At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.

In search of Cork's collecting traditions: from Kilcrea's Library to the Boole Library of today

The objective of this essay is not a description of the presently unresearched, unstated and unquantified tradition of collectors, collecting and collectables in Cork; it is rather one of signposting what survives in terms of influences which coalesced into what became the bibliographical and museological resources of the Queen's College and ultimately University College, Cork (UCC).

Perceptions of leadership in the public library: a transnational study

This study explores the topic of leadership as perceived and practised by public library leaders. Library leaders have a wide-ranging impact on society but have been largely overlooked as the subject of serious study. Prior to this study, only one small interview-based study and five survey-based studies have been undertaken on public library leaders/leadership — all in North America. No study on the topic has been researched and published outside of North America. The current study is the most in-depth study to date, drawing on face-to-face interviews with thirty public library leaders. As this study was undertaken in three national jurisdictions — Ireland, Britain, and America — it is also the first transnational study on the topic. The study investigates library leaders’ perceptions of leadership, and critically explores if head librarians distinguish classic leadership from management practices, both conceptually and in their work lives. In addition to exploring core leadership issues, such as positive or negative traits, the study also investigates the perceptions of library leaders on matters closely connected with their careers. The study investigates the impact of public library leaders on their followers and on the broader society they serve. This study of the perceptions of senior public library leaders, across national boundaries, makes a theoretical contribution not just to leadership in librarianship, but also to the broader theory of library and information science, and in a limited way to the broad corpus of literature on organizational leadership. The study aims to develop an understanding of the perceptions of current leaders in the field of public librarianship. The results of the study show that leadership is a relatively scarce quality in public libraries in Ireland, Britain, and America. Many public library leaders focus on management and administration issues rather than leadership. The study also illustrates that varying leadership styles are practised by the interviewed librarians, and that there are no universal or common traits, even within national boundaries, for effective public library leadership. The implications of the study for both practising librarians and research literatures in librarianship and organizational leadership are also explored and a future research agenda developed.

Victimisation of street children in Addis Ababa: factors of resilience and susceptibility

Cross-cultural variations in conceptions of childhood are discussed, particularly with regard to child abuse and child labour. Regardless of cultural background, a universal minimum standard of child rearing is required. The street child literature is reviewed, culminating in an analysis of Ethiopian street children. Theoretically this work is informed by victimology. Concepts shared by victimology and rational choice perspective are discussed, after Fattah (1993a). Victim surveys are described, highlighting their accuracy of crime estimates. Juvenile prostitution, runaways and rape are examined, particularly with regard to their relevance in Addis Ababa. Fifty five male and 135 female street children were interviewed. Interviews with boys focused on delinquency. An age-related pattern emerged, with younger boys less likely to drink, chew khat, steal or be sexually active. Interviews with street girls focused on the differences between girls living on the streets (girls of the street), girls working on the streets (girls on the street) and a sample of homebased girls. Girls of the street come to the street come to the streets for many reasons. Conflicts with a parent or guardian account for almost 50%. They are highly vulnerable to sexual assaults, particularly those 43% who have worked as prostitutes. Girls on the street experience considerably less victimisation. Urban poor girls live in socio-economic circumstances akin to girls on the street but enjoy almost universal protection from victimisation because they do not spend time on the streets. Unprotected by the stability which a family provides, girls of the street experience high victimisation levels. Such victimisation is often the result of reliance on types of work, such as prostitution, which brings the girls into contact with exploitative adults. Resistance to such victimisation is provided by a secure place to sleep, companions, and relatively safe types of work. Such protective factors are more readily available to family based children as compared to those living independently.