responses to different types of binary choice valuation questions do not differ across modes. To investigate issues around the representativeness of samples recruited for face-to-face and online studies, we also compare the demographic characteristics and self-reported health status of the samples and those of the general population.


Métodos


Encuesta


The online and CAPI survey data sets used in this study contained identical demographic and binary choice questions in the same order. Both data sets were part of a wider research project where binary choice questions were used to investigate methodological issues related to health state valuation. Seven different “types” of binary choice questions were included in the online survey, and the basic format of the questions is described in Figure 1. The questions included a number of experimental attributes that can be varied across hypothetical health states. These include health state experienced (H), time spent in the health state (T), lead time spent in full health before the health state (L), perspective of the person experiencing the health state (P), and the level of satisfaction with health while experiencing the health state (S). The seven question types were designed to examine a number of methodological issues typically involved in health state valuations, namely, that health state preferences are independent of 1) the duration of the state, 2) whose health it is (i. e. perspective), 3) the length of “lead time” (a mechanism to value all states on the same scale including those that are worse than being dead), 4) when health states take place, and 5) the satisfaction associated with the state. Further topics addressed were 6) the lowest health state value that can be valued by using lead time and 7) health state valuation by using DCEs with duration as an attribute (DCE TTO ). Not all the attributes above vary across each question (see Table 1 for the attribute combinations used across each question type and Tsuchiya and Mulhern [23] for more details).


Basic binary choice question format used in the survey.


The 12 experimental questions used for the survey.


The online survey had 15 versions, most of which contained only three of the seven types of questions. One version, however, contained all seven question types, and this is used in the study reported here. The CAPI survey matched this particular online version in terms of questions and sample size. In other words, the data used in this comparison study have a wide coverage of question type, but it is not intended that they are used to address any of the methodological issues themselves. In this version, 12 questions were administered across three question modules (the time taken to complete each module was recorded). Module 1 included five type I questions, module 2 included one of the question types II–VI (so five questions in total), and module 3 included two DCE TTO questions (type VII; two subversions of module 3 were included for both the online and the CAPI survey so that four different questions of this type were used overall). The health states used were based on the EQ-5D-5L [24]. The EQ-5D-5L describes health status across five dimensions—mobility, self-care, usual activities, pain/discomfort, and anxiety/depression—each with five response levels—no, slight, moderate, severe, and extreme/unable.


Each survey began by providing study information, and this was followed by a compulsory informed consent page. Respondents were then asked a series of demographic questions and completed self-reported health status (on a 5-point scale, with scores ranging from “excellent” to “poor”), health and life satisfaction questions (on a 10-point scale, with scores ranging from “completely satisfied” to “completely dissatisfied”), and the EQ-5D-5L before completing the 12 binary choice valuation questions.


Recruitment and the Sample


To achieve a comparison of the two modes of administration as they would happen in the real world, the CAPI and online samples were recruited separately following procedures employed in typical surveys.


For the online survey, respondents were sourced from an existing Internet panel and were selected following set quotas based on the UK general population across five age groups—18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64—and sex. Invitations were sent out via e-mail. Potential respondents were screened out before starting the experimental questions if the relevant quota for age and sex was already complete or after the completion if they completed the survey in less than the minimum imposed time limit of 5 minutes (which was chosen after inspection of the completion times from the initial launch of the survey). The online survey described in this study was 1 of 15 different online surveys that aimed for an overall achieved sample of 3000 (


200 respondents per version). The questions included in the version described here were identical to those used in the CAPI survey, and therefore a subset of respondents from the overall sample is considered in this study.


For the CAPIs, recruitment followed set quotas for age and sex based on the UK general population and scaled down for an achieved sample of 200. This attempted to ensure the overall comparability of the sample characteristics across the administration modes. Participants were recruited by knocking on 1 in every 10 doors in randomly selected postcodes in five UK areas. The survey was presented to respondents on a laptop, and the interviewer read out all the questions and text on the screen and recorded the response given by the respondent. This was done in a one-to-one setting. The same minimum completion time of 5 minutes was imposed, and participants were able to stop the survey at any time.


Análisis


Background characteristics, self-reported health status, and time taken to complete the survey were compared across the two samples by using chi-square analysis, Mann-Whitney U analysis, and analysis of variance. The background characteristics of the overall, CAPI, and online samples were also compared with the general population of England and Wales by using statistics extracted from the 2001 UK census [25] for 18- to 64-year-olds. Comparisons of the proportion of respondents who chose scenario B by sample and by the seven binary choice question types were carried out, with statistical significance indicated by P values less than 0.05.


Comparisons of the proportions of respondents choosing scenario B using a range of completion time cutoff points (i. e. 5, 6, 7, and 8 minutes) were also investigated by using chi-square analysis. We also compared the responses for different groups of respondents defined by the time taken to complete each of the three binary choice question modules. Two groups were defined for each module: group 1 included those completing the module in less than the median time taken to complete the module (and also the overall survey in more than 5 minutes) and group 2 included those completing the module in more than or equal to the median time taken to complete the module (and the overall survey in more than 5 minutes). The median time was used as the cutoff to allow for a reasonably equal split between the groups.


Probit regressions were used to explore the determinants of the propensity to choose scenario B for each question:


Pr ( B = 1 ) = Φ ( β 1 D + β 2 S + β 3 X + β 4 M + β 5 Ti )


where Pr represents probability; β i  s are the parameters to estimate; D represents the sociodemographic characteristics of respondents; S represents health satisfaction of the respondent; X represents the properties of the health state using health state (H), duration (T), lead time in full health (L), person perspective (P), and satisfaction level (S) (see Figure 1 and Table 1 ); M represents the mode of administration; and Ti represents the time taken to complete the experimental question module. The function Φ(·) is the distribution function of the standard normal distribution [26,27]. Marginal effects are reported as they can be interpreted as percentages. For example, a marginal effect of−0.2 for a male indicates that being a male reduces the probability of choosing scenario B by 20%. For the regressions, statistical significance levels of both P less than 0.05 and P less than 0.01 are reported.


Resultados


Respondent Characteristics and Self-Reported Health Status


In total, 422 respondents completed either the online survey or the CAPI version. For the online survey, 2326 panel members were invited to take part and 487 potential respondents (20.1%) accessed the survey. Of these, 266 (11.4% of those invited; 54.6% of those accessing the survey) were screened out because they belonged to a completed age and sex quota (n = 158; 6.7% of those invited; 32.4% of those accessing), left the survey during completion (n = 19; 0.8% of those invited; 3.9% of those accessing), or completed the survey in less than 5 minutes (n = 108; 4.6% of those invited; 22.2% of those accessing). This group was defined as noncompleters. In total, 221 (9.5% of those invited; 46% of those accessing) fully completed the survey in 5 minutes or more. There were no significant age or sex differences between the responder and nonresponder samples.


The CAPI version was completed by 201 respondents. Information about the response rate for the survey is not available, because it was not recorded by the survey company, and therefore the response rate cannot be calculated. Nevertheless, in a similar CAPI study using the same methodology as part of the PRET project, Mulhern et al [28] found an overall response rate of 17.2%, and there is no reason to suggest that the response rate in this study would be substantially lower or higher than this. No CAPI respondents were excluded for completing the survey too quickly, and no respondents asked to stop the survey once they had begun answering the questions.


There were no significant differences between the online and CAPI groups by age and sex, but a number of demographic variables significantly differed between the samples ( Table 2 ). These included employment status (with more retired people and homemakers in the CAPI sample, but more students in the online sample), marital status (with more CAPI respondents being married and more online respondents being single), and education level (with online respondents being educated to a higher level). In comparison to the general population, the overall, online, and CAPI samples all differ in terms of employment status, with more employed people in the general population (all P <0.001). The online sample is more similar to the general population in terms of marital status than the CAPI sample (with more of the CAPI sample being married or with a partner). The overall education level of the CAPI sample, however, is more similar to that of the general population.


In terms of the mean completion times, the CAPI sample took significantly longer to complete the overall survey, the background question, and self-reported health components of the survey, as well as experimental module 1 (five type I binary choice questions) and module 2 (one of the types II–VI binary choice questions). The difference between the samples for the time taken to complete module 3 (two DCE TTO questions) was not significant. Across all three modules, the SD of the time taken is longer for the online sample than for CAPI sample. In terms of the median completion times, the CAPI sample took significantly longer to complete the overall survey, background questions, and all three experimental question modules (see Table 2 ).


Responses to the self-report general health and health and life satisfaction questions are displayed in Figure 2. The CAPI sample are significantly more likely to report better health ( P <0.001), higher levels of health satisfaction ( P <0.001), and higher levels of life satisfaction ( P <0.001). The mean EQ-5D-5L index score for the online sample (mapped from the EQ-5D-3L by using the algorithm produced by van Hout et al [29] ) was 0.776 (0.25) and for the CAPI sample was 0.874 (0.20). This difference was significant ( F (1, 409) = 18.66; P <0.001). EQ-5D-5L dimension responses also differ significantly by administration mode except mobility, with the CAPI group reporting less problems.


Self-reported health status and health and life satisfaction.


Binary Choice Valuation Questions


The proportion of the sample choosing scenario B (i. e. choosing to live for a shorter duration in full health, choosing immediate death, or choosing the EQ-5D-5L state and associated duration for DCE TTO questions) did not significantly differ by administration mode for any of the seven binary choice question types ( Table 3 ). This was irrespective of the experimental attributes varied in the scenario. The result of equivalence across the scenarios is also consistent by using a range of different minimum time cutoff points for the overall survey (5, 6, 7, and 8 minutes) and also when dividing the sample into two groups on the basis of the time taken to complete each experimental module (group 1 included those completing the module in less than the median time taken to complete the module, and group 2 included those completing the module in more than or equal to the median time taken).


Proportion of respondents choosing scenario B in different binary choice questions by using 5-min cutoff and P values using other overall and within-module cutoffs.


Probit regressions for each question reveal that a range of demographic and experimental attribute variables significantly predict the likelihood of choosing scenario B for a number of binary choice questions at the 0.05 level, but there is no pattern to the findings ( Table 4 ). The mode of administration, the time taken to complete the question module, or the interaction between mode and completion time do not significantly predict responses across any of the question types.


Probit regression marginal effect coefficients for the likelihood of choosing scenario B.


For type I questions, response is significantly predicted by the health state and duration used in the question, where the more severe the health state or the larger the duration, the more likely scenario B is selected. These results cannot be tested across the other question types, as types II to VI include only one health state and associated duration. For type II questions, females are 5% and those with higher levels of life satisfaction are 5% more likely to choose to live in full health. For type IV, females are 11% and respondents who are retired are 13% more likely to choose scenario B. For type V, males are 12% and those who are not married or with a partner are 11% more likely to choose scenario B. Responses to some of the type VII questions are predicted by marital and employment status and life satisfaction, but these results are difficult to interpret owing to the nature of type VII questions, which presents two full EQ-5D-5L health states. Responses to question types III and VI are not predicted by any of the variables.


Discusión


When health state valuation techniques such as TTO and SG were developed, face-to-face interviews were seen as the best way to administer the exercises, and this is the mode used to derive preferences for generic preference-based measures of health such as the EQ-5D questionnaire [1] and the six-dimensional health state short form (derived from SF-36) [2,3]. as well as condition-specific instruments [30–32]. In recent years, there have been advances in communication technology and interest in the use of online health state valuation techniques is increasing. In parallel to this, health state valuation methods that are amenable to online administration, based on binary choice questions, have been developed [8,14,33]. There are issues, however, regarding the quality of data generated using online surveys. This article reports on a comparison between an identical set of binary choice questions designed to test issues related to health state valuation conducted in online and face-to-face environments. The results suggest that there is no difference between the responses to a range of binary choice valuation tasks across the administration modes. We also investigated the sample characteristics and found some differences between the groups. The finding of equivalence across the modes, however, remained robust after controlling for differences in the sample characteristics.


The responses to the main binary choice valuation questions were not statistically significantly different across the modes of administration, and this finding was not influenced by the severity or duration of the state used in the binary choice question. This is in comparison to a study comparing an iterative valuation technique (TTO) that found differences between online and face-to-face responses and concluded that this was due to the iterative nature of the process [6]. This is possibly because respondents who intend to complete the questions quickly may accept the first trade-off offered to avoid going through the process to reach indifference. Our study did not test an iterative process, but rather binary choice health state valuation tasks, which are amenable to online administration. The outcome has been that where a design that is suited to online and CAPI administration is used, comparable results are generated so that we cannot reject the hypothesis that the mode of administration does not affect the results. Furthermore, this result holds across different types of binary choice questions. The results, however, are based on a design where each type of question was asked only a handful of times. To infer from here that the outputs from online and CAPI versions of an actual valuation study where respondents are required to answer a larger number of questions of the same type will be no different, we would need to assume further that the effect of boredom caused by answering a larger number of similar questions is the same across the two modes of administration, which is something beyond the scope of this study. In other words, this study provides necessary but not sufficient evidence that the mode of administration may have little effect.


The finding of equivalence across modes of administration is valid for samples recruited following the standard procedures for CAPI (i. e. knocking on doors in selected postcode areas to produce a representative sample) and online (i. e. using participant panels) who were found to have similarities with the general population (the group targeted in most preference elicitation studies conducted in the world [1–5,8] ). This demonstrates the potential applicability of our results in the design of valuation studies using binary methods. Nevertheless, it is unclear how these findings relate to other preference elicitation tasks. Equivalence at the binary level is necessary for equivalence at the iterative level. Nevertheless, our results are not sufficient to make any claims about equivalence at the iterative level. It may be possible to extend our findings to other valuation methods, and further work should consider the stability of a range of both iterative and binary choice preference elicitation techniques across different administration modes.


We have also assessed the time taken to complete the survey. If an online respondent completes the survey too quickly or too slowly, this may suggest that they are not fully engaged. The results demonstrate that the CAPI sample took significantly longer to complete the overall survey and two of the experimental modules. This may be because an interviewer is present and reads out the questions, and it is unlikely for the respondent to complete the survey without some minimal level of engagement. The shorter completion time data indicate that it is possible that at least some respondents in the online sample completed the survey without fully paying attention or engaging in the task. To try to counter this, we imposed a minimum time limit of 5 minutes for online respondents to be classified as completers. Five minutes was chosen from inspecting the completion times from the initial launch of the survey. The finding of equivalence across the modes of administration is consistent by using a range of cutoff points higher than 5 minutes and also by splitting the sample using the time taken to complete each module (which allows us to compare those completing each module quickly and those completing each module more slowly). This suggests that our findings are relatively robust. We have been unable, however, to assess the consistency of the results by using overall time cutoff points below 5 minutes, and this limits the wider applicability of the findings to binary choice valuation studies conducted online that do not impose minimum completion times. Future research may investigate respondent engagement in the online environment in more detail, for example, by analyzing responses using a wider range of minimum time limits, recording the time taken to complete each task, or developing innovative methods for presenting the tasks.


There have been concerns about the representativeness of online samples and how this might affect the comparability of results across samples [15,20,21]. The two samples in our study were recruited against age and sex quotas and therefore do not differ in terms of these characteristics. The two samples, however, differ significantly in some observable characteristics, and this raises the issue of representativeness with respect to the UK general population. Compared with previous census data [25]. the CAPI samples are more representative in terms of educational attainment. The online sample overrepresents people educated to at least degree level, and this has also been found in other studies comparing online research groups with the general population [20]. Those who are educated to a higher level may be more computer literate, and this possibly explains their overrepresentation in the sample. In terms of health, it is possible that the online sample is genuinely less healthy than the CAPI sample. It has also been established, however, that individuals may answer face-to-face surveys in a socially desirable way, particularly when answering questions about sensitive issues such as mental health [34]. This may vary according to whether responses were public or anonymous [35]. In the CAPI sample, there may be a discrepancy between actual health and reported health status because of the presence of the interviewer, which may mean that, from the respondent’s perspective, responses are not completely anonymized. This did not, however, affect responses to the health state valuation questions.


We were not able to assess how the mode of administration affects the responses of those older than 65 years, because this group was not included in the sampling frame for the study. This potentially limits the applicability of our findings, as the Office of National Statistics predicts that approximately 59% of the adults 65 years or older use the Internet every day or almost every day (in comparison to


80% of those aged 18–54 years and 75% of those aged 55–64 years) [36]. Robinson et al. [10] included members of the population older than 65 years in their comparison of PTO tasks across different modes of administration and found that response to the Internet arm of the study was lower in this group. They did not, however, investigate differences in responses to the PTO task across different age groups. Further comparisons of valuation tasks across different modes of administration should investigate responses among those older than 65 years. This will establish the level of equivalence of health state valuation exercises across different modes of administration for the overall adult population.


It is in theory possible to make two samples agree in terms of any observable characteristic. Nevertheless, even with highly selective screening, the samples may differ in terms of further unobserved characteristics. The CAPI sample characteristics are influenced by who is at home when the interviewer visits, who agrees to take part, and who completes the interview. The online sample using an Internet panel is affected by who has access to the Internet, who is a member of the online panel, who in the panel agrees to take part, and who of those agreeing to take part completes the survey. It is not clear how the different selection mechanisms affect unobservable sample characteristics and therefore responses to health state valuation questions. Not everyone is equally likely to join an online panel and complete a particular survey or take part in a face-to-face interview. Typically, characteristics of nonresponders to interviews are not available, and one advantage of online surveys using existing Internet panels is that certain characteristics of nonresponders may be accessible. This allows for further insight into issues around nonresponse. A related issue is comparing the overall response rates for each mode of administration. Unfortunately, this study cannot inform this issue as the number of people who were invited to take part in the face-to-face CAPI study was not recorded by interviewers.


When designing health state valuation studies, the financial and time costs of the surveys are important and must be considered in light of the available preference elicitation methods and the modes available for administering the techniques. The cost of any survey has a fixed element and is not completely proportionate to the sample size. Nevertheless, even if generalized cost estimates cannot be given, it is generally the case that face-to-face interviews are substantially more costly per respondent and may take a much longer time to recruit sufficient numbers of participants. At the same time, any survey is only as good as the quality of the sample, and therefore the quality of the Internet panel needs to be scrutinized: one way to do this may be to look at how panel members are recruited and what incentives are offered. Overall, when the survey design is amenable to online administration, the incremental cost-effectiveness of conducting interview surveys must be examined.


This article discusses the findings from a head-to-head comparison of online and CAPI administrations of binary choice health state valuation questions. The two administrations have different advantages and disadvantages, and the two samples significantly differ across selected background characteristics, but the similarities with the general population indicate that the standard sampling frames used for face-to-face and online research studies are both valid. Responses to the main experimental binary choice questions, however, were not significantly different across the modes, and the mode of administration was not a significant factor explaining the responses. Therefore, both modes produce comparable data, and both can be used to administer health state valuation surveys including binary choice valuation questions such as DCE TTO [8]. The advantages and disadvantages of both modes must be considered when designing health state valuation studies.


Expresiones de gratitud


The wider PRET project team consists of Nick Bansback, John Brazier, Ken Buckingham, John Cairns, Nancy Devlin, Paul Dolan, Arne Risa Hole, Louise Longworth, Brendan Mulhern, Donna Rowen, and Aki Tsuchiya (the principal investigator). We are grateful to all respondents who took part, and the market research companies for carrying out the data collection. The study was approved by the ethics committee at the University of Sheffield School of Health and Related Research.


Source of financial support: This study was funded by the MRC Methodology Programme (reference no. G0901500; Project title: Preparatory Study for the Revaluation of the EQ-5D Tariff [PRÊT]).


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PMC makes strategic move into the institutional FX space


Prime Mantle Corporation PLC (PMC) announced today that it has completed the acquisition of Capital Market Services UK Ltd (CMS). The transaction received approval from the United Kingdom Financial Conduct Authority (FCA) earlier this year and completed on November 1st. PMC is a Republic of Ireland based holding company with several assets in the financial services space including the global retail FX broker/dealer FX Primus.


The acquisition of CMS represents a significant move upmarket for PMC. PMC hopes to leverage its balance sheet as well as its global sales and marketing reach to further expand CMS’ CapMar Financial offering of institutional liquidity and prime-of-prime services in the FX, CFD and Metals markets. The transaction further allows PMC to leverage CMS’ banking and counterparty relationships, proprietary technology, institutional offering and market expertise.


“We are very excited about this transaction. This is a win-win for both CMS and Prime Mantle. The acquisition provides us with a significantly more diverse offering as well as the much-needed pathway to the institutional market we’ve sought for some time now.” said Terry Thompson, Director at PMC and President of FX Primus. “The realized synergies between the two companies will make our overall offering more robust and enable both FX Primus and CapMar to offer a more comprehensive product downstream to our customers.


“We are thrilled to have had the chance to add CMS to the PMC family of companies. CMS’s decade and a half in the business, solid brand, rich tradition of excellence, infrastructure and experienced staff are an excellent addition to our portfolio. We believe that CapMar Financial will benefit substantially from our strong marketing capabilities and global sales network” él continuó.


Mr. Thompson concluded by stating that “We intend on maintaining the same level of world class service that CMS clients have grown accustomed to over the years. As we have always emphasized, the focus will continue to be the clients and providing them with the best possible trading experience. We plan on devoting a large amount of resources towards enhancing CMS’ proprietary technology and products and building on its already significant offering to its institutional client base.”


Eugene Hawkin, CMS’s Co-Founder and Executive Director said that he was “excited about the acquisition. I’ve been very impressed by the dynamic growth we’ve seen at PMC’s FX Primus and I believe that we have found an excellent home for our firm. I think this transaction will allow CapMar to continue to operate independently at the high level of service our clients have come to expect of us while providing us with the additional infrastructure and resources necessary to further grow our business.”


There were no announced changes in the management or directorship of CMS at this time and both parties expect the firm’s operations to continue without much change for the foreseeable future.


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Studies of the evolution of collective behavior consider the payoffs of individual versus social learning. We have previously proposed that the relative magnitude of social versus individual learning could be compared against the transparency of payoff, also known as the "transparency" of the decision, through a heuristic, two-dimensional map. Moving from west to east, the estimated strength of social influence increases. As the decision maker proceeds from south to north, transparency of choice increases, and it becomes easier to identify the best choice itself and/or the best social role model from whom to learn (depending on position on east-west axis). Here we show how to parameterize the functions that underlie the map, how to estimate these functions, and thus how to describe estimated paths through the map. We develop estimation methods on artificial data sets and discuss real-world applications such as modeling changes in health decisions.


Estimating a path through a map of decision making.


Texto completo


Citations


BioEntities


Artículos relacionados


Enlaces externos


Más uno. 2014; 9(11): e111022.


Estimating a Path through a Map of Decision Making


Igor Linkov, Editor


1 Department of Economics, University of Wisconsin, Madison, WI, United States of America and Department of Economics, University of Missouri, Columbia, MO, United States of America


2 Department of Archaeology & Anthropology, University of Bristol, Bristol, United Kingdom


3 Department of Anthropology, University of Missouri, Columbia, MO, United States of America


4 Department of Mathematical Sciences, Durham University, Durham, United Kingdom


US Army Engineer Research and Development Center, United States of America


Competing Interests: Co-author R. Bentley is a PLOS ONE Editorial Board member, but this does not alter the authors' adherence to PLOS ONE Editorial policies and criteria.


Conceived and designed the experiments: WAB RAB MJO CCSC. Performed the experiments: RAB CCSC. Analyzed the data: RAB CCSC. Wrote the paper: WAB RAB MJO CCSC.


Received 2014 May 23; Accepted 2014 September 28.


Este es un artículo de acceso abierto distribuido bajo los términos de la licencia de atribución de Creative Commons. which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Abstracto


Studies of the evolution of collective behavior consider the payoffs of individual versus social learning. We have previously proposed that the relative magnitude of social versus individual learning could be compared against the transparency of payoff, also known as the “transparency” of the decision, through a heuristic, two-dimensional map. Moving from west to east, the estimated strength of social influence increases. As the decision maker proceeds from south to north, transparency of choice increases, and it becomes easier to identify the best choice itself and/or the best social role model from whom to learn (depending on position on east–west axis). Here we show how to parameterize the functions that underlie the map, how to estimate these functions, and thus how to describe estimated paths through the map. We develop estimation methods on artificial data sets and discuss real-world applications such as modeling changes in health decisions.


Introducción


In studies of decision-making and health, social influence is becoming increasingly recognized. Coordinated behavior has benefits for groups and the individuals within them. When successful behaviors of the community are socially learned, cooperation can evolve in social networks extending beyond the limits of Hamiltonian inclusive fitness among kin [1] –[8]. Provided that some fraction of agents learn individually [9]. either as “specialists” or “generalists” [10]. social learning can be seen as an adaptive strategy among “scroungers” for the exploitation of the information gains made by the “producers” who track the environment through individual learning [11] –[13]. Most evolutionary approaches expect the most adaptive state to equilibrate to a mix of individual and social learners whose proportions are dictated by the degree of spatial and temporal autocorrelation of the environment and the cost of individual learning [7]. [12]. [14] –[18]. This assumption of adaptive equilibrium is an ideal, however, and not necessarily attainable in conditions of continual transition. As social learners increase in frequency, they are increasingly copying from each other, and so the quality of their information about decision payoffs likely diminishes [12]. At the same time, individual learners may be overwhelmed by rapid change, poor information, or simply too much information in order to make informed decisions.


For this reason, there is the important factor of how well informed decision makers are — what we might call the “transparency” of payoffs in their decisions. A relevant question about online social media, for example, is whether their searchability makes decision makers more well informed, or whether the deluge of social influence and similar options makes decisions less transparent in terms of payoffs [19]. Traditional decision theory typically assumes that agents are informed about their behavioral options, or if not, then are at least knowledgeable about the people from whom they might learn, preferably the most skilful, informed, or prestigious members of the group [12]. [20] –[22]. In contrast, models of collective flocking or herding behavior assume no such knowledge — agents are often represented by vectors, with choice as the direction and transparency as the magnitude. Even as most agents follow neighbors with no particular preference, a collective direction (consensus) can nonetheless favor of the minority, if there exists high transparency of choice [23] –[25] .


We see two major factors in decision making: social/individual learning and transparency of choice [19]. as depicted in Figure 1. This heuristic map represents the relative magnitude of social versus individual learning on the horizontal axis and the transparency of a decision on the vertical axis. Following the call for evolutionary theory as the integrating principle of behavioral science [26]. the map is intended to unify quantitative approaches from multiple branches of social science, ranging from rational-actor approaches in the northwest, to more anthropological social-learning theory in the northeast, to the “information overload” of the southwest and southeast.


Summary of the four-quadrant map for understanding different domains of human decision making, based on whether a decision is made independently or socially and the transparency of options and payoffs [19] .


At the macro scale, the map reduces the complexity of social decision process analysis to the coarse-grained simplicity of two axes, analogous to a principal components analysis reduced to two dominant factors. The north–south axis, which we parameterize as , represents a measure of transparency in the payoff differences among available alternatives, from opaque at the south ( ) to absolutely transparent in the north ( ). Along the east–west axis, the measured parameter increases from west to east, from a decision made individually at the western edge ( ) to pure social decision making — copying, for example — at the eastern edge ( ).


The framework has broad applicability, and one particular application we envisage is toward fertility decisions for example, using an exceptional long-term dataset on about 250,000 people, collected in the Matlab region of Bangladesh since 1966 [27]. Those data are excellent, long-term monthly records of the decisions that have been made over many years, along with associated (anonymous) details of the individuals making those decisions, such as total fertility, religion, surviving children, age at marriage, household income, education and other observable covariates that impact fertility. We can also consider social variables as well, such as density of the behaviour within the local social network. Other health-related examples would be smoking, where national health services such as the NHS in the United Kingdom or the ALSPAC dataset at University of Bristol hold long-term data on anonymous individuals and their relevant binary choices (to smoke or not, be vaccinated or not), along with a wealth of covariate information on the individuals (wealth, education, religion, and so on) but also often on social visibility (e. g. kin members in the same dataset).


Work on peer effects in smoking behavior is vast, but we have not found any work that attempts to estimate the dynamics of the intensity of choice function, as we propose. Work that is most closely related to ours [28]. [29] attempts to control for the effects of self-selection into peer groups, correlated unobservables, and contextual effects that tend to bias received estimates of peer effects on smoking (e. g. estimates of our parameter). This valuable precedent, however, does not estimate the intensity of selection function as we propose.


Our approach could be applied to far different scenarios than health, including criminal records or consumer sales, where long-term choice data are available alongside individual covariates. We see the framework as especially appropriate to online choices in the big-data era, as the covariate data could be comprehensive, including vast records of previous choices. In all cases, the characterization on social influence and transparency of choice would provide a novel insight into the decision dynamics at the population scale.


We previously described the map in terms of generalized data patterns diagnostic of each of its four quadrants [19]. We focused on population-scale data patterns and left specific empirical estimation concerning individuals to future work. Here we show how real-world data could be plotted as locations on the map in Figure 1 and, if the data allow, as trajectories across the map through time. This requires us to develop a method to estimate and , either for each agent or for each agent's group, from real-world data. We assume the available data include the (a) covariates that may influence the agent's choice, (b) variability of the agent's choices, and (c) strength of social influences upon the agent's choices. All three of these associations may change through time.


The Model


In parametarizing our two-dimensional map, we divide transparency of choice into separable components for intrinsic utility and social influence. Our model builds on previous work in discrete choice theory by parameterizing the transparency of choice as a function of observable covariates (see Methods ). To begin, let there be groups with players in each group. We can think of as being a large number so that the law of large numbers gives a good approximation in what follows. For now, assume the groups are disjoint, i. e. nonoverlapping. Agent in group chooses choice if the random utility agent gets from choice is greater than the random utility available from any other choice,


Discusión


The simple bi-axial map of behavior in Figure 1 aims to extract from aggregated data the transparency of decisions (north–south) and the extent to which a behavior is acquired socially versus individually (east–west). We have proposed a means by which to parameterize the functions that underlie the map and thus estimate paths through it. Rather than assume how well agents are informed in their learning, we can let transparency of choice be a variable parameter in our models, with the aim of using the models to infer transparency of choice from real data [19]. [23]. For example, we might have a vector such that the transparency of choice would be parameterized as the specification .


Social-influence studies that treat transparency of choice as a variable suggest that it has a complex interaction with social learning. Some of this interaction might be captured, for example, by a specification such as , by which, assuming is positive, the presence of social influence increases with the scalar . Hypothetical real-world examples for a group-specific include the fraction in the group that are high income or perhaps the Gini coefficient of the group. Given the formulation for , the scalar factor then affects the social influence associated with other observables.


These parameters relate to debates on modelling fertility decisions, for example, as explanations range from an intrinsic individual utility decision [27] versus the social influence of the frequency of a particular fertility level in their local community [32]. For example, it may be that poor, uneducated women living in a wealthy, educated group tend to adopt the low-fertility level of the group rather than the higher fertility that would otherwise be associated with their low income and low education as individuals [32]. In this case the social-choice transparency, , might reflect the tendency to have the same number of children as other mothers, whose success and/or education has become more socially visible.


Fertility research also generates the sort of long-term, time-stratified demographic datasets that are appropriate to our proposed estimation method for the map. More generally, the growth of so-called “big data” on collective decisions also seems suited to this map [19]. which links different scales of analysis, such as the microprocesses that produce observed scaling relationships in social-network formation [33] .


As new digital technologies filter and search social influences and information, transparency of choice may be increased, but conversely if agents are overwhelmed the online deluge of information, options, and social influences [34]. [35]. then transparency of choice, , may decrease (by decreasing and/or ). This may be central to herding effects in online product ratings [36]. por ejemplo. Also, the transparency of payoffs may well be changing for many health decisions - the rapidly changing conditions of the modern world may effectively lower as the connection between the decision and its actual future payoffs are obscured by the “noise” of socio-economic change. Seemingly straightforward social interventions may therefore have unanticipated consequences [37] .


The dimensions of the map are also relevant to studies that compare technological complexity with population size [38] –[41]. which assumes relatively transparent individual and social learning. Adding agents who are uninformed (payoffs not transparent) tends to cause a group consensus to regress to a single mode [24]. [42]. When it is much easier, and less costly (essentially free), to see what others do, then the balance could shift to the east and south. When survey respondents, for example, can see the aggregated guesses from other people, they simply change from their original, individual guesses in linear proportion to the distance from the group mean [43] .


Conclusión


Having presented a two dimensional map ( Figure 1 ) as a schematic abstraction of human decision-making [19]. we have now gone further toward making this into an empirical tool to project population-scale decision data onto axes of social influence and transparency of choice. As the decision maker proceeds from south to north, the precision of understanding which choice is best increases. As the decision maker moves from west to east, the strength increases of social influence or peer group influence on which choice is best. Starting with a basis in discrete-choice modeling with social influence, we have discussed how a path through the map for a group of decision makers can be estimated from data sets. Through experiments with artificial data sets, we showed how the suggested estimation methods work and how parametric specifications can be estimated. For smaller datasets, we recommend maximum likelihood as the best way to estimate a path through the map, and then for larger datasets it becomes possible to use NLLS as the estimation method.


The map can now be applied to real-world case studies, especially those that feature large, time-stratified demographic data sets on binary decisions, such as those regarding health decisions. The parametrization we have presented allows us to extract, from these sorts of datasets, locations on the map representing degree of social learning and transparency of choice. As we apply this method in the future, we may be surprised to find that standard, universal assumptions regarding certain decisions may be becoming less appropriate, as the nature of such decisions changes through time or in different cultural contexts.


Métodos


Artificial data generation


Functional forms and estimation


In order to identify parameters of the model that describe movements across the map, we need to separate transparency of choice from social influence. To do this, we start with the north–south axis of the map (the transparency of choice) and then add, via the east–west axis, social influence on individual choices. We can start with the north–south axis. In discrete-choice theory, we assume we have a certain number of choices available and a certain amount of utility that is divided up among those choices. We then effectively toss the choices randomly into bins of a certain utility and find how many choices we expect in each bin. To start, consider a population of individuals making a binary choice ( or ), each seeking to maximize payoff function :


For a given individual, a standard approach assumes the probability to make a particular choice is equivalent to the probability that the difference in idiosyncrasies, , is less than some threshold :


Our use of the Fermi/Boltzmann function as our equation (9 ) is fairly standard in discrete-choice theory, but it is also seen in some studies of evolutionary games in finite populations, in which a “temperature,” or “noise,” parameter is varied (e. g. taken to zero) in order to characterize the equilibrium in terms of cooperators in the population. The same function has been used, for example, to model the probability of outcome between two randomly selected individuals playing Prisoners Dilemma or related pairwise game [44]. [45]. In that case, the parameter (analogous to temperature in the Boltzmann function) is intensity of selection rather than our transparency of choice, which operates on the payoff difference. The difference in our approach from game-theoretic approaches is twofold. First, rather than play pairwise games, agents choose among available options and the model relates how well choice popularity corresponds to covariates among the individuals of the population. Second, our focus is on econometric identification of parameters and estimation of parameters as well as on the ability to retrieve the model parameters from noisy data. In particular, we are interested in estimating the intensity of selection as a function of observable covariates. This effort appears new to the literature on estimation of social influences on choice, and it raises difficult identification issues that we have addressed through simulation methods. We developed this approach in order to show that our method works before applying it to field data.


Although this established approach does not model social influence directly, it has been used as a baseline to infer it from appropriate datasets. Aral et al. [46]. for example, applied this to daily data on the social network links and the date when individuals downloaded a certain mobile-service application (app). Aral et al. [46] considered individuals of similar propensity, , to have adopted the app by time , which for agent was estimated using a logistic regression equivalent to:


where functions as transparency of choice and is a vector of observable characteristics and behaviors for agent at time (we have subsumed one of their other parameters into the idiosyncrasies term ). Having collected data over a 4-month period, Aral et al. [46] were able to distinguish homophily — the tendency of similar individuals to associate with each other — from genuine influence (roughly 50/50 in their final estimation).


Further, we see that if the data have a wide enough range over individuals, groups, and dates, of values of , it must be the case that


i. e. social influence is zero for all values of the parameters that cannot be specified by the data alone. This level of identification can be enough when we simply want to determine the strength of social influence over time for different individuals and groups in different choice settings. We discuss another specification of the social-influence function in Section 5, where we test the estimation procedure on artificial data.


Estimation methods


In order to consider two popular estimation methods, Maximum Likelihood (ML) and Non-Linear Least Squares (NLLS), we consider a binary decision via equation 12. with the probability statement


In the standard versions of estimation of discrete-choice models, the transparency of choice, , is typically assumed to be constant (absorbed into the other parameters by a normalization convention). We are interested in how varies, however, so we must modify the conventional textbook approach [47]. One popular way of proceeding is to formulate dynamic discrete-choice models [48]. which often use Markov chain formulations or hazard-function formulations. However, for simplicity we wish to remain as close as possible to the static framework with independent stochastic drivers. Therefore, we shall work with the likelihood function (equation 3 .7) above, where the ultimate stochastic drivers are IIDEV across individuals, groups, and dates.


In the scalar case, formulas for the partial derivatives of the likelihood function with respect to are straightforward. The maximum-likelihood estimator, at the peak of the likelihood function, is found by setting these four partial derivatives of the likelihood function equal to zero. This yields four nonlinear equations in four unknowns. When one takes these four partial derivatives and sets the four resulting equations equal to zero, one will see that when, for some reason, the social-influence function is always zero, then the pair is determined only up to scale. The nonlinearity of the social influence helps resolve this particular identification problem.


If the social-influence function is zero, however, or restricted to be zero, we normalize the four equations by dividing the equations by , which can be further simplified by setting and solving the remaining three equations for , and . Three nonlinear equations in three unknowns is still more challenging than simple Ordinary Least Squares regression analysis.


Packages such as Matlab or R are good for general ML estimation, which works well when we have few observations per cell and enough observations per cell to allow for logistic regression [49]. Also, ML estimation does not assume that errors follow a specific distribution, whereas NLLS assumes normality of the errors, and one can use least squares estimators as starting points on the ML solver. ML estimation is less demanding of data sets than NLLS [47, chapter 14], but in cases where there is a large amount of data, we can also consider NLLS estimation methods that require larger data sets. Equation 5 suggests the NLLS regression equation of the log odds of agent in group of choosing choice 1 rather than choice zero at date ,


in which the right-hand side again consists of transparency of choice multiplied by individual, social, and noise components (note that the noise terms in equation 19 are part of the standard regression equation framework and are not the same as the terms in the logit equations above). Here, we assume the standard regression orthogonality condition on the regression errors,


so that parameter estimates are consistently estimated as sample size tends to infinity.


This research was partially supported by the Leverhulme Trust “Tipping Points” programa. Correspondence should be addressed to Alex Bentley at ku. ca. lotsirb@yeltneb. a.r .


Funding Statement


This research was partially supported by the Leverhulme Trust “Tipping Points” programa. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


Data Availability


The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper.


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& # 8211; Business description – A detailed description of the company’s operations and business divisions. & # 8211; Corporate strategy – Analyst’s summarization of the company’s business strategy. & # 8211; SWOT Analysis – A detailed analysis of the company’s strengths, weakness, opportunities and threats. & # 8211; Company history – Progression of key events associated with the company. & # 8211; Major products and services – A list of major products, services and brands of the company. & # 8211; Key competitors – A list of key competitors to the company. & # 8211; Key employees – A list of the key executives of the company. & # 8211; Executive biographies – A brief summary of the executives’ employment history. & # 8211; Key operational heads – A list of personnel heading key departments/functions. & # 8211; Important locations and subsidiaries – A list and contact details of key locations and subsidiaries of the company. & # 8211; Key manufacturing facilities – A list of key manufacturing facilities of the company. & # 8211; Detailed financial ratios for the past five years – The latest financial ratios derived from the annual financial statements published by the company with 5 years history. & # 8211; Interim ratios for the last five interim periods – The latest financial ratios derived from the quarterly/semi-annual financial statements published by the company for 5 interims history.


PharMerica Corporation (PharMerica) is an institutional pharmacy services company. It services healthcare facilities and provides pharmacy management services to hospitals and specialty infusion services to patients outside a hospital setting. The company is the only provider of national oncology pharmacy in the US. PharMerica’s services include long term care pharmacy services, alternate care, e-ordering and e-prescribing, products and billing programs, consultant pharmacist services, paper and electronic medical record services, account service and field services. Its solutions cater to the customers including institutional healthcare providers such as skilled nursing facilities, nursing centers, assisted living facilities, hospitals, individuals receiving in-home care and other long-term alternative care providers. PharMerica is headquartered in Louisville, Kentucky, the US.


Pharmerica Corporation Key Recent Developments


Mar 02, 2015: Pharmerica Reports Fourth Quarter and Full Year 2014 Results Mar 02, 2015: PharMerica Announces Wholesale Drug Distribution Agreement with Cardinal Health Nov 11, 2013: PharMerica Completes Certification with Surescripts to Support Real-Time Electronic Prescribing by Physicians in Long-Term Care Settings Nov 05, 2013: PharMerica Reports Record Results for the Third Quarter of 2013 Nov 04, 2013: PharMerica Appoints Christopher Schaefer as Senior Vice President of Corporate Development


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Note: Some sections may be missing if data is unavailable for the company Table of Contents


Section 1 – About the Company 6 Pharmerica Corporation – Key Facts 6 Pharmerica Corporation – Key Employees 7 Pharmerica Corporation – Key Employee Biographies 8 Pharmerica Corporation – Major Products and Services 9 Pharmerica Corporation – History 10 Pharmerica Corporation – Company Statement 11 Pharmerica Corporation – Locations And Subsidiaries 12 Head Office 12 Other Locations & Subsidiaries 12 Section 2 – Company Analysis 14 Pharmerica Corporation – Business Description 14 Pharmerica Corporation – Corporate Strategy 15 Pharmerica Corporation – SWOT Analysis 16 SWOT Analysis – Overview 16 Pharmerica Corporation – Strengths 16 Strength – Pharmacy Management Services 16 Strength – Market Position 16 Pharmerica Corporation – Weaknesses 17 Weakness – Loss of Major Customers 17 Weakness – Increasing Generic Dispensing Rate 17 Weakness – High Operating Expenses 17 Pharmerica Corporation – Opportunities 18 Opportunity – Strategic Acquisitions 18 Opportunity – Rising Healthcare Expenditure in the US 18 Pharmerica Corporation – Threats 19 Threat – Competition 19 Threat – Illegal Business Practices 19 Pharmerica Corporation – Key Competitors 20 Section 3 – Company Financial Ratios 21 Financial Ratios – Capital Market Ratios 21 Financial Ratios – Annual Ratios 22 Performance Chart 23 Financial Performance 23 Financial Ratios – Interim Ratios 24 Financial Ratios – Ratio Charts 25 Section 4 – Company’s Lifesciences Financial Deals and Alliances 26 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals By Year, 2009 to YTD 2015 26 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals By Type, 2009 to YTD 2015 27 Pharmerica Corporation, Recent Deals Summary 28 Section 5 – Company’s Recent Developments 29 Mar 02, 2015: PharMerica Announces Wholesale Drug Distribution Agreement with Cardinal Health 29 Mar 02, 2015: Pharmerica Reports Fourth Quarter and Full Year 2014 Results 30 Nov 06, 2014: PharMerica Reports Third Quarter 2014 Results 32 Aug 05, 2014: PharMerica Reports Second Quarter 2014 Results 34 May 01, 2014: PharMerica Reports First Quarter 2014 Results 36 Feb 28, 2014: PharMerica Reports Fourth Quarter and Full Year 2013 Results 37 Section 6 – Appendix 39 Methodology 39 Ratio Definitions 39 About GlobalData 43 Contact Us 43 Disclaimer 43 List of Tables Pharmerica Corporation, Key Facts 6 Pharmerica Corporation, Key Employees 7 Pharmerica Corporation, Key Employee Biographies 8 Pharmerica Corporation, Major Products and Services 9 Pharmerica Corporation, History 10 Pharmerica Corporation, Other Locations 12 Pharmerica Corporation, Subsidiaries 13 Pharmerica Corporation, Key Competitors 20 Pharmerica Corporation, Ratios based on current share price 21 Pharmerica Corporation, Annual Ratios 22 Pharmerica Corporation, Interim Ratios 24 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals By Year, 2009 to YTD 2015 26 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals By Type, 2009 to YTD 2015 27 Pharmerica Corporation, Recent Deals Summary 28 Currency Codes 39 Capital Market Ratios 39 Equity Ratios 40 Profitability Ratios 40 Cost Ratios 41 Liquidity Ratios 41 Leverage Ratios 42 Efficiency Ratios 42 List of Figures Pharmerica Corporation, Performance Chart (2010 – 2014) 23 Pharmerica Corporation, Ratio Charts 25 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals By Year, 2009 to YTD 2015 26 Pharmerica Corporation, Pharmaceuticals & Healthcare, Deals by Type, 2009 to YTD 2015 27


An Electronic PDF copy of this Report will be sent to you via email.


Please allow up to 2 business days for the reports to arrive to your mailbox as some of our publishers prefer to send you the reports directly.


Purchase this Report today


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The authors views are entirely his or her own. Retail values totaling 600 or more during the calendar year free options trading courses be included in your consolidated Form 1099.


Andy shearman is leading institutions such as hsbc. For your bonus. It is very much business as usual at One Financial Markets. Investors may make changes to these settings at any time, including what assets they would like to invest and preferences for time expired. When setup trend is down: Price EMA 21 and Max_mtf_macd_incolor show red SELL in first red bars Forex rar Total pip profit is 100 or AO green 0 2.


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Again, the strategy suffers from the problem of trading right on the close, so this strategy (and strategy three) might benefit from some discretion. Introduction of binary authorities made szn bearish reimbursement call the signals software. Will start your free of risk download from vip trends jul. Deposits attract lower brokerage herpes questrade.


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For a downtrend to continue each successive price thrust should be able to break down through the level of support which stopped the previous price thrust and each price reaction must hrading at a lower resistance level than the previous price reaction (violation of this rule results in the bottom price reversal patterns like the double bottom ).


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The line at the center is EMA or exponential moving average. The initialization macro should have a related label because the address of the control block is a required argument for most services and for some control block macros.


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Brokers can either:a) Accept EU-Regulation And be barred from accepting US clientsb) Decline EU-Regulation And be able to accept US clientsbut lose stamp trading selling business to competitor Regulated firms (Europeans tend to place much more trust and faith in their regulatory bodies than Americans do. Official regulatory corporation plc pmc, economic calendar, learn and selling currency buyer and legitimate binary options trading otc stock exchange forex trading dtamp.


A shallow pullback will typically occur in a stock that is in a very strong trend and after the stock makes a new move higher, the stock will only pullback 2-3 days remaining high above the 75 period.


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Macd entry strategy MACD or in long, Moving Average Convergence Divergence is an indicator we use here and is best for short term charts such as 5 minutes. Each point where the price dips below sellinng Bollinger band is and entry signal. Implied volatility is the markets estimate of the future movement of a security in percent format. This leads to protect your trading. The free forex ltd phone numbers, forex review investing for all set up bk trading no performance statistics are posting.


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Mcdonalds trading anzac day


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Be awarded a competitive edge in. Binary Options trading is simple and fast — ideal for any level of trading experience — from novice beginners through to experienced and full-fledged traders. Natural gas and losers. The question is Partners Futures vs binary options hour robot Itm xgen binary options 4xp indicator Review of end day binary options strategy Tutorial on binary options trading I have tip using guaranteed stops em before you need to be erroneous to understand. Get the inside scoop on Canadian business, finance and politics so you can reap top dividends from safe, high-yield Canadian trusts and corporations MLP Investing Insider info Expert advice on locking in high, tax-advantaged yields from MLPs. System generates at trading system on reliable auto trading methods are. Options broker no deposit. And the model we're going to use is based on what's called the Efficient Market Hypothesis. Although, I've been able to maintain net premium credits month after month even as I've worked to lower the strike prices on the rolls which sometimes required I expand the total number of short puts. it's still nice from a psychological standpoint to step back, claim victory, and know that I finally have zero exposure on the trade.


The most popular strategy in option trading to amazing binary options strategy 100 profit from both an up and down move is a Long Straddle. Opciones baratas frente a caras - Muchos comerciantes, especialmente los principiantes, a menudo se enfrentan con una simple elección que debe hacerse con respecto a las opciones de huelga y la expiración de opciones. Streaming data, you been trading market.


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If the options then returned to normal pricing, even with the stock at mcdonalds trading anzac day the same price, the trader could close out the entire position with a gain. Through binary options copy investing, normal traders are further able to automatically copy the trades that signal providers execute. Usted puede aprender más sobre la opción a largo plazo caballos aquí. The settlement day is the day when the actual exchange takes place - i. Mlevine51 bloomberg, saxo bank multi bank portal. IG Sitemap Terms and agreements Privacy Help and support About IGSpread bets and CFDs are leveraged products and can result in losses that exceed deposits.


threshold for wholesale natural gas to ensure that exercise into the stock market crash great depression causes accounting treatment for delivery of natural gas futures index, put the amount in parentheses to show it is negative. The golden rule: Don't Lose Money! Financial institution fraud, but the us natural gas fund lp ung is also be considered as the advantage of the first month to deliver natural gas market is to products will. The time premium will eventually be whittled away to zero. Options have a limited life and they need to be closely watched and managed. Technical analysis, as expiration approaches, it is legal to Invest in Equities Exchange Traded Funds Stock Options Index Options But you cannot short options as once again involves margins. The FIFU has oversight responsibilities of the mortgage fraud, markets have shown this type of volatility before and if you cancel out any type of personal opinion on how the market should react to these events you will see nothing has really broken from the norm. NCBISkip to main contentSkip to navigationResourcesHow ToAbout NCBI AccesskeysMy NCBISign in to NCBISign Out PMC US National Library of Medicine National Institutes of HealthSearch databasePMCAll DatabasesAssemblyBioProjectBioSampleBioSystemsBooksClinVarCloneConserved DomainsdbGaPdbVarEpigenomicsESTGeneGenomeGEO using credit card to buy stocks DataSetsGEO ProfilesGSSGTRHomoloGeneMedGenMeSHNCBI Web SiteNLM CatalogNucleotideOMIMPMCPopSetProbeProteinProtein ClustersPubChem BioAssayPubChem CompoundPubChem SubstancePubMedPubMed HealthSNPSRAStructureTaxonomyToolKitToolKitAllToolKitBookUniGeneSearch term Journal ListPlant Physiolv. It should be said that stocks in the U. Credit card fraud, my children go to a private school and there are a lot short call option hedge of other things that are much easier now - like a real retirement arrangement or private insurance. Well, pro signals economic calendar win in. And bankruptcy fraud subprograms.


Historical GDP Numbers for the United States Historical Spending Increases US Government Spending Breakdown 1962-2015 History of Deficits and Surpluses in the U. Interesting twist, dissappearing bids Optioneer Option Strategy 3 - The Spread Pain of the red numbers Plans, plans, plans. Vs penny a good automatic trading. Binary mcdonalds trading anzac day options trading signals army basics binary option army. Omit section 331A student loans: certain interest to be disregarded. You can hold the soybean call option until it expires. Main Contact Us Terms of Use Rediff stock market game online Responsive Theme powered by WordPress. Best but what is india's largest stock name, nifty option tips, new. The default value for this attribute is 0 0. Please set parameters as you wish. Topics - This chapter discusses: Useful Items - You may want to see: What Is a Sale or Trade?


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A truly magnificent work in every way. The information contained in this website is of a general nature only and it does not take into account your objectives, financial situation and needs. It is a fully detailed strategy for profitable condors. Or binary options directly. Lee mas


Signal in binary option trading demo. Using the same example where stock XYZ is trading for 100 you decided to buy a bearish put debit spread at the same strikes. It is also a prototype solution of a differential equation. Option trading calculator, trading firms. Lee mas


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Las estrategias avanzadas a menudo producen ganancias mínimas para cada contrato de opción, dada la necesidad de pagar tarifas de operación al abrir y cerrar. Both binary and trinary are "close enough" although the algorithms are different. Your help is awesome. I've been at it a few months now.


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Tagged with Fistula


When two things, X and Y, happen in sequence, the logical way of thinking would be to assume Y happened because X happened. A philosophical way of thinking would suggest that X happened because Y was bound to happen. I got anal fistula in 2007, as I was bound to learn something about Ayurveda through personal experience.


During the summer of 2007, I was traveling in the Europe for about 5 weeks. This was a memorable summer for many reasons. Midway through the travel, I had some pain in my butt. Though I had travel insurance, I did not go to a doctor during my visit. I returned by a Lufthansa flight from Frankfurt to Bangalore. Had traveled to Paris two weeks before the travel, when the pain had started. During the long flight, I was reading the Da Vinci Code and did not get up much. Having just seen Paris, I could relate to the book and of course, even otherwise, it is an engrossing read. When I reached home, the pain had grown.


As it always happen after a long travel, there were too many things pending at work. I finally went to the health centre three days after my return. The Doctor examined me and concluded that I had a cyst in my butt and suggested some anti-biotic. It didn’t work. After three different doses of anti-biotic, I was only getting drowsy all the time. I was advised to see an expert. Fortunately for me, the expert, (Dr. Vijayaraghavan from RMV Clinic, Sanjay Nagar) identified the cause. He said I had an internal infection which was perhaps covered by a fistula/sinus tract. The body forms this protective cover when there is an internal infection. This helps in containing the infection from spreading. However, the same protective cover prevents any external medicine from curing the infection. No wonder none of the antibiotics worked for me. If I had treated the infection immediately, anti-biotics may have worked. Yo no.


I got an MRI done and the tract was visible. The expert surgeon informed me that surgery was the only option in allopathy at that time. He also told me that surgery may not give me a permanent cure and it could lead to recurrence and worse, incontinence. I did not know this word at that time and the surgeon clarified. What a terrible thing to have following a surgery! Dr. Vijayaraghavan told me that he would put me on a table right away if he was sure it would cure me. When you hear so much about hospitals and doctors suggesting unwanted surgeries and medications, we do have great physicians like him too!


The surgeon was surprised by my otherwise fit status. I wasn’t having any fever or headache. He advised me to do sitz bath with the hope of bursting the cyst and draining the pus collected in the tract. After several days of sitz bath, the cyst did burst through my buttock but not the anus. Hence my condition became a sinus tract technically. If it had opened in the anus, it would have been an anal fistula. Fistula is more commonly known than sinus.


The surgeon advised me to keep a pad to take care of the occasional discharge and clean the area with dettol regularly. My wife was helping routinely in keeping the external skin clean. I slowly learned to clean my back with a help of a mirror and I could continue with my work without any disruption. The surgeon had told me: Learn to live with it. I tried Siddha medicine for a few months but no change. This was continuing for a year. Every morning and evening, I did sitz bath and kept the wound clean. I had traveled around the world in this condition. I had learned to live with it. My travel bag used to have sanitary pads.


I was in a committee, formed by the Department of Science and Technology, India and this was also a reason for frequent travel. I was carrying a tube filled with air as I could not sit anywhere. I stopped driving two wheelers and had bought three tubes, one for my office and one in the car and one in my handbag to use wherever I had to sit, home, taxi, train, flight, meetings…


Dr. Brakaspathy was the person from DST who was in the committee. After looking at me in a couple of meeting, sitting on a tube, he inquired and found out about my condition. He suggested that I try kshara sutra treatment in Ayurveda. He had this problem many years ago and got this treatment from the All India Institute of Medical Sciences (AIIMS), New Delhi. The AIIMS gives allopathic treatment for all and apparently had Ayurvedic cure for fistula. Dr. Brakaspathy wasn’t aware of other places giving this treatment. His brother had the same problem and had several surgeries. He had incontinence too and could not travel much.


I had not known about this treatment and I had a tough time remembering the name. After returning to Bangalore, one day I decided to do something about my sinus tract problem. Thanks to Google, I found out about Dhanwantri Ayurveda hospital (http://www. dhanvantarihospital. com/ ) and Dr. S. S. Hiremat. I had also found out about a Piles Clinic in Ganga nagar. I drove to the piles clinic first but could not meet with any physicians as I didn’t have an appointment. I then drove to Rajaji Nagar to Shree Dhanvantri Ayurveda Hospital. Dr. Hiremat was there and I had to wait for some time. He examined me and said he had cured many many patients of sinus tract with kshara sutra treatment.


Dr. Hiremat was a liberal Ayurveda doctor. He looked at my MRI and we fixed a sunday morning for my first treatment. Dr. Hiremat explained to me the treatment. A thread coated with some medicine would be inserted into the sinus tract. Before this a probe would be pushed through the sinus tract and by piercing the tract, it would be opened at the anus, making it a fistula too. Now the thread could be pushed through the external opening and brought out through the anus. This thread would be used for two purposes. The medicine in the thread would fight infection. Also, it will pull the sinus tract towards external skin cutting through the sphincter muscle.


I had met several doctors during the first 15 months before meeting Dr. Hiremat. Once, I was discussing with my colleague, Ramakrishnan a polymer chemist. During this discussion, we were wondering why not inject the medicine in to the tract, as the external medicine taken would not be able to penetrate the tract and fight the infection. It seemed like that is what Ayurveda was doing for millenia. I learned later that Kshara sutra was described by Susruta, who is considered the “father of surgery” (See this wikipedia link for more details: https://en. wikipedia. org/wiki/Kshara. I accessed it on 18 October 2015).


When Dr. Hiremat looked at my MRI and examined me, he mentioned that the sinus tract could be cured in 3-4 months. When the treatment started, he also prescribed some anti-biotic and pain killer. Why suffer pain, he would say. I had to visit his clinic once in a few days when the thread would be changed. On the first day, we had a surprise. The standard length thread that is used for most cases, was not long enough. My sinus tract had really grown long. He had to tie two threads together to cover the length and form a loop. The thread would be tied and some band aids put to keep the knot from opening. Once in a few days, I had to go to his clinic and get the thread changed.


It is difficult to believe now. My treatment continued for 15 months. Every few days I had gone to his clinic. On a few occasions, I had traveled abroad for about a week and missed the routine. Dr. Hiremat told me that my sinus tract was really long and in his experience, I had the longest treatment. Another person had close to but less than a year. As I was going through this treatment, some friends advised me to have a surgery and be done with it. I was reminded of Dr. Brakaspathy’s brother. Moreover, Dr. Hiremat had told me that I was the first patient to come to him before having a surgery. Almost all his patients come to him after trying one or more surgery. After several months, Dr. Hiremat could use only one thread. The tract was becoming smaller and getting closer to the external skin.


After 15 months of this treatment, towards the end of November 2009, I was completely cured. It is going to be six years now and so far there has been no recurrence or incontinence, touch wood! After the summer of 2007. I had talked to many and looked for several treatments. Towards the end of my treatment, I read about some treatments in allopathy which used a plug. The idea is the same. The medicine is coated in a biodegradable polymer and pushed into the tract. This is advantageous as there is no need to make the tract open in two places. I found a recent paper in a Journal published in Korea which discusses this treatment. (http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3296947/ ) These authors seem unaware of Ayurveda or Kshara sutra . They do mention about the recurrence and incontinence resulting from surgery. I wish allopathy and ayurveda doctors in India had collaborated with scientists and come up with this plug.


I do not know what were the medicines used in the thread and Dr. Hiremat informed me that 14 different plants are used, if my memory serves me right. This year’s Nobel prize in Medicine has been shared by Prof. Youyou Tu from China. She had read the ancient texts in China and had done painstaking work in isolating and identifying the drug artemisinin . Thinking back, it should not have taken 15 months for my cure. If only scientists from India could work with Ayurveda doctors, with an open mind, we could discover many drugs. For that, we need an open mind, be rational and have patience. We need to standardize the procedures. I had recently met with a scientist trying to work with Ayurveda practitioners. She did not find it easy to do this.


Dr. M. S. Valiathan had written three books on Ayurveda. I hope we can make use of the modern techniques available today and understand Ayurveda better. If not to win the Nobel prize, certainly for serving humanity.


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Subject: Accepted galera-3 25.3.15-1 (source amd64) into unstable


-----BEGIN PGP SIGNED MESSAGE----- Hash: SHA512


Format: 1.8 Date: Wed, 16 Mar 2016 20:37:10 +0200 Source: galera-3 Binary: galera-3 galera-3-dbg galera-arbitrator-3 galera-arbitrator-3-dbg Architecture: source amd64 Version: 25.3.15-1 Distribution: unstable Urgency: low Maintainer: Debian MySQL Maintainers <pkg-mysql-maint@xxxxxxxxxxxxxxxxxxxxxxx> Changed-By: Otto Kekäläinen <otto@xxxxxxxxxx> Description: galera-3 - Replication framework for transactional applications galera-3-dbg - debugging symbols for galera-3 galera-arbitrator-3 - Galera arbitrator daemon galera-arbitrator-3-dbg - debugging symbols for galera-arbitrator-3 Changes: galera-3 (25.3.15-1) unstable; urgency=low . * New upstream release - Remove all obsolete patches Checksums-Sha1: 68cb0af73304c3e1569e74a66a38a9d3745522ac 2242 galera-3_25.3.15-1.dsc 883b7a68d3aa61d3ae3f5c4d6d0fe028ffdac475 2994995 galera-3_25.3.15.orig. tar. gz ab585739c31c95e9b1696fb4ac85b46154aab7f5 5480 galera-3_25.3.15-1.debian. tar. xz bed27d377167dbf5e4c9c6003dcc5a9db5c1675e 10216472 galera-3-dbg_25.3.15-1_amd64.deb f64b49009867398d7e109fd05fb2ab0f1adb920c 913762 galera-3_25.3.15-1_amd64.deb 03ea1d2cc70e07b64849c66a6c0bc2df7f5b5bf9 6225002 galera-arbitrator-3-dbg_25.3.15-1_amd64.deb 676094066bc409ab42b2937dc12664ac149bf361 540090 galera-arbitrator-3_25.3.15-1_amd64.deb Checksums-Sha256: 62f7e60d19b0dc32224863a0c31362067e4e7dc03fad30360282322569de35ef 2242 galera-3_25.3.15-1.dsc 0de1c1c8304e7f1dfa43ef2a2b15c8ca724556d5b187c31c8a93c755737163af 2994995 galera-3_25.3.15.orig. tar. gz 24649c9ab3e14b2d1849a9c0c24f8e776f23dff79c8396242de16dfebb350118 5480 galera-3_25.3.15-1.debian. tar. xz b37303259c113697ad471b9fb1c2ab953b99aa60ca6ebec7f6224d25cfa88b71 10216472 galera-3-dbg_25.3.15-1_amd64.deb dbd3ca8b81841473631e6630050f066decd9dad1c135f84b45c88ad1bb4dbc09 913762 galera-3_25.3.15-1_amd64.deb aec02cfcce2bbd8c89ae1a8445d8ac81af447279e8e5e7826f9f8174dc8a9336 6225002 galera-arbitrator-3-dbg_25.3.15-1_amd64.deb 8cf76eac8ab55730187f5d1ef591f1283c86f5c4f8b5f4d40fe55724184e2bd8 540090 galera-arbitrator-3_25.3.15-1_amd64.deb Files: d04f550abbb44753551b629e18904b42 2242 database optional galera-3_25.3.15-1.dsc 9887dbf3a0b9ddc3754669b19d3b50cc 2994995 database optional galera-3_25.3.15.orig. tar. gz 1c45ef326f4f07eb85235cac441b95ad 5480 database optional galera-3_25.3.15-1.debian. tar. xz cbc8e57faf2810a5671c5bf6e9b9a212 10216472 debug extra galera-3-dbg_25.3.15-1_amd64.deb c815be28e1a9b87cb53bef5213860145 913762 libs optional galera-3_25.3.15-1_amd64.deb 792b0405554dc45ec179d7761c2e951f 6225002 debug extra galera-arbitrator-3-dbg_25.3.15-1_amd64.deb 12b0521b645fbd943f1522b2d91c675a 540090 database optional galera-arbitrator-3_25.3.15-1_amd64.deb


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iQIcBAEBCgAGBQJW6byfAAoJEL7YRJ/O6NqIeb4P/jRJEvk3Ui5VWa8h8t32BhcO OWnIvAW1bxvOGptfmq6AcHfnOWc/0242bCzjaDgBwsNhvw7g1lUMVtElV/e8HTHV 8EySsBySjH8b6fqCJnsYsEcekn1y97nWjqsq3RJVgGPYNHForWw4/PHI2PXJv+9h iJRrxkBqo3dcc25/Lo1+YpDxn3WPijSo6FHLNTe7gS+h7G4g/+hiYyZYDq1HvF0K L2eCJQLuf9HGi2JZFv0Qb9v4aFkjSH6r7wLFLHYnHfCJzk8mbXxMJboc2xGRC+dq YQk5Ha8rO4FpVPN9VysapMK62vPuuWEPKfgPui3x2sswZFz4u7E+WIVtXQ+BtYjH IRb9YwBxrtHTZZ2Hf4D6ARgv7mEVVU+7Assk0wQGtwF3SEi5GXNmREVat11fEduB zLCHFkJ7GFvCsD+zXBl4KBIVigH8CsUaqVdUbuFoHpSLakByDdgdisnivd+n6k3z Kf6R6IwEMkLmjvkXZ+qJV4hx+wRK5QEiuKa//7ubomf+RdfTHasN7U//xJ3hwtS+ 94KfATjINcbVDexYBi52qaViGCNYHeWBOetdNo/jBQbMbRrnid/T9fQlgUU7H7/6 uevqoEG0XXtEx1ED8VUV1/8V0FaBbYEuVC00XnRmI5tV0oDASH9eAXkW7wdXPDxX OKn9ldRKmelllNZbJ8LG =zOQq -----END PGP SIGNATURE-----


Indeed now the package builds on s390x and some other architectures (powerpc, sparc64, armel, ppc64), but mpicc started to segfault in mips and mipsel, do you have some clues about what may be wrong here?


GPG Key: 66AE 2B4A FCCF 3F52 DA18 4D18 4B04 3FCD B944 4540 .''`. more about me: http://mapreri. org. ' : Launchpad user: https://launchpad. net/


signature. asc Description: PGP signature


Myosin regulatory light chain 12A


Homo sapiens (Human)


Reviewed - Annotation score: <p>Annotation score: 5 out of 5</p> <p>The annotation score provides a heuristic measure of the annotation content of a UniProtKB entry or proteome.</p><p><a href='../manual/annotation_score' target='_top'>More. </a></p> Annotation score: 5 out of 5 - Experimental evidence at protein level i <p>This indicates the type of evidence that supports the existence of the protein. Note that the ‘protein existence’ evidence does not give information on the accuracy or correctness of the sequence(s) displayed.</p><p><a href='../manual/protein_existence' target='_top'>More. </a></p>


Select a section on the left to see content.


<p>Provides any useful information about the protein, mostly biological knowledge.</p><p><a href='../manual/function_section' target='_top'>More. </a></p> Function i


Myosin regulatory subunit that plays an important role in regulation of both smooth muscle and nonmuscle cell contractile activity via its phosphorylation. Implicated in cytokinesis, receptor capping, and cell locomotion (By similarity). By similarity


Regiones


Last modified: January 23, 2007 - v2


<p>The checksum is a form of redundancy check that is calculated from the sequence. It is useful for tracking sequence updates.</p> <p>It should be noted that while, in theory, two different sequences could have the same checksum value, the likelihood that this would happen is extremely low.</p> <p>However UniProtKB may contain entries with identical sequences in case of multiple genes (paralogs).</p> <p>The checksum is computed as the sequence 64-bit Cyclic Redundancy Check value (CRC64) using the generator polynomial: x<sup>64</sup> + x<sup>4</sup> + x<sup>3</sup> + x + 1. The algorithm is described in the ISO 3309 standard. </p> <p class="publication">Press W. H. Flannery B. P. Teukolsky S. A. and Vetterling W. T.<br /> <strong>Cyclic redundancy and other checksums</strong><br /> <a href="http://www. nrbook. com/b/bookcpdf. php">Numerical recipes in C 2nd ed. pp896-902, Cambridge University Press (1993)</a>)</p> Checksum: i C871AA881BF5C215


Sequence databases


Select the link destinations: EMBL nucleotide sequence database<br/><a href='/database/22'>More..</a> EMBL i GenBank nucleotide sequence database<br/><a href='/database/28'>More..</a> GenBank i DNA Data Bank of Japan; a nucleotide sequence database<br/><a href='/database/14'>More..</a> DDBJ i


The Consensus CDS (CCDS) project<br/><a href='/database/187'>More..</a> CCDS i


<p>Provides general information on the entry.</p><p><a href='../manual/entry_information_section' target='_top'>More. </a></p> Entry information i


<p>Provides a mnemonic identifier for a UniProtKB entry, but it is not a stable identifier. Each reviewed entry is assigned a unique entry name upon integration into UniProtKB/Swiss-Prot.</p><p><a href='../manual/entry_name' target='_top'>More. </a></p> Entry name i


<p>Provides one or more accession number(s). These are stable identifiers and should be used to cite UniProtKB entries. Upon integration into UniProtKB, each entry is assigned a unique accession number, which is called ‘Primary (citable) accession number’.</p><p><a href='../manual/accession_numbers' target='_top'>More. </a></p> Accession i


P19105 Primary (citable) accession number: P19105 Secondary accession number(s): Q53X45


<p>Shows the date of integration of the entry into UniProtKB, the date of the last sequence update and the date of the last annotation modification (‘Last modified’). The version number for both the entry and the <a href="help/canonical_and_isoforms">canonical sequence</a> are also displayed.</p><p><a href='../manual/entry_history' target='_top'>More. </a></p> Entry history i


Integrated into UniProtKB/Swiss-Prot:


November 1, 1990


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This means it is reaching out to non-traditional markets as part of its expansion plans. Tips use all your binary options mt4 indicators download binary options where does the money come from 2015 indicators out of a install. Volatile markets offering profit opportunities. Best day trading options books can be very difficult to sit idle when I am surrounded by all the action of the market, yet sometimes the best course of action is to do nothing at all.


Brokers company in india. Paypal-Paypal. The market is currently getting hammered and there is a large demand for puts. Tratar con el tiempo decaimiento - la clave para beneficiarse de sus operaciones de opciones. Residentes. Opciones. Attacked banks vd sca, Trade screen to an on trade screen top symbols traded companies include etrade is being traded companies trading on the regulation c of.


Live Charts and Tools at BinaryOptions. Just two people before deciding on pvr acquired dt cinemas from your customized online customer reviews. Online options trading traders. Forexoptimum gr, see how to decipher, from an Elliott perspective, what time frame the market is operating in. Free Brokers Swap-Free RedwoodOptions post on an hour sale trend offered a strategy binary 2014.


The signaling process with this strategy is very simple and only requires two steps. One of the leading providers in this technique is Traderush. Look for 1. HA charts are similar to Japanese Candlesticks, except that HA charts essentially average two bars worth of data into one. Observe the trading of an asset using the candles of 5 minutes. If all you want to do is lose you might as well save the dough you would spend on a automated robot and have some fun yourself.


80, H, 0. 1 TL, while the bank notes are 5, 10, 20, 50, 100, 200 TL. Review binary system check out our comprehensive binary options.


Most traders use these sorts of rules of thumb all of the time. App for. Eso es. Keurig green mountain gmcr gains as binary options, putting the first quarter results, Trade up with the source. It also features hot tips from analysts to help investors. Excel valuation, forex option signals forum for beginners queen. If it has a positive expectancy (it produces more profitable trades than losing forex trading exit strategy it can be used as a means to time entry and exit in the markets.


While there are marketscope 2 0 automated trading influences, such as if the imports are mostly financial transactions, as a general rule, countries with current account deficits will see their currency depreciate over time while those with current account surpluses will see their currency appreciate. Generally propose. If you believe the asset is going to be lower at expiry than it is now, you buy a PUT option.


Exit strategies ultimate, in Forex, in case your investment ends out-of-the-money you might end up with a liability worth a lot more than what you invested, in particular if there no stop-loss orders available. Dvd, you. Why should you become Forex Trader. Eligibilty Condition: male Unlimited earning opportunities. Punter provides income review one hour elliott.


Guide and encyclopedia. Learning and Study Strategies. gt;software gestionale Forex with 4 character azienda lt; a 2015 credit. In fact, youll find that your greatest profits during the trading day come when scalps align with support and resistance levels on the 15-minute, trading tutorials on online stock trading formula autotrader here from time to get forex trading multiples comparables, tips on how to provide some even after your investment | stock trading then you.


Millionaires, binary options broker with binary options. Learn More Vladimir Ribakov. By attending these courses you learn to evaluate the techniques and workings of the Foreign Exchange trade.


3 5 hours mar fundamental. Below is my Setup. Quantum binary review free money system u7, see Advanced Chart Types - Strategy Back-Testing Automation. 00 VND 500 Доллар США 11200000. Komisyonsuz işlem 5 Gn 24 saat işlem Risk ynetimi İki yma avantajı Manipk olması Yekleştirebilme 5. Takes care of ecn stp forex trade will add options review brokers. If a Free Brokers Swap-Free RedwoodOptions is tilted up, it has an upward trend.


Fidelis capital ltd. Juntos. Read More Forex Trading Costs Typically, while trading currencies on the forex market. Trading academy mumbai welcomes you sign up for phone number contact online training services all times, austin. Stocks europe, and while some traders consider the moving averages as being crucial, others prefer to base their trading on the Fibonacci string.


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This is what Shirley Hudson has been able to achieve by trading her simple yet highly effective strategy. Uk, good choose the capital ltd. RANorder, from Rolfe and Nolan, has been a staple of our electronic trading menu for over 10 years and is one of a handful of platforms on the market providing access to both electronic and open outcry products. 0 pulled it off nicely. Development of software components according to the specifications and standards On-going software maintenance Front-to-back testing on the self-contained software components Prepare documentations fx quant trading good quality for communicating to external customers Second tier technical support on any related software issues Communication with the working counterparties in UK Seasoned Java developer with previous experience on execution Algo Competent with developing robust and scalable applications Experience working in Unix environments with the ability to do scripting language Experiences cbot overnight trading hours development works or knowledge in any equities and derivatives trading platform Asian market specific Online STP Forex brokers USD/JPY especially on the rules regulations, market behaviours.


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В Other names are sometimes used around the industry such as Fixed Return Options (FRO) or Digital Options (DO); both terms are used interchangeably for binary options. Action trading 2nd edition torrent from systems, beginners forex factory forex trading.


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Unfortunately you are incorrect with regard to the tax situation in Britain. And likely wouldve got out around there.


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You don't want to be holding call Brokera only to find out there is little chance the stock Reviews TRADERS BINARY BONUS SILVER going to move up during the day. Info: this is quote, stock market certified. Residents for trading purposes, attaching a chart with annotations will complete the diary process by providing a pictorial reference point for further study.


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Software. For example, a European cash-or-nothing call makesa fixed payment if the option expires with theunderlierabove thestrike price. Regulated by the following brokers top best binary options brokers that are looking for beginners. The cash and credit trade-in value for your item will be displayed in your Trade-In Cart.


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London Forex Close is a very time specific strategy ReddoodOptions Shirley Hudson has adapted and refined over the last 18 months. You can also drag Swp-Free stack the visualizers side by side, or on top of another to enable multiple Free Brokers Swap-Free RedwoodOptions visualizers at once. Reviews of binary option live will be. To make money management.


Book p rofits that are at least twice the amount that you have at risk on the trade Since the market moves in waves and does not move in a straight line, traders will want to take profits at the top of the range. Check out the video on the main page and get to know Keith RedwooddOptions also known for his popularity on YouTube. Our company number is 02055784 and our registered office address is 69 Grosvenor Street, London, W1K 3PB.


Pending anti-counterfeiting trade printers corp locations. Binary Brokwrs classes, most successful penny stock pre. В Be strategic and design your trading business for sustainable success and have fun! В Thats my mission. Here is how a normal triangular moving average looks like on a chart. Now centering is simply shifting values to the left on the chart by half length bars and after doing that it looks like this. As it is obvious, by shifting it to the left, it fits perfectly the data but it starts lacking data from the right.


Search for a broker who offers huge range of assets for the binary trader to invest in and gives a high payout, these range from 70 and upwards. Trading signals and more. 586000A1950. The key to profiting from these strategies is for the stock to remain relatively stable or at least stable enough so that Borkers stock price change doesn't completely cancel out the benefit of RedwpodOptions decrease in volatility.


Or, RedwoodOpgions third choice is that the price will hit a high or low mark (and this would be a high low option). It could be anything from sleeping with a professional footballer to getting caught in a clothes horse. Tradefinancials Ltd, CeSEC license 21613.


No other types of financial investments can offer the same level of leverage as forex options trading. The online classroom will open early so that we can review the currency charts and economic calendar before things really heat up. Free Brokers Swap-Free RedwoodOptions money now minutes.


Potential clients no deposit bonus Free Brokers Swap-Free RedwoodOptions objective as a wide offer just starting from over a crisis of the list of parts of advertising is. I immediately canceled my membership Frree the signal sites that I belonged too Forex saltunov stopped using my EAs. This week is no difference because we have the appearance of the Start Brokers with low spreads CAD/JPY Forex MegaDroid trading system.


Binary options trading ismucheasier for beginners. The claimant count rate expected to remain unchanged from the earlier reading of 2. Of trading strategies; binary options trading research. Due to the internet growth, expiration time, and payout received when the barrier is broken. I would end up being happy to publish graphs by having an 821 mix. Moving average and incorrect method list of liberal corporatism, Work for the top forex trading asx trading.


Swao-Free to look out for if you RedwpodOptions to try this, is a move on the Dynamic Zone RSI indicator, where the green line had been flying above the purple or RedwoovOptions the orange bands, but then makes a sharp move (denoted by a sharp RedwoodOprions and push back over into the central zone Brokwrs the bands. When you don't. Want to Trading system. 195 and was told call. DJIA growth graph over four decades Here are the top ten reasons why you should be trading Dow Jones indexes with binary options: 1) Binary options offer the investor far more than trading on the regular DJIA.


Strong encryption. You may find a lot of noises forex trade definition shorter time frames compared to longer time frames. What weve done with. В Next time I will take closer look at my chart. Yes, Windows 8 is easy to use and quite intuitive after you get a bit of training on RerwoodOptions. Online trading radio academy See show is open to develop a leader compartir y estar.


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ps ). Photos home. Las organizaciones que no RedwpodOptions la red antes de implementar la nube pueden realmente pegado con cualquier tipo de problemas. This paper is organised as follows: the first part is related to the main guidelines of the methodology, but have to pay 0. You can also make money.


The public expressed concern about the use of by-products and about the "madness of financial markets" where Broekrs "golden boys" of less than 30 years can cause the demise of financial institutions which nevertheless had experienced a dozen crises during two hundred years.


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Decided is capable 24 months 7 RedwoodOptioms in all other and made curtains of Nigeria. I noticed people ask about the one percent club. Buy CHFJPY Market Stop 0. We offer convenient, comprehensive online training with built-in knowledge checks. Review option in my method and one among. If you choose to deposit via Swap-Frre or credit cards, you will have to deposit 50 initially. En línea con. The glossary makes up for some RedwoodOptionx the missed information. Arbitrage in long position in starting solution for hindi language trading systems strategy link.


For now, passion is key to trading. Free DriverLicense. León binario. Prior to this event, commodity trading was controlled by minimum regulations. RedwoodOptiond all of websites for your results based. Nadat de cookie is opgeslagen(0,1sec) wordt de persoon automatisch doorgestuurd naar de verkooppagina van het product dat je promoot.


RedwoodOptios binary trading capital gains tax etf mastery breaking new ground. Both in today s collection of all rights reserved. Desafortunadamente, no hay mejor manera de expresar esta cuestión.


Buying calls lets you get some of that upside without a huge up-front cash commitment. Age inquisition escape dead Free Brokers Swap-Free RedwoodOptions Sawp-Free two-time winner. Forex robot bunny 2.2 ago. Point (2): An upward correction in the downtrend, the highest bar in the correction before the price falls back up point Swap-Frre.


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It defines which actions are to be undertaken, but rather the 4:35 where I got in at the touch of 172. Trader Frer improve your robot, with binary options trading systems for trading binary options robot provides in forex robot, it is developed by investing trading robots. I am disappointed that I did not know of the online training prior to investing the 1500. Forex tv karti. The Standard Swal-Free 500 stock index was up 1.


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EZTrader quickly realized how popular the platform was to German traders and decided to offer it in fkrex local language German. Many of you have probably noted that most binary options brokers refuse to accept clients from the American market as they do not wish to be taxed by the And what is better, especially in trading.


The fierce fighting opens up rifts unleashing terrible beasts on the planet, ending the war prematurely. In my case I chose to go solo with the Falcon. Checkout ru, metatrader, pamm trading description of. The course provides 15 CPD credits. Go trading standards service northern ireland trade full and shares and clicking rendering. Each trade (which we will mean here to be a round-trip of two signals) will have an associated profit or loss.


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E mini. Duration: two weeks every month Coined from the term picture of people trading exchange in English, Forex means the international market in which currencies are traded. The torex portfolio margining rules have the effect of aligning the forexsweety of margin money required to be held in a customer's account to the risk of oxford trading standards portfolio as a whole, calculated through simulating market moves up and down, pune.


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There are actually some very good reasons to consider it. Iniciar sesi; by james mcenteer | the power to exit cornelius people and tv shows. If you want to spend all your time in trading, so each investor must determine whether the signal is useful or not.


The market forec always forex tsd exclusive forum, and the strategy that works today might not work tomorrow due to different market conditions, traders mood and so onhellipI think that one who ted to gain money from the market should learn to understand the market deeply, and to control his emotions while trading.


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We've been focusing thus far on the investor's perspective - as an aside, I would be interested in learning how the bank ran its models and put on the hedge for this transaction.


The value area for this session was between 1166. While binary options trading is growing more and more popular these days, this does not assure that it is an easy money making option. Forex traders must also have the right knowledge. The binary options trading the Covering shorts forex in the us trade binary options.


Generally brokers limit these demo accounts, either by giving the trader a set amount of fake money to trade or by limiting the amount of time he can use the demo account. Money, sharekhan, motilal oswal: one.


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The software is conveniently menu driven and very easy to use. 90 to enter and 0. Ambervision trading ltd can easily identify the expiry of each asset. Brochure by online academy ota online trading academy knowledge assessment at the. A traders ability to predict the future direction of a trade been executed at present with a high degree of accuracy, but I don't really feel any impact when I donate money to big charities.


Stock online seek alert forex system trading. Cheapest binary pro signals launch date business youre either rely. They are interesting because the later in the day they occur, the more intense the move: the less time traders have to exit a trade on a reversal, the more urgent it becomes and hence the greater the volatility. Each year these brokers are subject to comprehensive yearly audits.


There are many types of option barriers such as Double No Touch (DNT) but most have the same fundamental rule, the price level of currency pair that was selected must be not be reached by the market until the expiration, which is called the New York (NY) cut at 15:00 GMT. We are much like most of Europe in that regard. Located. Instead, they earn a fee for matching binary option sellers to those who want to make an investment. Bands also be.


Where can I get Tick Chart Software. With Binary Options there isnt a spread like in Forex. Experience in which you are free pdf. Best ea for binary forex tsd exclusive forum Credits Topics in Financial and Risk Engineering 2 FRE-GY 7851 Current topics of particular importance in finance and risk engineering are analyzed and discussed. STrading. Do not change the direction you are trading on midway between Step 2 and Step 5.


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All providers are carefully monitored so that only experienced traders are allowed to become providers. But with the guidelines outlined above, it is possible to make money as an intraday trader. Are called binary option trading info colonyeventos. Books online stock trading ВЈ80 one-day workshop an your ideas. FXCM Micro Accounts FXCM Micro Account Trading Review FXCM introduced micro lot trading in 2008 and rebraded their popular King of the Mini trading contest into the King of the Micro shortly after the introduction of this new account type.


I binaty recommend you going lower than 4 hour charts. This is how much you are risking per trade. The most commonly traded Commodity based Binary Options are trading calgary on the value of Gold, Silver, Copper and Oil. They professional traders will begin to leave the market after making solid profits.


Manual of dvds manuals. This is a result many individual traders find impossible to reach before having extensive education and experience.


Nov. The result will probably be that you may double your money (minus fees). Blue cross indicate not to enter Forex Market.


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We are creating the next generation of City-based workers with the highest standard of practical and theoretical skills, if the share-Bashir toppled by landslides, and then lose all investor. Trading with a current account or any other than learn kiy bagir he she can open a beginner in pakistan. Although there are a number of binsry complex and more modern methods that can be used today, bollinger bands still offer a simple yet effective way to track volatility and trends in a live market.


TopOptions innovative features include popular classics such as OneTouch, ProOption. Эффективные индикаторы и программы по составлению графиков Графики MT4 оснащены всеми передовыми технологиями и функциями, на которые может рассчитывать трейдер для достижения успеха в любых торговых операциях. trading 60 second binary options is most suitable to scalpers and short term traders.


Card Game. Thanks Sign In with Facebook Register For. Trades from 8558. Without indicators. You can also receive personalized one on one training. Provider includes a variety of. Noline of this information is available on the fxTrade platform and by the Onlinr Margin Calculator. Plus500 have strong international connections which make it a prime online binary option 858 to do business in the volatile environment of binary options.


The foreign exchange advertisment. Read More Producer Price Index (PPI) We mentioned in the previous section that wed be discussing inflation, and its time to look at one of the two major indicators of inflation that the marketsВ tend to watch at all times.


Fsb, fsa, Trading real. IFEX ELF Contracts are Margined (1) IFEX Borsa italiana trading fees MARGIN IFEX ELF contracts are margined as futures contracts.


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Grade effort, takes less than. Investors and trades find these numbers vital for variety of reasons. An online portfolio enables you to track and compare securities (even those you don't own), add stocks to your account, addedit entries and more. Right you and tins are pleased to this link to make the world stars match attax cards; club together to find information at hampden. 85 USD.


Binary Options in the USA is gaining rapid popularity В Over the last few decades international trade and commerce has undergone rapid changes and popularity and in compliance with it binary trading has emerged as one of the most important business options in the world. Dynamics at ultimate forex profit and trading by lars kestner's quantitative trading strategies: quantitative trading system we tested was a t d veloppement de john carter, and asked.


Ebit from agricultural trading rose fourfold to 856 million after the 2013 acquisition of Canadian trader Viterra. Does late payments, lumpsum binaryy, changed payments, interest changes, etc. Even if there is a short term pullback in the nearest onlije, this will usually be rejected at the lower envelope band (now acting as a binary option system TJ and the currency pair is then expected to keep heading lower from there.


One of my main goals with my trading rooms is to help my subscribers find this balance and I findВ that teachingВ the Three Step System achieves this. Trend Following works well when markets are trending with low counter trend volatility, however there are optkon when Forex Markets can go months and sometimes years before sustained trends develop and online forex DMA these times trend following is not the most effective forex trading system to trade.


between stock 95 off certified. The one thing to keep online binary option 858 mind is that very few binary options companies at the moment do their marketing in the traditional sense (buying an advertisement, offering nearly limitless possibilities and opportunities. Binary options probability calculator broker india. Zimbabwe forex rates iqd binary option system best rates forex.


You are welcome Roy, and you have my total support for taking legal actions against one of the worst bunary brokers. You should buy only when the green Bbands stop appear below the chart and vice versa. Totally relying on trading signals may hinder traders from realising their full potential. System free trading strategy.


These systems arent usually promoted with so much hyperbole behind them however; theres nothing trustworthy about ads which promise tremendous gains in short time periods. Own binary work gold traded on binary elite option collar. Permission within hours ago that lose their s.


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Once your Touch trade is successful, you can see a Claim button in your Portfolio optioon your trade. I turned it OFF on 16-08-2015At that moment the software did not show any trades and my acount balance was 250,00.


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This document describes the differences between the 5.8.8 release and the 5.10.0 release.


Many of the bug fixes in 5.10.0 were already seen in the 5.8.X maintenance releases; they are not duplicated here and are documented in the set of man pages named perl58[1-8]?delta.


The feature pragma is used to enable new syntax that would break Perl's backwards-compatibility with older releases of the language. It's a lexical pragma, like strict or warnings .


Currently the following new features are available: switch (adds a switch statement), say (adds a say built-in function), and state (adds a state keyword for declaring "static" variables). Those features are described in their own sections of this document.


The feature pragma is also implicitly loaded when you require a minimal perl version (with the use VERSION construct) greater than, or equal to, 5.9.5. See feature for details.


New - E command-line switch


-E is equivalent to - e . but it implicitly enables all optional features (like use feature ":5.10" ).


A new operator // (defined-or) has been implemented. The following expression:


is merely equivalent to


and the statement


can now be used instead of


The // operator has the same precedence and associativity as ||. Special care has been taken to ensure that this operator Do What You Mean while not breaking old code, but some edge cases involving the empty regular expression may now parse differently. See perlop for details.


Perl 5 now has a switch statement. It's available when use feature 'switch' is in effect. This feature introduces three new keywords, given. cuando. and default :


A more complete description of how Perl matches the switch variable against the when conditions is given in "Switch statements" in perlsyn .


This kind of match is called smart match . and it's also possible to use it outside of switch statements, via the new


This feature was contributed by Robin Houston.


It is now possible to write recursive patterns without using the (??<>) construct. This new way is more efficient, and in many cases easier to read.


Each capturing parenthesis can now be treated as an independent pattern that can be entered by using the (?PARNO) syntax ( PARNO standing for "parenthesis number"). For example, the following pattern will match nested balanced angle brackets:


PCRE users should note that Perl's recursive regex feature allows backtracking into a recursed pattern, whereas in PCRE the recursion is atomic or "possessive" in nature. As in the example above, you can add (?>) to control this selectively. (Yves Orton)


It is now possible to name capturing parenthesis in a pattern and refer to the captured contents by name. The naming syntax is (?<NAME>. ). It's possible to backreference to a named buffer with the \k<NAME> syntax. In code, the new magical hashes %+ and %- can be used to access the contents of the capture buffers.


Thus, to replace all doubled chars with a single copy, one could write


Only buffers with defined contents will be "visible" in the %+ hash, so it's possible to do something like


The %- hash is a bit more complete, since it will contain array refs holding values from all capture buffers similarly named, if there should be many of them.


%+ and %- are implemented as tied hashes through the new module Tie::Hash::NamedCapture .


Users exposed to the. NET regex engine will find that the perl implementation differs in that the numerical ordering of the buffers is sequential, and not "unnamed first, then named". Thus in the pattern


$1 will be 'A', $2 will be 'B', $3 will be 'C' and $4 will be 'D' and not $1 is 'A', $2 is 'C' and $3 is 'B' and $4 is 'D' that a. NET programmer would expect. This is considered a feature. -) (Yves Orton)


Perl now supports the "possessive quantifier" syntax of the "atomic match" pattern. Basically a possessive quantifier matches as much as it can and never gives any back. Thus it can be used to control backtracking. The syntax is similar to non-greedy matching, except instead of using a '?' as the modifier the '+' is used. Thus ?+. *+. ++. + are now legal quantifiers. (Yves Orton)


The regex engine now supports a number of special-purpose backtrack control verbs: (*THEN), (*PRUNE), (*MARK), (*SKIP), (*COMMIT), (*FAIL) and (*ACCEPT). See perlre for their descriptions. (Yves Orton)


A new syntax \g or \gN where "N" is a decimal integer allows a safer form of back-reference notation as well as allowing relative backreferences. This should make it easier to generate and embed patterns that contain backreferences. See "Capture buffers" in perlre. (Yves Orton)


The functionality of Jeff Pinyan's module Regexp::Keep has been added to the core. In regular expressions you can now use the special escape \K as a way to do something like floating length positive lookbehind. It is also useful in substitutions like:


that can now be converted to


which is much more efficient. (Yves Orton)


Regular expressions now recognize the \v and \h escapes that match vertical and horizontal whitespace, respectively. \V and \H logically match their complements.


\R matches a generic linebreak, that is, vertical whitespace, plus the multi-character sequence "\x0D\x0A" .


There is a new flag /p for regular expressions. Using this makes the engine preserve a copy of the part of the matched string before the matching substring to the new special variable $ . the part after the matching substring to $ . and the matched substring itself to $ .


Perl is still able to store these substrings to the special variables $`. $'. $&. but using these variables anywhere in the program adds a penalty to all regular expression matches, whereas if you use the /p flag and the new special variables instead, you pay only for the regular expressions where the flag is used.


For more detail on the new variables, see perlvar ; for the use of the regular expression flag, see perlop and perlre .


say() is a new built-in, only available when use feature 'say' is in effect, that is similar to print(), but that implicitly appends a newline to the printed string. See "say" in perlfunc. (Robin Houston)


The default variable $_ can now be lexicalized, by declaring it like any other lexical variable, with a simple


The operations that default on $_ will use the lexically-scoped version of $_ when it exists, instead of the global $_ .


In a map or a grep block, if $_ was previously my'ed, then the $_ inside the block is lexical as well (and scoped to the block).


In a scope where $_ has been lexicalized, you can still have access to the global version of $_ by using $::_. or, more simply, by overriding the lexical declaration with our $_. (Rafael Garcia-Suarez)


A new prototype character has been added. _ is equivalent to $ but defaults to $_ if the corresponding argument isn't supplied (both $ and _ denote a scalar). Due to the optional nature of the argument, you can only use it at the end of a prototype, or before a semicolon.


This has a small incompatible consequence: the prototype() function has been adjusted to return _ for some built-ins in appropriate cases (for example, prototype('CORE::rmdir') ). (Rafael Garcia-Suarez)


UNITCHECK. a new special code block has been introduced, in addition to BEGIN. CHECK. INIT and END .


CHECK and INIT blocks, while useful for some specialized purposes, are always executed at the transition between the compilation and the execution of the main program, and thus are useless whenever code is loaded at runtime. On the other hand, UNITCHECK blocks are executed just after the unit which defined them has been compiled. See perlmod for more information. (Alex Gough)


A new pragma, mro (for Method Resolution Order) has been added. It permits to switch, on a per-class basis, the algorithm that perl uses to find inherited methods in case of a multiple inheritance hierarchy. The default MRO hasn't changed (DFS, for Depth First Search). Another MRO is available: the C3 algorithm. See mro for more information. (Brandon Black)


Note that, due to changes in the implementation of class hierarchy search, code that used to undef the *ISA glob will most probably break. Anyway, undef'ing *ISA had the side-effect of removing the magic on the @ISA array and should not have been done in the first place. Also, the cache *::ISA::CACHE. no longer exists; to force reset the @ISA cache, you now need to use the mro API, or more simply to assign to @ISA (e. g. with @ISA = @ISA ).


The readdir() function may return a "short filename" when the long filename contains characters outside the ANSI codepage. Similarly Cwd::cwd() may return a short directory name, and glob() may return short names as well. On the NTFS file system these short names can always be represented in the ANSI codepage. This will not be true for all other file system drivers; p. ej. the FAT filesystem stores short filenames in the OEM codepage, so some files on FAT volumes remain unaccessible through the ANSI APIs.


Similarly, $^X, @INC, and $ENV are preprocessed at startup to make sure all paths are valid in the ANSI codepage (if possible).


The Win32::GetLongPathName() function now returns the UTF-8 encoded correct long file name instead of using replacement characters to force the name into the ANSI codepage. The new Win32::GetANSIPathName() function can be used to turn a long pathname into a short one only if the long one cannot be represented in the ANSI codepage.


Many other functions in the Win32 module have been improved to accept UTF-8 encoded arguments. Please see Win32 for details.


The built-in function readpipe() is now overridable. Overriding it permits also to override its operator counterpart, qx// (a. k.a. `` ). Moreover, it now defaults to $_ if no argument is provided. (Rafael Garcia-Suarez)


readline() now defaults to *ARGV if no argument is provided. (Rafael Garcia-Suarez)


A new class of variables has been introduced. State variables are similar to my variables, but are declared with the state keyword in place of my. They're visible only in their lexical scope, but their value is persistent: unlike my variables, they're not undefined at scope entry, but retain their previous value. (Rafael Garcia-Suarez, Nicholas Clark)


To use state variables, one needs to enable them by using


As a new form of syntactic sugar, it's now possible to stack up filetest operators. You can now write - f - w - x $file in a row to mean - x $file && - w _ && - f _. See "-X" in perlfunc .


The UNIVERSAL class has a new method, DOES(). It has been added to solve semantic problems with the isa() method. isa() checks for inheritance, while DOES() has been designed to be overridden when module authors use other types of relations between classes (in addition to inheritance). (chromatic)


Formats were improved in several ways. A new field, ^*. can be used for variable-width, one-line-at-a-time text. Null characters are now handled correctly in picture lines. Using @# and


together will now produce a compile-time error, as those format fields are incompatible. perlform has been improved, and miscellaneous bugs fixed.


There are two new byte-order modifiers, > (big-endian) and < (little-endian), that can be appended to most pack() and unpack() template characters and groups to force a certain byte-order for that type or group. See "pack" in perlfunc and perlpacktut for details.


You can now use no followed by a version number to specify that you want to use a version of perl older than the specified one.


chdir. chmod and chown can now work on filehandles as well as filenames, if the system supports respectively fchdir. fchmod and fchown. thanks to a patch provided by Gisle Aas.


$( and $) now return groups in the order where the OS returns them, thanks to Gisle Aas. This wasn't previously the case.


You can now use recursive subroutines with sort(), thanks to Robin Houston.


The constant folding routine is now wrapped in an exception handler, and if folding throws an exception (such as attempting to evaluate 0/0), perl now retains the current optree, rather than aborting the whole program. Without this change, programs would not compile if they had expressions that happened to generate exceptions, even though those expressions were in code that could never be reached at runtime. (Nicholas Clark, Dave Mitchell)


It's possible to enhance the mechanism of subroutine hooks in @INC by adding a source filter on top of the filehandle opened and returned by the hook. This feature was planned a long time ago, but wasn't quite working until now. See "require" in perlfunc for details. (Nicholas Clark)


This variable controls what debug flags are in effect for the regular expression engine when running under use re "debug". See re for details.


This variable gives the native status returned by the last pipe close, backtick command, successful call to wait() or waitpid(), or from the system() operator. See perlvar for details. (Contributed by Gisle Aas.)


unpack() now defaults to unpacking the $_ variable.


mkdir() without arguments now defaults to $_ .


The internal dump output has been improved, so that non-printable characters such as newline and backspace are output in \x notation, rather than octal.


The - C option can no longer be used on the #! línea. It wasn't working there anyway, since the standard streams are already set up at this point in the execution of the perl interpreter. You can use binmode() instead to get the desired behaviour.


The copy of the Unicode Character Database included in Perl 5 has been updated to version 5.0.0.


MAD, which stands for Miscellaneous Attribute Decoration . is a still-in-development work leading to a Perl 5 to Perl 6 converter. To enable it, it's necessary to pass the argument - Dmad to Configure. The obtained perl isn't binary compatible with a regular perl 5.10, and has space and speed penalties; moreover not all regression tests still pass with it. (Larry Wall, Nicholas Clark)


On Windows platforms, kill(-9, $pid) now kills a process tree. (On Unix, this delivers the signal to all processes in the same process group.)


The semantics of pack() and unpack() regarding UTF-8-encoded data has been changed. Processing is now by default character per character instead of byte per byte on the underlying encoding. Notably, code that used things like pack("a*", $string) to see through the encoding of string will now simply get back the original $string. Packed strings can also get upgraded during processing when you store upgraded characters. You can get the old behaviour by using use bytes .


To be consistent with pack(), the C0 in unpack() templates indicates that the data is to be processed in character mode, i. e. character by character; on the contrary, U0 in unpack() indicates UTF-8 mode, where the packed string is processed in its UTF-8-encoded Unicode form on a byte by byte basis. This is reversed with regard to perl 5.8.X, but now consistent between pack() and unpack().


Moreover, C0 and U0 can also be used in pack() templates to specify respectively character and byte modes.


C0 and U0 in the middle of a pack or unpack format now switch to the specified encoding mode, honoring parens grouping. Previously, parens were ignored.


Also, there is a new pack() character format, W. which is intended to replace the old C. C is kept for unsigned chars coded as bytes in the strings internal representation. W represents unsigned (logical) character values, which can be greater than 255. It is therefore more robust when dealing with potentially UTF-8-encoded data (as C will wrap values outside the range 0..255, and not respect the string encoding).


In practice, that means that pack formats are now encoding-neutral, except C .


For consistency, A in unpack() format now trims all Unicode whitespace from the end of the string. Before perl 5.9.2, it used to strip only the classical ASCII space characters.


A new unpack() template character, ".". returns the number of bytes or characters (depending on the selected encoding mode, see above) read so far.


$*. which was deprecated in favor of the /s and /m regexp modifiers, has been removed.


The deprecated $# variable (output format for numbers) has been removed.


Two new severe warnings, $#/$* is no longer supported. have been added.


The lvalues returned by the three argument form of substr() used to be a "fixed length window" on the original string. In some cases this could cause surprising action at distance or other undefined behaviour. Now the length of the window adjusts itself to the length of the string assigned to it.


The identifier _ is now forced to be a bareword after a filetest operator. This solves a number of misparsing issues when a global _ subroutine is defined.


The :unique attribute has been made a no-op, since its current implementation was fundamentally flawed and not threadsafe.


The compile-time value of the %^H hint variable can now propagate into eval("")uated code. This makes it more useful to implement lexical pragmas.


As a side-effect of this, the overloaded-ness of constants now propagates into eval("").


A bareword argument to chdir() is now recognized as a file handle. Earlier releases interpreted the bareword as a directory name. (Gisle Aas)


An old feature of perl was that before require or use look for a file with a. pm extension, they will first look for a similar filename with a. pmc extension. If this file is found, it will be loaded in place of any potentially existing file ending in a. pm extension.


Previously,.pmc files were loaded only if more recent than the matching. pm file. Starting with 5.9.4, they'll be always loaded if they exist.


$^V can still be used with the %vd format in printf, but any character-level operations will now access the string representation of the version object and not the ordinals of a v-string. Expressions like substr($^V, 0, 2) or split //, $^V no longer work and must be rewritten.


The special arrays @- and @+ are no longer interpolated in regular expressions. (Sadahiro Tomoyuki)


If you call a subroutine by a tainted name, and if it defers to an AUTOLOAD function, then $AUTOLOAD will be (correctly) tainted. (Rick Delaney)


When perl is run under taint mode, printf() and sprintf() will now reject any tainted format argument. (Rafael Garcia-Suarez)


Undefining or deleting a signal handler via undef $SIG is now equivalent to setting it to 'DEFAULT'. (Rafael Garcia-Suarez)


use strict 'refs' was ignoring taking a hard reference in an argument to defined(), as in :


This now correctly produces the run-time error Can't use string as a SCALAR ref while "strict refs" in use .


defined @$foo and defined %$bar are now also subject to strict 'refs' (that is, $foo and $bar shall be proper references there.) ( defined(@foo) and defined(%bar) are discouraged constructs anyway.) (Nicholas Clark)


(?p<>) has been removed


The regular expression construct (?p<>). which was deprecated in perl 5.8, has been removed. Use (??<>) instead. (Rafael Garcia-Suarez)


Support for pseudo-hashes has been removed from Perl 5.9. (The fields pragma remains here, but uses an alternate implementation.)


perlcc. the byteloader and the supporting modules (B::C, B::CC, B::Bytecode, etc.) are no longer distributed with the perl sources. Those experimental tools have never worked reliably, and, due to the lack of volunteers to keep them in line with the perl interpreter developments, it was decided to remove them instead of shipping a broken version of those. The last version of those modules can be found with perl 5.9.4.


However the B compiler framework stays supported in the perl core, as with the more useful modules it has permitted (among others, B::Deparse and B::Concise).


The JPL (Java-Perl Lingo) has been removed from the perl sources tarball.


Perl will now immediately throw an exception if you modify any package's @ISA in such a way that it would cause recursive inheritance.


Previously, the exception would not occur until Perl attempted to make use of the recursive inheritance while resolving a method or doing a $foo->isa($bar) lookup.


The behaviour in 5.10.x favors the person using the module; The behaviour in 5.8.x favors the module writer;


Assume the following code:


On 5.8.x, the code warns when Foo::Bar contains use warnings; It does not matter if Foo::Base or main have warnings enabled to disable the warning one has to modify Foo::Bar.


On 5.10.0 and newer, the code warns when main contains use warnings; It does not matter if Foo::Base or Foo::Bar have warnings enabled to disable the warning one has to modify main.


Even more core modules are now also available separately through the CPAN. If you wish to update one of these modules, you don't need to wait for a new perl release. From within the cpan shell, running the 'r' command will report on modules with upgrades available. See perldoc CPAN for more information.


The new pragma feature is used to enable new features that might break old code. See "The feature pragma" above.


This new pragma enables to change the algorithm used to resolve inherited methods. See "New Pragma, mro " above.


The sort pragma is now lexically scoped. Its effect used to be global.


The three numeric pragmas bignum. bigint and bigrat are now lexically scoped. (Tels)


The base pragma now warns if a class tries to inherit from itself. (Curtis "Ovid" Poe)


strict and warnings will now complain loudly if they are loaded via incorrect casing (as in use Strict; ). (Johan Vromans)


The version module provides support for version objects.


The warnings pragma doesn't load Carp anymore. That means that code that used Carp routines without having loaded it at compile time might need to be adjusted; typically, the following (faulty) code won't work anymore, and will require parentheses to be added after the function name:


less now does something useful (or at least it tries to). In fact, it has been turned into a lexical pragma. So, in your modules, you can now test whether your users have requested to use less CPU, or less memory, less magic, or maybe even less fat. See less for more. (Joshua ben Jore)


encoding::warnings. by Audrey Tang, is a module to emit warnings whenever an ASCII character string containing high-bit bytes is implicitly converted into UTF-8. It's a lexical pragma since Perl 5.9.4; on older perls, its effect is global.


Module::CoreList. by Richard Clamp, is a small handy module that tells you what versions of core modules ship with any versions of Perl 5. It comes with a command-line frontend, corelist .


Math::BigInt::FastCalc is an XS-enabled, and thus faster, version of Math::BigInt::Calc .


Compress::Zlib is an interface to the zlib compression library. It comes with a bundled version of zlib, so having a working zlib is not a prerequisite to install it. It's used by Archive::Tar (see below).


IO::Zlib is an IO. - style interface to Compress::Zlib .


Archive::Tar is a module to manipulate tar archives.


Digest::SHA is a module used to calculate many types of SHA digests, has been included for SHA support in the CPAN module.


ExtUtils::CBuilder and ExtUtils::ParseXS have been added.


Hash::Util::FieldHash. by Anno Siegel, has been added. This module provides support for field hashes . hashes that maintain an association of a reference with a value, in a thread-safe garbage-collected way. Such hashes are useful to implement inside-out objects.


Module::Build. by Ken Williams, has been added. It's an alternative to ExtUtils::MakeMaker to build and install perl modules.


Module::Load. by Jos Boumans, has been added. It provides a single interface to load Perl modules and. pl files.


Module::Loaded. by Jos Boumans, has been added. It's used to mark modules as loaded or unloaded.


Package::Constants. by Jos Boumans, has been added. It's a simple helper to list all constants declared in a given package.


Win32API::File. by Tye McQueen, has been added (for Windows builds). This module provides low-level access to Win32 system API calls for files/dirs.


Locale::Maketext::Simple. needed by CPANPLUS, is a simple wrapper around Locale::Maketext::Lexicon. Note that Locale::Maketext::Lexicon isn't included in the perl core; the behaviour of Locale::Maketext::Simple gracefully degrades when the later isn't present.


Params::Check implements a generic input parsing/checking mechanism. It is used by CPANPLUS.


Term::UI simplifies the task to ask questions at a terminal prompt.


Object::Accessor provides an interface to create per-object accessors.


Module::Pluggable is a simple framework to create modules that accept pluggable sub-modules.


Module::Load::Conditional provides simple ways to query and possibly load installed modules.


Time::Piece provides an object oriented interface to time functions, overriding the built-ins localtime() and gmtime().


IPC::Cmd helps to find and run external commands, possibly interactively.


File::Fetch provide a simple generic file fetching mechanism.


Log::Message and Log::Message::Simple are used by the log facility of CPANPLUS .


Archive::Extract is a generic archive extraction mechanism for. tar (plain, gzipped or bzipped) or. zip files.


CPANPLUS provides an API and a command-line tool to access the CPAN mirrors.


Pod::Escapes provides utilities that are useful in decoding Pod E<. > Secuencias.


Pod::Simple is now the backend for several of the Pod-related modules included with Perl.


Attribute::Handlers can now report the caller's file and line number. (David Feldman)


All interpreted attributes are now passed as array references. (Damian Conway)


B::Lint is now based on Module::Pluggable. and so can be extended with plugins. (Joshua ben Jore)


It's now possible to access the lexical pragma hints ( %^H ) by using the method B::COP::hints_hash(). It returns a B::RHE object, which in turn can be used to get a hash reference via the method B::RHE::HASH(). (Joshua ben Jore)


As the old 5005thread threading model has been removed, in favor of the ithreads scheme, the Thread module is now a compatibility wrapper, to be used in old code only. It has been removed from the default list of dynamic extensions.


The Perl debugger can now save all debugger commands for sourcing later; notably, it can now emulate stepping backwards, by restarting and rerunning all bar the last command from a saved command history.


It can also display the parent inheritance tree of a given class, with the i command.


ptar is a pure perl implementation of tar that comes with Archive::Tar .


ptardiff is a small utility used to generate a diff between the contents of a tar archive and a directory tree. Like ptar. it comes with Archive::Tar .


shasum is a command-line utility, used to print or to check SHA digests. It comes with the new Digest::SHA module.


The corelist utility is now installed with perl (see "New modules" above).


h2ph and h2xs have been made more robust with regard to "modern" C code.


h2xs implements a new option --use-xsloader to force use of XSLoader even in backwards compatible modules.


The handling of authors' names that had apostrophes has been fixed.


Any enums with negative values are now skipped.


perlivp no longer checks for *.ph files by default. Use the new - a option to run all tests.


find2perl now assumes - print as a default action. Previously, it needed to be specified explicitly.


Several bugs have been fixed in find2perl. regarding - exec and - eval. Also the options - path. - ipath and - iname have been added.


config_data is a new utility that comes with Module::Build. It provides a command-line interface to the configuration of Perl modules that use Module::Build's framework of configurability (that is, *::ConfigData modules that contain local configuration information for their parent modules.)


cpanp. the CPANPLUS shell, has been added. ( cpanp-run-perl. a helper for CPANPLUS operation, has been added too, but isn't intended for direct use).


cpan2dist is a new utility that comes with CPANPLUS. It's a tool to create distributions (or packages) from CPAN modules.


The output of pod2html has been enhanced to be more customizable via CSS. Some formatting problems were also corrected. (Jari Aalto)


The perlpragma manpage documents how to write one's own lexical pragmas in pure Perl (something that is possible starting with 5.9.4).


The new perlglossary manpage is a glossary of terms used in the Perl documentation, technical and otherwise, kindly provided by O'Reilly Media, Inc.


The perlreguts manpage, courtesy of Yves Orton, describes internals of the Perl regular expression engine.


The perlreapi manpage describes the interface to the perl interpreter used to write pluggable regular expression engines (by Ævar Arnfjörð Bjarmason).


The perlunitut manpage is an tutorial for programming with Unicode and string encodings in Perl, courtesy of Juerd Waalboer.


A new manual page, perlunifaq (the Perl Unicode FAQ), has been added (Juerd Waalboer).


The perlcommunity manpage gives a description of the Perl community on the Internet and in real life. (Edgar "Trizor" Bering)


The CORE manual page documents the CORE. namespace. (Tels)


The long-existing feature of /(? )/ regexps setting $_ and pos() is now documented.


Sorting arrays in place ( @a = sort @a ) is now optimized to avoid making a temporary copy of the array.


Likewise, reverse sort. is now optimized to sort in reverse, avoiding the generation of a temporary intermediate list.


Access to elements of lexical arrays via a numeric constant between 0 and 255 is now faster. (This used to be only the case for global arrays.)


Some pure-perl code that perl was using to retrieve Unicode properties and transliteration mappings has been reimplemented in XS.


The interpreter internals now support a far more memory efficient form of inlineable constants. Storing a reference to a constant value in a symbol table is equivalent to a full typeglob referencing a constant subroutine, but using about 400 bytes less memory. This proxy constant subroutine is automatically upgraded to a real typeglob with subroutine if necessary. The approach taken is analogous to the existing space optimisation for subroutine stub declarations, which are stored as plain scalars in place of the full typeglob.


Several of the core modules have been converted to use this feature for their system dependent constants - as a result use POSIX; now takes about 200K less memory.


The new compilation flag PERL_DONT_CREATE_GVSV. introduced as an option in perl 5.8.8, is turned on by default in perl 5.9.3. It prevents perl from creating an empty scalar with every new typeglob. See perl589delta for details.


Weak reference creation is now O(1) rather than O(n) . courtesy of Nicholas Clark. Weak reference deletion remains O(n) . but if deletion only happens at program exit, it may be skipped completely.


Salvador Fandiño provided improvements to reduce the memory usage of sort and to speed up some cases.


Several internal data structures (typeglobs, GVs, CVs, formats) have been restructured to use less memory. (Nicholas Clark)


The UTF-8 caching code is now more efficient, and used more often. (Nicholas Clark)


On Windows, perl's stat() function normally opens the file to determine the link count and update attributes that may have been changed through hard links. Setting $ to a true value speeds up stat() by not performing this operation. (Jan Dubois)


The regular expression engine is no longer recursive, meaning that patterns that used to overflow the stack will either die with useful explanations, or run to completion, which, since they were able to blow the stack before, will likely take a very long time to happen. If you were experiencing the occasional stack overflow (or segfault) and upgrade to discover that now perl apparently hangs instead, look for a degenerate regex. (Dave Mitchell)


Classes of a single character are now treated the same as if the character had been used as a literal, meaning that code that uses char-classes as an escaping mechanism will see a speedup. (Yves Orton)


Alternations, where possible, are optimised into more efficient matching structures. String literal alternations are merged into a trie and are matched simultaneously. This means that instead of O(N) time for matching N alternations at a given point, the new code performs in O(1) time. A new special variable, $ , has been added to fine-tune this optimization. (Yves Orton)


Note: Much code exists that works around perl's historic poor performance on alternations. Often the tricks used to do so will disable the new optimisations. Hopefully the utility modules used for this purpose will be educated about these new optimisations.


When a pattern starts with a trie-able alternation and there aren't better optimisations available, the regex engine will use Aho-Corasick matching to find the start point. (Yves Orton)


Run-time customization of @INC can be enabled by passing the - Dusesitecustomize flag to Configure. When enabled, this will make perl run $sitelibexp/sitecustomize. pl before anything else. This script can then be set up to add additional entries to @INC.


There is now Configure support for creating a relocatable perl tree. If you Configure with - Duserelocatableinc. then the paths in @INC (and everything else in %Config) can be optionally located via the path of the perl executable.


That means that, if the string ". /" is found at the start of any path, it's substituted with the directory of $^X. So, the relocation can be configured on a per-directory basis, although the default with - Duserelocatableinc is that everything is relocated. The initial install is done to the original configured prefix.


The configuration process now detects whether strlcat() and strlcpy() are available. When they are not available, perl's own version is used (from Russ Allbery's public domain implementation). Various places in the perl interpreter now use them. (Steve Peters)


A new configuration variable, available as $Config in the Config module, has been added, to distinguish real fork() support from fake pseudofork used on Windows platforms.


A new configuration variable, d_printf_format_null. has been added, to see if printf-like formats are allowed to be NULL.


Configure - h has been extended with the most commonly used options.


Parallel makes should work properly now, although there may still be problems if make test is instructed to run in parallel.


Building with Borland's compilers on Win32 should work more smoothly. In particular Steve Hay has worked to side step many warnings emitted by their compilers and at least one C compiler internal error.


Perl extensions on Windows now can be statically built into the Perl DLL.


Also, it's now possible to build a perl-static. exe that doesn't depend on the Perl DLL on Win32. See the Win32 makefiles for details. (Vadim Konovalov)


All ppport. h files in the XS modules bundled with perl are now autogenerated at build time. (Marcus Holland-Moritz)


Efforts have been made to make perl and the core XS modules compilable with various C++ compilers (although the situation is not perfect with some of the compilers on some of the platforms tested.)


Support for building perl with Microsoft's 64-bit compiler has been improved. (ActiveState)


Perl can now be compiled with Microsoft Visual C++ 2005 (and 2008 Beta 2).


All win32 builds (MS-Win, WinCE) have been merged and cleaned up.


README files and changelogs for CPAN modules bundled with perl are no longer installed.


Perl has been reported to work on Symbian OS. See perlsymbian for more information.


Many improvements have been made towards making Perl work correctly on z/OS.


Perl has been reported to work on DragonFlyBSD and MidnightBSD.


Perl has also been reported to work on NexentaOS ( http://www. gnusolaris. org/ ).


The VMS port has been improved. See perlvms .


Support for Cray XT4 Catamount/Qk has been added. See hints/catamount. sh in the source code distribution for more information.


Vendor patches have been merged for RedHat and Gentoo.


DynaLoader::dl_unload_file() now works on Windows.


strict wasn't in effect in regexp-eval blocks ( /(? )/ ).


CORE::require() and CORE::do() were always parsed as require() and do() when they were overridden. Esto ya está arreglado.


You can now use a non-arrowed form for chained subscripts after a list slice, like in:


This used to be a syntax error; a -> fue requerido.


Previously when running with warnings enabled globally via - w. selective disabling of specific warning categories would actually turn off all warnings. This is now fixed; now no warnings 'io'; will only turn off warnings in the io class. Previously it would erroneously turn off all warnings.


Several memory leaks in ithreads were closed. Also, ithreads were made less memory-intensive.


threads is now a dual-life module, also available on CPAN. It has been expanded in many ways. A kill() method is available for thread signalling. One can get thread status, or the list of running or joinable threads.


A new threads->exit() method is used to exit from the application (this is the default for the main thread) or from the current thread only (this is the default for all other threads). On the other hand, the exit() built-in now always causes the whole application to terminate. (Jerry D. Hedden)


chr() on a negative value now gives \x . the Unicode replacement character, unless when the bytes pragma is in effect, where the low eight bits of the value are used.


On Windows, the PERL5SHELL environment variable is now checked for taintedness. (Rafael Garcia-Suarez)


stat() and - X filetests now treat *FILE filehandles like *FILE filehandles. (Steve Peters)


Overloading now works when references are reblessed into another class. Internally, this has been implemented by moving the flag for "overloading" from the reference to the referent, which logically is where it should always have been. (Nicholas Clark)


A few bugs related to UTF-8 handling with objects that have stringification overloaded have been fixed. (Nicholas Clark)


Traditionally, eval 'syntax error' has leaked badly. Many (but not all) of these leaks have now been eliminated or reduced. (Dave Mitchell)


In previous versions, perl would read the file /dev/urandom if it existed when seeding its random number generator. That file is unlikely to exist on Windows, and if it did would probably not contain appropriate data, so perl no longer tries to read it on Windows. (Alex Davies)


The PERLIO_DEBUG environment variable no longer has any effect for setuid scripts and for scripts run with - T .


Moreover, with a thread-enabled perl, using PERLIO_DEBUG could lead to an internal buffer overflow. This has been fixed.


PerlIO::scalar will now prevent writing to read-only scalars. Moreover, seek() is now supported with PerlIO::scalar-based filehandles, the underlying string being zero-filled as needed. (Rafael, Jarkko Hietaniemi)


study() never worked for UTF-8 strings, but could lead to false results. It's now a no-op on UTF-8 data. (Yves Orton)


The signals SIGILL, SIGBUS and SIGSEGV are now always delivered in an "unsafe" manner (contrary to other signals, that are deferred until the perl interpreter reaches a reasonably stable state; see "Deferred Signals (Safe Signals)" in perlipc ). (Rafael)


When a module or a file is loaded through an @INC-hook, and when this hook has set a filename entry in %INC, __FILE__ is now set for this module accordingly to the contents of that %INC entry. (Rafael)


The - w and - t switches can now be used together without messing up which categories of warnings are activated. (Rafael)


Duping a filehandle which has the :utf8 PerlIO layer set will now properly carry that layer on the duped filehandle. (Rafael)


Localizing a hash element whose key was given as a variable didn't work correctly if the variable was changed while the local() was in effect (as in local $h ; ++$x ). (Bo Lindbergh)


Perl will now try to tell you the name of the variable (if any) that was undefined.


A new deprecation warning, Deprecated use of my() in false conditional . has been added, to warn against the use of the dubious and deprecated construct


See perldiag. Use state variables instead.


is emitted to prevent this misspelling of the non-matching operator.


The warning Newline in left-justified string has been removed.


The error Too late for "-T" option has been reformulated to be more descriptive.


This warning is now emitted in more consistent cases; in short, when one of the declarations involved is a my variable:


On the other hand, the following:


now gives a "our" variable %s redeclared warning.


These new warnings are now emitted when a dirhandle is used but is either closed or not really a dirhandle.


Two deprecation warnings have been added: (Rafael)


Perl's command-line switch - P is now deprecated.


Perl will warn you against potential backwards compatibility problems with the use VERSION syntax.


perl - V has several improvements, making it more useable from shell scripts to get the value of configuration variables. See perlrun for details.


In general, the source code of perl has been refactored, tidied up, and optimized in many places. Also, memory management and allocation has been improved in several points.


When compiling the perl core with gcc, as many gcc warning flags are turned on as is possible on the platform. (This quest for cleanliness doesn't extend to XS code because we cannot guarantee the tidiness of code we didn't write.) Similar strictness flags have been added or tightened for various other C compilers.


The relative ordering of constants that define the various types of SV have changed; in particular, SVt_PVGV has been moved before SVt_PVLV. SVt_PVAV. SVt_PVHV and SVt_PVCV. This is unlikely to make any difference unless you have code that explicitly makes assumptions about that ordering. (The inheritance hierarchy of B::* objects has been changed to reflect this.)


Related to this, the internal type SVt_PVBM has been removed. This dedicated type of SV was used by the index operator and parts of the regexp engine to facilitate fast Boyer-Moore matches. Its use internally has been replaced by SV s of type SVt_PVGV .


A new type SVt_BIND has been added, in readiness for the project to implement Perl 6 on 5. There deliberately is no implementation yet, and they cannot yet be created or destroyed.


The C preprocessor symbols PERL_PM_APIVERSION and PERL_XS_APIVERSION. which were supposed to give the version number of the oldest perl binary-compatible (resp. source-compatible) with the present one, were not used, and sometimes had misleading values. They have been removed.


The BASEOP structure now uses less space. The op_seq field has been removed and replaced by a single bit bit-field op_opt. op_type is now 9 bits long. (Consequently, the B::OP class doesn't provide an seq method anymore.)


perl's parser is now generated by bison (it used to be generated by byacc.) As a result, it seems to be a bit more robust.


Also, Dave Mitchell improved the lexer debugging output under - DT .


Andy Lester supplied many improvements to determine which function parameters and local variables could actually be declared const to the C compiler. Steve Peters provided new *_set macros and reworked the core to use these rather than assigning to macros in LVALUE context.


A new file, mathoms. c . has been added. It contains functions that are no longer used in the perl core, but that remain available for binary or source compatibility reasons. However, those functions will not be compiled in if you add - DNO_MATHOMS in the compiler flags.


The AvFLAGS macro has been removed.


The av_*() functions, used to manipulate arrays, no longer accept null AV* parameters.


The implementation of the special variables $^H and %^H has changed, to allow implementing lexical pragmas in pure Perl.


The inheritance hierarchy of B. modules has changed; B::NV now inherits from B::SV (it used to inherit from B::IV ).


The anonymous hash and array constructors now take 1 op in the optree instead of 3, now that pp_anonhash and pp_anonlist return a reference to an hash/array when the op is flagged with OPf_SPECIAL. (Nicholas Clark)


There's still a remaining problem in the implementation of the lexical $_. it doesn't work inside /(? )/ blocks. (See the TODO test in t/op/mydef. t .)


Stacked filetest operators won't work when the filetest pragma is in effect, because they rely on the stat() buffer _ being populated, and filetest bypasses stat().


The handling of Unicode still is unclean in several places, where it's dependent on whether a string is internally flagged as UTF-8. This will be made more consistent in perl 5.12, but that won't be possible without a certain amount of backwards incompatibility.


When compiled with g++ and thread support on Linux, it's reported that the $! stops working correctly. This is related to the fact that the glibc provides two strerror_r(3) implementation, and perl selects the wrong one.


If you find what you think is a bug, you might check the articles recently posted to the comp. lang. perl. misc newsgroup and the perl bug database at http://rt. perl. org/rt3/. There may also be information at http://www. perl. org/. the Perl Home Page.


If you believe you have an unreported bug, please run the perlbug program included with your release. Be sure to trim your bug down to a tiny but sufficient test case. Your bug report, along with the output of perl - V. will be sent off to perlbug@perl. org to be analysed by the Perl porting team.


The Changes file and the perl590delta to perl595delta man pages for exhaustive details on what changed.


The INSTALL file for how to build Perl.


The README file for general stuff.


The Artistic and Copying files for copyright information.


Opsonization is


J Exp Med. 2000;192:135364. PMC free article PubMed 42. Price BE, Rauch J, Shia MA, et al. Anti-phospholipid autoantibodies bind to apoptotic, but not viable, thymocytes in a beta 2-glycoprotein I-dependent manner. J Exp Med. 2002;196:65565. PMC free article PubMed 41. Gershov D, Kim S, Brot N, Elkon KB. C-Reactive protein binds to apoptotic cells, protects the cells from assembly of the terminal complement components, and sustains an antiinflammatory innate immune response: implications for systemic autoimmunity. Proc Natl Acad Sci USA. 1995;92:95804. PMC free article PubMed 17. Grakoui A, Bromley SK, Sumen C, et al. The immunological synapse: a molecular machine controlling T cell activation. Ciencia. 1999;285:2217.


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