PERFECT Stroke : PERFormance, Effectiveness, and Costs of treatment episodes in Stroke

Stroke is a major cause of death and disability, incurs significant costs to healthcare systems, and inflicts severe burden to the whole society. Stroke care in Finland has been described in several population-based studies between 1967 and 1998, but not since. In the PERFECT Stroke study presented here, a system for monitoring the Performance, Effectiveness, and Costs of Treatment episodes in Stroke was developed in Finland. Existing nationwide administrative registries were linked at individual patient level with personal identification numbers to depict whole episodes of care, from acute stroke, through rehabilitation, until the patients went home, were admitted to permanent institutional care, or died. For comparisons in time and between providers, patient case-mix was adjusted for. The PERFECT Stroke database includes 104 899 first-ever stroke patients over the years 1999 to 2008, of whom 79% had ischemic stroke (IS), 14% intracerebral hemorrhage (ICH), and 7% subarachnoid hemorrhage (SAH). A 18% decrease in the age and sex adjusted incidence of stroke was observed over the study period, 1.8% improvement annually. All-cause 1-year case-fatality rate improved from 28.6% to 24.6%, or 0.5% annually. The expected median lifetime after stroke increased by 2 years for IS patients, to 7 years and 7 months, and by 1 year for ICH patients, to 4 years 5 months. No change could be seen in median SAH patient survival, >10 years. Stroke prevalence was 82 000, 1.5% of total population of Finland, in 2008. Modern stroke center care was shown to be associated with a decrease in both death and risk of institutional care of stroke patients. Number needed to treat to prevent these poor outcomes at one year from stroke was 32 (95% confidence intervals 26 to 42). Despite improvements over the study period, more than a third of Finnish stroke patients did not have access to stroke center care. The mean first-year healthcare cost of a stroke patient was ~20 000 , and among survivors ~10 000 annually thereafter. Only part of this cost was incurred by stroke, as the same patients cost ~5000 over the year prior to stroke. Total lifetime costs after first-ever stroke were ~85 000 . A total of 1.1 Billion , 7% of all healthcare expenditure, is used in the treatment of stroke patients annually. Despite a rapidly aging population, the number of new stroke patients is decreasing, and the patients are more likely to survive. This is explained in part by stroke center care, which is effective, and should be made available for all stroke patients. It is possible, in a suitable setting with high-quality administrative registries and a common identifier, to avoid the huge workload and associated costs of setting up a conventional stroke registry, and still acquire a fairly comprehensive dataset on stroke care and outcome.

Productive coexistence and gain in agroforestry systems.

Productive coexistence and coexistence gain of populations were studied using nine years' data from field experiments of Taxodium ascendens-intercrop systems in Lixiahe, Jiangsu Province, China. A theoretical framework for productive coexistence in agroforestry was developed. Interaction patterns between trees and intercrops were presented within this framework. A model framework was developed to describe the coexistence gain and interaction of populations in T. ascendens-intercrop systems. Facilitation and resource sharing were identified as main contribution to the advantage of species combination in agroforestry. The model of population interaction developed in the present study was accepted for describing the interaction of populations in T. ascendens-intercrop systems, because it explained a high proportion of the variance of experimental data and fitted well the observations in most intercropping types. The model developed in the present study provides flexibility for describing different patterns of intra- and inter-specific interactions. Model coefficients were applied to the determination of the ecological compatibility of species. Managed T. ascendens-intercrop systems were advantageous as compared to a monoculture of trees or arable crops. In T. ascendens stands up to the age of three, arable crops contributed about 50-80 % of the total biomass yield of agroforestry. The diameter or height growth of T. ascendens was not significantly influenced by intercrops, indicating that intercropping under trees produced extra yields but did not depress the tree growth. When the trees were young (during the first three years), T. ascendens did not depress the crop yields, and a land equivalent ratio greater than unity was obtained together with a high yield of both components. The diameter and height of the trees were similar in four spacing configurations with an equal number of trees per hectare up to the age of eight, but wider between-rows open range were beneficial for the intercrops. The relationship between open-ranges and species coexistence was also analysed and the distribution of soil nutrients studied.

Costs and Benefits of a Shared Digital Long-Term Preservation System

This paper describes the cost-benefit analysis of digital long-term preservation (LTP) that was carried out in the context of the Finnish National Digital Library Project (NDL) in 2010. The analysis was based on the assumption that as many as 200 archives, libraries, and museums will share an LTP system. The term ‘system’ shall be understood as encompassing not only information technology, but also human resources, organizational structures, policies and funding mechanisms. The cost analysis shows that an LTP system will incur, over the first 12 years, cumulative costs of €42 million, i.e. an average of €3.5 million per annum. Human resources and investments in information technology are the major cost factors. After the initial stages, the analysis predicts annual costs of circa €4 million. The analysis compared scenarios with and without a shared LTP system. The results indicate that a shared system will have remarkable benefits. At the development and implementation stages, a shared system shows an advantage of €30 million against the alternative scenario consisting of five independent LTP solutions. During the later stages, the advantage is estimated at €10 million per annum. The cumulative cost benefit over the first 12 years would amount to circa €100 million.