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

Joshua A Salomon, Theo Vos, Daniel R Hogan, Michael Gagnon, Mohsen Naghavi, Ali Mokdad, Nazma Begum, Razibuzzaman Shah, Muhammad Karyana, Soewarta Kosen, Mario Reyna Farje, Gilberto Moncada, Arup Dutta, Sunil Sazawal, Andrew Dyer, Jason Seiler, Victor Aboyans, Lesley Baker, Amanda Baxter, Emelia J Benjamin, Kavi Bhalla, Aref Bin Abdulhak, Fiona Blyth, Rupert Bourne, Tasanee Braithwaite, Peter Brooks, Traolach S Brugha, Claire Bryan-Hancock, Rachelle Buchbinder, Peter Burney, Bianca Calabria, Honglei Chen, Sumeet S Chugh, Rebecca Cooley, Michael H Criqui, Marita Cross, Kaustubh C Dabhadkar, Nabila Dahodwala, Adrian Davis, Louisa Degenhardt, Cesar Díaz-Torné, E Ray Dorsey, Tim Driscoll, Karen Edmond, Alexis Elbaz, Majid Ezzati, Valery Feigin, Cleusa P Ferri, Abraham D Flaxman, Louise Flood, Marlene Fransen, Kana Fuse, Belinda Gabbe Orcid Logo, Richard F Gillum, Juanita Haagsma, James E Harrison, Rasmus Havmoeller, Roderick J Hay, Abdullah Hel-Baqui, Hans W Hoek, Howard Hoffman, Emily Hogeland, Damian Hoy, Deborah Jarvis, Ganesan Karthikeyan, Lisa Marie Knowlton, Tim Lathlean, Janet L Leasher, Stephen S Lim, Steven E Lipshultz, Alan D Lopez, Rafael Lozano, Ronan Lyons Orcid Logo, Reza Malekzadeh, Wagner Marcenes, Lyn March, David J Margolis, Neil McGill, John McGrath, George A Mensah, Ana-Claire Meyer, Catherine Michaud, Andrew Moran, Rintaro Mori, Michele E Murdoch, Luigi Naldi, Charles R Newton, Rosana Norman, Saad B Omer, Richard Osborne, Neil Pearce, Fernando Perez-Ruiz, Norberto Perico, Konrad Pesudovs, David Phillips, Farshad Pourmalek, Martin Prince, Jürgen T Rehm, Guiseppe Remuzzi, Kathryn Richardson, Robin Room, Sukanta Saha, Uchechukwu Sampson, Lidia Sanchez-Riera, Maria Segui-Gomez, Saeid Shahraz, Kenji Shibuya, David Singh, Karen Sliwa, Emma Smith, Isabelle Soerjomataram, Timothy Steiner, Wilma A Stolk, Lars Jacob Stovner, Christopher Sudfeld, Hugh R Taylor, Imad M Tleyjeh, Marieke J van der Werf, Wendy L Watson, David J Weatherall, Robert Weintraub, Marc G Weisskopf, Harvey Whiteford, James D Wilkinson, Anthony D Woolf, Zhi-Jie Zheng, Christopher JL Murray

The Lancet, Volume: 380, Issue: 9859, Pages: 2129 - 2143

Swansea University Authors: Belinda Gabbe Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1016/S0140-6736(12)61680-8

Abstract

Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disabilityweights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensivedebate about a range of conceptual and methodological issues concern...

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Published in: The Lancet
ISSN: 0140-6736
Published: 2012
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URI: https://cronfa.swan.ac.uk/Record/cronfa13936
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There has been extensivedebate about a range of conceptual and methodological issues concerning the defi nition and measurement of theseweights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden ofDisease Study 2010 through a large-scale empirical investigation in which judgments about health losses associatedwith many causes of disease and injury were elicited from the general public in diverse communities through a new,standardised approach.Methods We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-faceinterviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009,and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys usedpaired comparison questions, in which respondents considered two hypothetical individuals with diff erent, randomlyselected health states and indicated which person they regarded as healthier. The web survey added questions aboutpopulation health equivalence, which compared the overall health benefi ts of diff erent life-saving or diseasepreventionprogrammes. We analysed paired comparison responses with probit regression analysis on all 220 uniquestates in the study. We used results from the population health equivalence responses to anchor the results from thepaired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health lossequivalent to death). Additionally, we compared new disability weights with those used in WHO&#x2019;s most recent updateof the Global Burden of Disease Study for 2004.Findings 13 902 individuals participated in household surveys and 16 328 in the web survey. Analysis of pairedcomparison responses indicated a high degree of consistency across surveys: correlations between individual surveyresults and results from analysis of the pooled dataset were 0&#xB7;9 or higher in all surveys except in Bangladesh (r=0&#xB7;75).Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weightsbelow 0&#xB7;05. Five (11%) states had weights below 0&#xB7;01, such as mild anaemia, mild hearing or vision loss, andsecondary infertility. The health states with the highest disability weights were acute schizophrenia (0&#xB7;76) and severemultiple sclerosis (0&#xB7;71). We identifi ed a broad pattern of agreement between the old and new weights (r=0&#xB7;70),particularly in the moderate-to-severe range. However, in the mild range below 0&#xB7;2, many states had signifi cantlylower weights in our study than previously.Interpretation This study represents the most extensive empirical eff ort as yet to measure disability weights. Bycontrast with the popular hypothesis that disability assessments vary widely across samples with diff erent culturalenvironments, we have reported strong evidence of highly consistent results.</abstract><type>Journal Article</type><journal>The Lancet</journal><volume>380</volume><journalNumber>9859</journalNumber><paginationStart>2129</paginationStart><paginationEnd>2143</paginationEnd><publisher/><placeOfPublication/><issnPrint>0140-6736</issnPrint><issnElectronic/><keywords/><publishedDay>15</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2012</publishedYear><publishedDate>2012-12-15</publishedDate><doi>10.1016/S0140-6736(12)61680-8</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2013-08-08T08:38:40.1987549</lastEdited><Created>2013-01-21T11:08:09.3539013</Created><path><level 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Reyna</firstname><surname>Farje</surname><order>11</order></author><author><firstname>Gilberto</firstname><surname>Moncada</surname><order>12</order></author><author><firstname>Arup</firstname><surname>Dutta</surname><order>13</order></author><author><firstname>Sunil</firstname><surname>Sazawal</surname><order>14</order></author><author><firstname>Andrew</firstname><surname>Dyer</surname><order>15</order></author><author><firstname>Jason</firstname><surname>Seiler</surname><order>16</order></author><author><firstname>Victor</firstname><surname>Aboyans</surname><order>17</order></author><author><firstname>Lesley</firstname><surname>Baker</surname><order>18</order></author><author><firstname>Amanda</firstname><surname>Baxter</surname><order>19</order></author><author><firstname>Emelia J</firstname><surname>Benjamin</surname><order>20</order></author><author><firstname>Kavi</firstname><surname>Bhalla</surname><order>21</order></author><author><firstname>Aref Bin</firstname><surname>Abdulhak</surname><order>22</order></author><author><firstname>Fiona</firstname><surname>Blyth</surname><order>23</order></author><author><firstname>Rupert</firstname><surname>Bourne</surname><order>24</order></author><author><firstname>Tasanee</firstname><surname>Braithwaite</surname><order>25</order></author><author><firstname>Peter</firstname><surname>Brooks</surname><order>26</order></author><author><firstname>Traolach S</firstname><surname>Brugha</surname><order>27</order></author><author><firstname>Claire</firstname><surname>Bryan-Hancock</surname><order>28</order></author><author><firstname>Rachelle</firstname><surname>Buchbinder</surname><order>29</order></author><author><firstname>Peter</firstname><surname>Burney</surname><order>30</order></author><author><firstname>Bianca</firstname><surname>Calabria</surname><order>31</order></author><author><firstname>Honglei</firstname><surname>Chen</surname><order>32</order></author><author><firstname>Sumeet S</firstname><surname>Chugh</surname><order>33</order></author><author><firstname>Rebecca</firstname><surname>Cooley</surname><order>34</order></author><author><firstname>Michael H</firstname><surname>Criqui</surname><order>35</order></author><author><firstname>Marita</firstname><surname>Cross</surname><order>36</order></author><author><firstname>Kaustubh C</firstname><surname>Dabhadkar</surname><order>37</order></author><author><firstname>Nabila</firstname><surname>Dahodwala</surname><order>38</order></author><author><firstname>Adrian</firstname><surname>Davis</surname><order>39</order></author><author><firstname>Louisa</firstname><surname>Degenhardt</surname><order>40</order></author><author><firstname>Cesar</firstname><surname>D&#xED;az-Torn&#xE9;</surname><order>41</order></author><author><firstname>E 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D</firstname><surname>Flaxman</surname><order>49</order></author><author><firstname>Louise</firstname><surname>Flood</surname><order>50</order></author><author><firstname>Marlene</firstname><surname>Fransen</surname><order>51</order></author><author><firstname>Kana</firstname><surname>Fuse</surname><order>52</order></author><author><firstname>Belinda</firstname><surname>Gabbe</surname><orcid>0000-0001-7096-7688</orcid><order>53</order></author><author><firstname>Richard F</firstname><surname>Gillum</surname><order>54</order></author><author><firstname>Juanita</firstname><surname>Haagsma</surname><order>55</order></author><author><firstname>James E</firstname><surname>Harrison</surname><order>56</order></author><author><firstname>Rasmus</firstname><surname>Havmoeller</surname><order>57</order></author><author><firstname>Roderick 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spelling 2013-08-08T08:38:40.1987549 v2 13936 2013-01-21 Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010 4bdcc94332b2bd10530c5e71ceb04f14 0000-0001-7096-7688 Belinda Gabbe Belinda Gabbe true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2013-01-21 MEDS Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disabilityweights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensivedebate about a range of conceptual and methodological issues concerning the defi nition and measurement of theseweights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden ofDisease Study 2010 through a large-scale empirical investigation in which judgments about health losses associatedwith many causes of disease and injury were elicited from the general public in diverse communities through a new,standardised approach.Methods We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-faceinterviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009,and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys usedpaired comparison questions, in which respondents considered two hypothetical individuals with diff erent, randomlyselected health states and indicated which person they regarded as healthier. The web survey added questions aboutpopulation health equivalence, which compared the overall health benefi ts of diff erent life-saving or diseasepreventionprogrammes. We analysed paired comparison responses with probit regression analysis on all 220 uniquestates in the study. We used results from the population health equivalence responses to anchor the results from thepaired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health lossequivalent to death). Additionally, we compared new disability weights with those used in WHO’s most recent updateof the Global Burden of Disease Study for 2004.Findings 13 902 individuals participated in household surveys and 16 328 in the web survey. Analysis of pairedcomparison responses indicated a high degree of consistency across surveys: correlations between individual surveyresults and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75).Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weightsbelow 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, andsecondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severemultiple sclerosis (0·71). We identifi ed a broad pattern of agreement between the old and new weights (r=0·70),particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had signifi cantlylower weights in our study than previously.Interpretation This study represents the most extensive empirical eff ort as yet to measure disability weights. Bycontrast with the popular hypothesis that disability assessments vary widely across samples with diff erent culturalenvironments, we have reported strong evidence of highly consistent results. Journal Article The Lancet 380 9859 2129 2143 0140-6736 15 12 2012 2012-12-15 10.1016/S0140-6736(12)61680-8 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2013-08-08T08:38:40.1987549 2013-01-21T11:08:09.3539013 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Joshua A Salomon 1 Theo Vos 2 Daniel R Hogan 3 Michael Gagnon 4 Mohsen Naghavi 5 Ali Mokdad 6 Nazma Begum 7 Razibuzzaman Shah 8 Muhammad Karyana 9 Soewarta Kosen 10 Mario Reyna Farje 11 Gilberto Moncada 12 Arup Dutta 13 Sunil Sazawal 14 Andrew Dyer 15 Jason Seiler 16 Victor Aboyans 17 Lesley Baker 18 Amanda Baxter 19 Emelia J Benjamin 20 Kavi Bhalla 21 Aref Bin Abdulhak 22 Fiona Blyth 23 Rupert Bourne 24 Tasanee Braithwaite 25 Peter Brooks 26 Traolach S Brugha 27 Claire Bryan-Hancock 28 Rachelle Buchbinder 29 Peter Burney 30 Bianca Calabria 31 Honglei Chen 32 Sumeet S Chugh 33 Rebecca Cooley 34 Michael H Criqui 35 Marita Cross 36 Kaustubh C Dabhadkar 37 Nabila Dahodwala 38 Adrian Davis 39 Louisa Degenhardt 40 Cesar Díaz-Torné 41 E Ray Dorsey 42 Tim Driscoll 43 Karen Edmond 44 Alexis Elbaz 45 Majid Ezzati 46 Valery Feigin 47 Cleusa P Ferri 48 Abraham D Flaxman 49 Louise Flood 50 Marlene Fransen 51 Kana Fuse 52 Belinda Gabbe 0000-0001-7096-7688 53 Richard F Gillum 54 Juanita Haagsma 55 James E Harrison 56 Rasmus Havmoeller 57 Roderick J Hay 58 Abdullah Hel-Baqui 59 Hans W Hoek 60 Howard Hoffman 61 Emily Hogeland 62 Damian Hoy 63 Deborah Jarvis 64 Ganesan Karthikeyan 65 Lisa Marie Knowlton 66 Tim Lathlean 67 Janet L Leasher 68 Stephen S Lim 69 Steven E Lipshultz 70 Alan D Lopez 71 Rafael Lozano 72 Ronan Lyons 0000-0001-5225-000X 73 Reza Malekzadeh 74 Wagner Marcenes 75 Lyn March 76 David J Margolis 77 Neil McGill 78 John McGrath 79 George A Mensah 80 Ana-Claire Meyer 81 Catherine Michaud 82 Andrew Moran 83 Rintaro Mori 84 Michele E Murdoch 85 Luigi Naldi 86 Charles R Newton 87 Rosana Norman 88 Saad B Omer 89 Richard Osborne 90 Neil Pearce 91 Fernando Perez-Ruiz 92 Norberto Perico 93 Konrad Pesudovs 94 David Phillips 95 Farshad Pourmalek 96 Martin Prince 97 Jürgen T Rehm 98 Guiseppe Remuzzi 99 Kathryn Richardson 100 Robin Room 101 Sukanta Saha 102 Uchechukwu Sampson 103 Lidia Sanchez-Riera 104 Maria Segui-Gomez 105 Saeid Shahraz 106 Kenji Shibuya 107 David Singh 108 Karen Sliwa 109 Emma Smith 110 Isabelle Soerjomataram 111 Timothy Steiner 112 Wilma A Stolk 113 Lars Jacob Stovner 114 Christopher Sudfeld 115 Hugh R Taylor 116 Imad M Tleyjeh 117 Marieke J van der Werf 118 Wendy L Watson 119 David J Weatherall 120 Robert Weintraub 121 Marc G Weisskopf 122 Harvey Whiteford 123 James D Wilkinson 124 Anthony D Woolf 125 Zhi-Jie Zheng 126 Christopher JL Murray 127
title Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
spellingShingle Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
Belinda Gabbe
Ronan Lyons
title_short Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
title_full Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
title_fullStr Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
title_full_unstemmed Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
title_sort Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010
author_id_str_mv 4bdcc94332b2bd10530c5e71ceb04f14
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv 4bdcc94332b2bd10530c5e71ceb04f14_***_Belinda Gabbe
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Belinda Gabbe
Ronan Lyons
author2 Joshua A Salomon
Theo Vos
Daniel R Hogan
Michael Gagnon
Mohsen Naghavi
Ali Mokdad
Nazma Begum
Razibuzzaman Shah
Muhammad Karyana
Soewarta Kosen
Mario Reyna Farje
Gilberto Moncada
Arup Dutta
Sunil Sazawal
Andrew Dyer
Jason Seiler
Victor Aboyans
Lesley Baker
Amanda Baxter
Emelia J Benjamin
Kavi Bhalla
Aref Bin Abdulhak
Fiona Blyth
Rupert Bourne
Tasanee Braithwaite
Peter Brooks
Traolach S Brugha
Claire Bryan-Hancock
Rachelle Buchbinder
Peter Burney
Bianca Calabria
Honglei Chen
Sumeet S Chugh
Rebecca Cooley
Michael H Criqui
Marita Cross
Kaustubh C Dabhadkar
Nabila Dahodwala
Adrian Davis
Louisa Degenhardt
Cesar Díaz-Torné
E Ray Dorsey
Tim Driscoll
Karen Edmond
Alexis Elbaz
Majid Ezzati
Valery Feigin
Cleusa P Ferri
Abraham D Flaxman
Louise Flood
Marlene Fransen
Kana Fuse
Belinda Gabbe
Richard F Gillum
Juanita Haagsma
James E Harrison
Rasmus Havmoeller
Roderick J Hay
Abdullah Hel-Baqui
Hans W Hoek
Howard Hoffman
Emily Hogeland
Damian Hoy
Deborah Jarvis
Ganesan Karthikeyan
Lisa Marie Knowlton
Tim Lathlean
Janet L Leasher
Stephen S Lim
Steven E Lipshultz
Alan D Lopez
Rafael Lozano
Ronan Lyons
Reza Malekzadeh
Wagner Marcenes
Lyn March
David J Margolis
Neil McGill
John McGrath
George A Mensah
Ana-Claire Meyer
Catherine Michaud
Andrew Moran
Rintaro Mori
Michele E Murdoch
Luigi Naldi
Charles R Newton
Rosana Norman
Saad B Omer
Richard Osborne
Neil Pearce
Fernando Perez-Ruiz
Norberto Perico
Konrad Pesudovs
David Phillips
Farshad Pourmalek
Martin Prince
Jürgen T Rehm
Guiseppe Remuzzi
Kathryn Richardson
Robin Room
Sukanta Saha
Uchechukwu Sampson
Lidia Sanchez-Riera
Maria Segui-Gomez
Saeid Shahraz
Kenji Shibuya
David Singh
Karen Sliwa
Emma Smith
Isabelle Soerjomataram
Timothy Steiner
Wilma A Stolk
Lars Jacob Stovner
Christopher Sudfeld
Hugh R Taylor
Imad M Tleyjeh
Marieke J van der Werf
Wendy L Watson
David J Weatherall
Robert Weintraub
Marc G Weisskopf
Harvey Whiteford
James D Wilkinson
Anthony D Woolf
Zhi-Jie Zheng
Christopher JL Murray
format Journal article
container_title The Lancet
container_volume 380
container_issue 9859
container_start_page 2129
publishDate 2012
institution Swansea University
issn 0140-6736
doi_str_mv 10.1016/S0140-6736(12)61680-8
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description Background Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disabilityweights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensivedebate about a range of conceptual and methodological issues concerning the defi nition and measurement of theseweights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden ofDisease Study 2010 through a large-scale empirical investigation in which judgments about health losses associatedwith many causes of disease and injury were elicited from the general public in diverse communities through a new,standardised approach.Methods We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-faceinterviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009,and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys usedpaired comparison questions, in which respondents considered two hypothetical individuals with diff erent, randomlyselected health states and indicated which person they regarded as healthier. The web survey added questions aboutpopulation health equivalence, which compared the overall health benefi ts of diff erent life-saving or diseasepreventionprogrammes. We analysed paired comparison responses with probit regression analysis on all 220 uniquestates in the study. We used results from the population health equivalence responses to anchor the results from thepaired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health lossequivalent to death). Additionally, we compared new disability weights with those used in WHO’s most recent updateof the Global Burden of Disease Study for 2004.Findings 13 902 individuals participated in household surveys and 16 328 in the web survey. Analysis of pairedcomparison responses indicated a high degree of consistency across surveys: correlations between individual surveyresults and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75).Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weightsbelow 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, andsecondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severemultiple sclerosis (0·71). We identifi ed a broad pattern of agreement between the old and new weights (r=0·70),particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had signifi cantlylower weights in our study than previously.Interpretation This study represents the most extensive empirical eff ort as yet to measure disability weights. Bycontrast with the popular hypothesis that disability assessments vary widely across samples with diff erent culturalenvironments, we have reported strong evidence of highly consistent results.
published_date 2012-12-15T12:27:58Z
_version_ 1822405037748387840
score 11.048626

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