The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

L'Impatto delle Condizioni Interne ed Esterne sul Ruolo del Cda : un'Analisi Empirica sulle Grandi Imprese Italiane [The impact of internal and external contingencies on board tasks performance : an empirical investigation of Italian companies]

Il Consiglio di Amministrazione (CdA) è il principale organo di governo delle aziende. La letteratura gli attribuisce tre ruoli: controllo, indirizzo strategico e collegamento con l’ambiente (networking). Precedenti studi empirici hanno analizzato se un Consiglio di Amministrazione è attivo o meno in tutti e tre i ruoli in un dato momento. Nel presente lavoro, invece, si propone un approccio «contingente» e si analizzano i ruoli svolti dal CdA al variare delle condizioni interne (aziende in crisi o di successo) ed esterne (aziende in settori competitivi o regolamentati).. L’indagine empirica è stata condotta su un campione di 301 imprese italiane di grandi dimensioni. I risultati supportano la tesi iniziale secondo cui le condizioni interne ed esterne incidono sul ruolo svolto dal CdA. In particolare i risultati evidenziano che il CdA non svolge sempre tutti e tre i ruoli nello stesso momento, ma esso si concentra sul ruolo o sui ruoli che assumono grande importanza nella situazione in cui si trova l’azienda. Con riferimento alle condizioni interne, nelle imprese in crisi il CdA è attivo in tutti e tre i ruoli, mentre in quelle di successo prevale un orientamento verso la funzione strategica. Nelle aziende che operano in settori competitivi il ruolo di controllo è più pressante mentre nei settori regolamentati prevale una funzione di networking.

Le vie dell'Impero. Le strade coloniali italiane e il loro rapporto con la manualistica del Ventennio

Imperial roads. The Italian colonial routes and their relationship with 1920-40 manuals

CAD/CAm-assisted breast reconstruction

The application of computer-aided design and manufacturing (CAD/CAM) techniques in the clinic is growing slowly but steadily. The ability to build patient-specific models based on medical imaging data offers major potential. In this work we report on the feasibility of employing laser scanning with CAD/CAM techniques to aid in breast reconstruction. A patient was imaged with laser scanning, an economical and facile method for creating an accurate digital representation of the breasts and surrounding tissues. The obtained model was used to fabricate a customized mould that was employed as an intra-operative aid for the surgeon performing autologous tissue reconstruction of the breast removed due to cancer. Furthermore, a solid breast model was derived from the imaged data and digitally processed for the fabrication of customized scaffolds for breast tissue engineering. To this end, a novel generic algorithm for creating porosity within a solid model was developed, using a finite element model as intermediate.

Varianza analitica y aproximada del costo total de un proyecto

La varianza estadística del costo total de un proyecto usualmente se estima por medio de la simulación de Monte Carlo, bajo el supuesto de que los acercamientos analíticos son demasiado complicados. Este artículo analiza este supuesto y muestra que, contrario a lo esperado, la solución analítica es relativamente directa. También se muestra que el coeficiente de variación no se ve afectado por el tamaño (área superficial) del proyecto cuando se usan los costos de los componentes estandarizados. Se provee un caso de estudio en el cual se analizan los costos reales de los componentes para obtener la varianza del costo total requerida. Los resultados confirman trabajos previos al mostrar que la aproximación del segundo momento (varianza) bajo el supuesto de independencia subestima considerablemente el valor exacto. El análisis continua examinando los efectos del juicio profesional y con los datos simulados utilizados, la aproximación resulta razonablemente exacta - el juicio profesional absorbe la mayor parte de las intercorrelaciones involucradas. También se da un ejemplo en el cual las cantidades de los componentes unitarios son valoradas por sus costos unitarios promedios y muestra, una vez más, que la aproximación es cercana al valor real. Finalmente, el trabajo se extiende mostrando cómo obtener, para cada proyecto, las varianzas exactas del costo total.

Developmental lessons from the Capricornia Arts Mob (CAM)

The Capricornia Arts Mob (CAM) is a collective of Aboriginal and Torres Strait Islander visual artists, sculptors, photographers, carvers and writers based in the Rockhampton region of Central Queensland. This paper explores the early development of CAM, identifies some of the lessons its members have learned about working together, and considers its role as a regional artists’ collective. The authors identify that traditional Indigenous practices, such as yarning and the sharing of food, have helped to facilitate the emergence of CAM as a vibrant, challenging, eclectic artistic family. They recognise the cultural challenges faced by the collective – including finding a culturally appropriate place to meet and work, and the cross-cultural issues that can emerge within Aboriginal and Torres Strait Islander groups. In just 18 months, CAM has held successful exhibitions and developed public artworks. It is a strong part of regional Queensland’s arts scene, which supports emerging artists and provides a space to celebrate and support Indigenous art.

Proposing and developing a definition and conceptual framework for health care resilience to cope with disasters [Resiliencia: Propuesta y desarrollo de la definicion y del marco conceptual en relacion a los desastres en el ambito sanitario]

La creación del término resiliencia en salud es un paso importante hacia la construcción de comunidades más resilientes para afrontar mejor los desastres futuros. Hasta la fecha, sin embargo, parece que hay poca literatura sobre cómo el concepto de resiliencia en salud debe ser definido. Este artículo tiene como objetivo construir un enfoque de gestión de desastres de salud integral guiado por el concepto de resiliencia. Se realizaron busquedas en bases de datos electrónicas de salud para recuperar publicaciones críticas que pueden haber contribuido a los fines y objetivos de la investigación. Un total de 61 publicaciones se incluyeron en el análisis final de este documento, que se centraron en aquéllas que proporcionan una descripción completa de las teorías y definiciones de resiliencia ante los desastres y las que proponen una definición y un marco conceptual para la capacidad de resiliencia en salud. La resiliencia es una capacidad inherente de adaptación para hacer frente a la incertidumbre del futuro. Esto implica el uso de múltiples estrategias, un enfoque de riesgos máximos y tratar de lograr un resultado positivo a través de la vinculación y cooperación entre los distintos elementos de la comunidad. Resiliencia en salud puede definirse como la capacidad de las organizaciones de salud para resistir, absorber, y responder al impacto de los desastres, mientras mantiene las funciones esenciales y se recupera a su estado original o se adapta a un nuevo estado. Puede evaluarse por criterios como la robustez, la redundancia, el ingenio y la rapidez e incluye las dimensiones clave de la vulnerabilidad y la seguridad, los recursos y la preparación para casos de desastre, la continuidad de los servicios esenciales de salud, la recuperación y la adaptación. Este nuevo concepto define las capacidades en gestión de desastres de las organizaciones sanitarias, las tareas de gestión, actividades y resultados de desastres juntos en una visión de conjunto integral, y utiliza un enfoque integrado y con un objetivo alcanzable. Se necesita urgentemente investigación futura de su medición

CAM : a collaborative object memory system

Physical design objects such as sketches, drawings, collages, storyboards and models play an important role in supporting communication and coordination in design studios. CAM (Cooperative Artefact Memory) is a mobile-tagging based messaging system that allows designers to collaboratively store relevant information onto their design objects in the form of messages, annotations and external web links. We studied the use of CAM in a Product Design studio over three weeks, involving three different design teams. In this paper, we briefly describe CAM and show how it serves as 'object memory'.

Exploring young student's functional thinking (Exploración del pensamiento funcional de estudiantes jóvenes)

The Early Years Generalizing Project (EYGP) involves Australian years 1 to 4 (age 5 to 9) students and investigates how they grasp and express generalizations. This paper focuses on data collected from 6 Year 1 students in an exploratory study within a clinical interview setting that required students to identify function rules. Preliminary findings suggest that the use of gestures (both by students and interviewers), self-talk (by students), and concrete acting out, assisted students to reach generalizations and to begin to express these generalities. It also appears that as students became aware of the structure, their use of gestures and selftalk tended to decrease.

Additive tissue manufacturing for breast reconstruction: Combining CAD/CAM with adipose tissue engineering

The primary aim of this multidisciplinary project was to develop a new generation of breast implants. Disrupting the currently prevailing paradigm of silicone implants which permanently introduce a foreign body into mastectomy patients, highly porous implants developed as part of this PhD project are biodegradable by the body and augment the growth of natural tissue. Our technology platform leverages computer-assisted-design which allows us to manufacture fully patient-specific implants based on a personalised medicine approach. Multiple animal studies conducted in this project have shown that the polymeric implant slowly degrades within the body harmlessly while the body's own tissue forms concurrently.

Contribución de la fuerza y el dolor en la función del paciente con artrosis trapecio metacarpiana. Estudio transversal

Objetivo Establecer una posible relación entre la fuerza (Jamar), el dolor (EVA) y la capacidad funcional referida por el paciente (DASH) determinando en qué grado influyen unas en otras. Estudio observacional transversal analítico. Participantes Muestra de 72 pacientes que presentaban una artrosis trapecio metacarpiana grado 2-3 de Eaton. Los pacientes fueron reclutados cuando acudían a la Unidad de Cirugía de mano. Método Se realizaron mediciones de fuerza de agarre, pinza, valoración del dolor y funcionalidad, y se establecieron las correlaciones entre cada una de ellas. Resultados El modelo más significativo para la función (R2 =0.83) incluye la variable dolor y la fuerza. Pero es la fuerza punta contra punta la que presenta una mayor correlación con el cuestionario DASH (B-estandarizado: –57). Respecto al dolor, influye en todas las mediciones de fuerza realizadas con el dinamómetro, siendo también la fuerza de la pinza punta contra punta la que presenta una mayor correlación. Conclusiones Los hallazgos corroboran que existe una correlación significativa entre la función referida por el paciente y variables que podemos medir en consulta, como la fuerza del puño y la pinza. Pero también esta correlación es significativa entre las variables función y dolor entre sí, pero es la pinza punta contra punta la que presenta una mayor asociación con el cuestionario DASH. Abstract in English Objective To assess the relationship between muscle strength (Jama), and pain (VAS) levels with hand function (DASH) in patients with trapeziometarcapal osteoarthritis. Cross-sectional study. Participants Sample of 72 patients with osteoarthritis stage 2-3 (Eaton) and trapeziometacarpal osteoarthritis. Patients were recruited when they came to the Hand Surgery Unit. Method Grip strength, pinch, pain and hand function were measured, and correlation and regression coefficients between them were obtained. Results For function, the most significant model (R2 = 0.83) included pain and strength. But it is tip to tip pinch force which has a stronger relationship with DASH (Standardized B: –57) questionnaire. Pain also influenced strength measured with the dynamometer but it was tip to tip pinch force that was the most affected. Conclusions Findings confirm that there is a significant correlation between function referred by the patient and variables that can be measured in the clinic such as grip strength and pinch. The correlation between pain intensity and function was also significant, but tip to tip pinch strength had the greatest impact on the function.

Etapas del cambio en personas inactivas tras un programa de promoción de la actividad física en Atención Primaria

Objetivo El objetivo del estudio fue evaluar las Etapas del cambio en relación con la actividad física y el estado de salud general entre personas que participaron en un Programa de promoción de la actividad física (PPAF) de 12 semanas frente a un grupo control. Diseño Ensayo clínico aleatorizado. Participantes Noventa y ocho personas inactivas de ambos sexos con una edad media de 62,82 años procedentes de 2 centros de Atención Primaria del Distrito Sanitario Costa del Sol. Intervención Un PPAF organizado en grupos y siguiendo los criterios del Colegio Americano de Medicina del Deporte, 2 sesiones semanales de 60 min durante 12 semanas. Mediciones principales La variable principal de resultado fue resistencia al cambio en relación con la actividad física. La variable secundaria fue el estado de salud general (componentes físicos y mentales), determinado con el cuestionario de salud general SF12. Resultados Se encontraron diferencias significativas en las etapas del cambio a favor del grupo experimental (p < 0,05). No se encontraron diferencias estadísticamente significativas entre grupos después de la intervención en el estado general de salud. Conclusión Las etapas del cambio se modificaron en las personas inactivas que realizaron el PPAF en Atención Primaria. Futuros estudios son necesarios para identificar qué factores del entorno de los participantes influyen en la resistencia al cambio de la actividad física. Abstract Objective This study has aimed to evaluate the stages of change in relation to physical activity and overall health status among persons who participated in a 12-week Physical activity promotion program (PAPP) compared to a control group. Design Randomized clinical trial. Participants The study included 98 inactive persons of both sexes with a mean age of 62.82 years from 2 of Primary Care Centers of the Malaga Health Care District. Interventions A PAPP organized in groups according to the American College of Sports Medicine criteria including two weekly sessions of 60 minutes each for 3 months. Main measures The primary outcome was to assess resistance to change in relation to physical activity. The secondary variable was overall health (physical and mental components) determined with the SF12 general health questionnaire. Results Significant differences were found in the stages of change (P<.05). There were no significant differences found in general health status improvement in regards to the initial assessment. Conclusion The stages of change were modified in the inactive persons who carried out the PAPP in Primary Care. Future studies are needed to identify which environmental factors influence the resistance to change in physical activity of the participants.

Adolescent sexual behavioral intentions measurement: A gender approach in the Colombian Caribbean region [Medición de la Intención en la Actividad Sexual en Adolescentes: una Aproximación de Acuerdo al Género del Caribe Colombiano]

The study of 1777 male and female adolescent students of 11-19 years in the Colombian Caribbean had two objectives: development and validation of two reproductive health intention scales and analyze gender differences. The pilot of the scale consisted of 8 items and was reduced to 6, to check the reliability and validity using factor analysis and principal components with VARIMAX rotation yielded two factors: Intention and Intention Risk Protection, explained between 69.4% and 70% respectively. In the male Protection Intent (M = 3.87 and SD = 1.29) and risk (M = 2.56 and SD = 1.18) obtained an alpha between 0.74 and 0.86, and in Protection of Intent to female (M = 3.49 and SD = 1.35) and risk (M = 1.50 and SD = 0.89) ranged between 0.78 and 086. In conclusion, the reliability and structural stability are adequate and there are gender differences in the scales.