Using the effect size to model change in preference values from descriptive health status

Objectives: This pilot study describes a modelling approach to translate group-level changes in health status into changes in preference values, by using the effect size (ES) to summarize group-level improvement. Methods: ESs are the standardized mean difference between treatment groups in standard deviation (SD) units. Vignettes depicting varying severity in SD decrements on the SF-12 mental health summary scale, with corresponding symptom severity profiles, were valued by a convenience sample of general practitioners (n = 42) using the rating scale (RS) and time trade-off methods. Translation factors between ES differences and change in preference value were developed for five mental disorders, such that ES from published meta-analyses could be transformed into predicted changes in preference values. Results: An ES difference in health status was associated with an average 0.171-0.204 difference in preference value using the RS, and 0.104-0.158 using the time trade off. Conclusions: This observed relationship may be particular to the specific versions of the measures employed in the present study. With further development using different raters and preference measures, this approach may expand the evidence base available for modelling preference change for economic analyses from existing data.

The use of a change in gentamicin clearance as an early predictor of gentamicin-induced nephrotoxicity

A retrospective review was undertaken in 744 patients who were dose-individualized with gentamicin once daily to evaluate a change in gentamicin clearance as a potential predictor of nephrotoxicity. The definition of nephrotoxicity was chosen to be a change in creatinine clearance greater than 20%. Similarly, a change in gentamicin clearance of greater than 20% was also considered a possible index of nephrotoxicity. Four criteria were developed to assess the usefulness of gentamicin clearance as a predictor of nephrotoxicity. Following the application of the inclusion/exclusion criteria, 132 patients were available for the analysis. The sensitivity, specificity, positive predictive value, and negative predictive value were assessed for each of the criteria. Receiver operating characteristic (ROC) curves were produced to determine if an optimum value in the change of gentamicin clearance could be found to maximize sensitivity and specificity. The overall incidence of nephrotoxicity based on a decrease in creatinine clearance by 20% or more was 3.8%. Women were overrepresented in the nephrotoxic group [71.4% versus 40.1% (P = 0.0025)]. Patients with nephrotoxicity had statistically longer treatment periods, increased cumulative dose, and more dosing predictions (P < 0.05 in each case). The sensitivity of the criteria ranged from 43 to 46%, and specificity ranged from 93 to 99%. The positive and negative predictive values ranged from 63 to 94% and 86 to 89%, respectively. In those patients in whom nephrotoxicity was predicted from a change in gentamicin clearance, this change occurred on average 3 days before the change in creatinine clearance (P < 0.05). A change in gentamicin clearance to predict nephrotoxicity may be a useful addition to current monitoring methods, although it is not the complete answer.

Cattle, crops and clearing: Regional drivers of landscape change in the Brigalow Belt, Queensland, Australia, 1840-2004

Landscape change occurs through the interaction of a multitude of natural and human driving forces at a range of organisational levels, with humans playing an increasingly dominant role in many regions of the world. Building on the current knowledge of the underlying drivers of landscape change, a conceptual framework of regional landscape change was developed which integrated population, economic and cultural values, policy and science/technology. Using the Southern Brigalow Belt biogeographic region of Queensland as a case study, the role of natural and human drivers in landscape change was investigated in four phases of settlement since 1840. The Brigalow Belt has experienced comparable rates of vegetation clearance over the past 50 years to areas of tropical deforestation. Economic factors were important during all phases of development, but the five regional drivers often acted in synergy. Environmental constraints played a significant role in slowing rates of change. Temporal trends of deforestation followed a sigmoidal curve, with initial slow change accelerating though the middle phases then slowing in recent times. Future landscape management needs to take account of the influence of all the components of the conceptual framework, at a range of organisational levels, if more ecologically sustainable outcomes are to be achieved. (c) 2006 Elsevier B.V. All rights reserved.

Change in abundance of dugongs in Shark Bay, Ningaloo and Exmouth Gulf, Western Australia: evidence for large-scale migration

The third in a series of five-yearly aerial surveys for dugongs in Shark Bay, Ningaloo Reef and Exmouth Gulf was conducted in July 1999. The first two surveys provided evidence of an apparently stable population of dugongs, with similar to 1000 animals in each of Exmouth Gulf and Ningaloo Reef, and 10000 in Shark Bay. We report estimates of less than 200 for each of Exmouth Gulf and Ningaloo Reef and similar to 14000 for Shark Bay. This is an apparent overall increase in the dugong population over this whole region, but with a distributional shift of animals to the south. The most plausible hypothesis to account for a large component of this apparent population shift is that animals in Exmouth Gulf and Ningaloo Reef moved to Shark Bay, most likely after Tropical Cyclone Vance impacted available dugong forage in the northern habitat. Bias associated with survey estimate methodology, and normal changes in population demographics may also have contributed to the change. The movement of large numbers of dugongs over the scale we suggest has important management implications. First, such habitat-driven shifts in regional abundance will need to be incorporated in assessing the effectiveness of marine protected areas that aim to protect dugongs and their habitat. Second, in circumstances where aerial surveys are used to estimate relative trends in abundance of dugongs, animal movements of the type we propose could lead to errors in interpretation.

A decade of downsizing: Understanding the contours of change in Australia, 1990-99

his paper seeks to map a decade of organizational downsizing in Australia utilizing a comprehensive longitudinal data set of 4153 firms. Aggregate downsizing measures conceal extensive change within organizations. We seek to assess these processes by comparing a conventional downsizing measure with more specific occupational downsizing measures. The results show the contours of change in Australia over the 1990s; indicate that there are distinctive and contrasting trends; and raise significant issues for future theoretical and empirical research.

Mapping hippocampal and ventricular change in Alzheimer disease

We developed an anatomical mapping technique to detect hippocampal and ventricular changes in Alzheimer disease (AD). The resulting maps are sensitive to longitudinal changes in brain structure as the disease progresses. An anatomical surface modeling approach was combined with surface-based statistics to visualize the region and rate of atrophy in serial MRI scans and isolate where these changes link with cognitive decline. Fifty-two high-resolution MRI scans were acquired from 12 AD patients (age: 68.4 +/- 1.9 years) and 14 matched controls (age: 71.4 +/- 0.9 years), each scanned twice (2.1 +/- 0.4 years apart). 3D parametric mesh models of the hippocampus and temporal horns were created in sequential scans and averaged across subjects to identify systematic patterns of atrophy. As an index of radial atrophy, 3D distance fields were generated relating each anatomical surface point to a medial curve threading down the medial axis of each structure. Hippocampal atrophic rates and ventricular expansion were assessed statistically using surface-based permutation testing and were faster in AD than in controls. Using color-coded maps and video sequences, these changes were visualized as they progressed anatomically over time. Additional maps localized regions where atrophic changes linked with cognitive decline. Temporal horn expansion maps were more sensitive to AD progression than maps of hippocampal atrophy, but both maps correlated with clinical deterioration. These quantitative, dynamic visualizations of hippocampal atrophy and ventricular expansion rates in aging and AD may provide a promising measure to track AD progression in drug trials. (C) 2004 Elsevier Inc. All rights reserved.

SubCM: A tool for improved visibility of software change in an industrial setting

Software Configuration Management is the discipline of managing large collections of software development artefacts from which software products are built. Software configuration management tools typically deal with artefacts at fine levels of granularity - such as individual source code files - and assist with coordination of changes to such artefacts. This paper describes a lightweight tool, designed to be used on top of a traditional file-based configuration management system. The add-on tool support enables users to flexibly define new hierarchical views of product structure, independent of the underlying artefact-repository structure. The tool extracts configuration and change data with respect to the user-defined hierarchy, leading to improved visibility of how individual subsystems have changed. The approach yields a range of new capabilities for build managers, and verification and validation teams. The paper includes a description of our experience using the tool in an organization that builds large embedded software systems.

Protective Eyewear Promotion: Applying Principles of Behaviour Change in the Design of a Squash Injury Prevention Programme

Eye injuries in squash have the potential to be severe. Although these injuries can be prevented through the use of protective eyewear, few players wear such eyewear. The aim of this paper is, to outline the behavioural principles guiding the design of a squash eyewear promotion initiative, the Protective Eyewear Promotion (PEP). Ecological principles of behaviour change were used to provide a comprehensive perspective on intrapersonal factors, policies and physical environmental influences of protective eyewear use. Results of baseline player surveys and venue manager inter-views were used to provide relevant and specific intervention content. At baseline, protective eyewear was not found to be readily available, and players' behaviours, knowledge and attitudes did not favour its use. The main components of PEP involved informing and educating both players and squash venue operators of the risk of eye injury and of appropriate protective eyewear, as well as assisting with the availability of the eyewear and offering incentives for players to use it. A structural strength of PEP was the strong collaborative links with the researchers of different disciplines, the squash governing body, eyewear manufacturers, squash venue personnel, as well as players. Attempts were made within the project structure to make provision for the future dissemination and sustainability of more widespread eye injury prevention measures in the sport of squash.

Water quality monitoring: A combined approach to investigate gradients of change in the Great Barrier Reef, Australia

For the managers of a region as large as the Great Barrier Reef, it is a challenge to develop a cost effective monitoring program, with appropriate temporal and spatial resolution to detect changes in water quality. The current study compares water quality data (phytoplankton abundance and water clarity) from remote sensing with field sampling (continuous underway profiles of water quality and fixed site sampling) at different spatial scales in the Great Barrier Reef north of Mackay (20 degrees S). Five transects (20-30 km long) were conducted from clean oceanic water to the turbid waters adjacent to the mainland. The different data sources demonstrated high correlations when compared on a similar spatial scale (18 fixed sites). However, each data source also contributed unique information that could not be obtained by the other techniques. A combination of remote sensing, underway sampling and fixed stations will deliver the best spatial and temporal monitoring of water quality in the Great Barrier Reef. (c) 2004 Elsevier Ltd. All rights reserved.

A picrotoxin-specific conformational change in the glycine receptor M2-M3 loop.

The external loop linking the M2 and M3 transmembrane domains is crucial for coupling agonist binding to channel gating in the glycine receptor chloride channel (GlyR). A substituted cysteine accessibility scan previously showed that glycine activation increased the surface accessibility of 6 contiguous residues (Arg(271) Lys(276)) toward the N-terminal end of the homomeric alpha 1 GlyR M2 - M3 loop. In the present study we used a similar approach to determine whether the allosteric antagonist, picrotoxin, could impose conformational changes to this domain that cannot be induced by varying agonist concentrations alone. Picrotoxin slowed the reaction rate of a sulfhydryl-containing compound ( MTSET) with A272C, S273C, and L274C. Before interpreting this as a picrotoxin-specific conformational change, it was necessary to eliminate the possibility of steric competition between picrotoxin and MTSET. Accordingly, we showed that picrotoxin and the structurally unrelated blocker, bilobalide, were both trapped in the R271C GlyR in the closed state and that a point mutation to the pore-lining Thr(6') residue abolished inhibition by both compounds. We also demonstrated that the picrotoxin dissociation rate was linearly related to the channel open probability. These observations constitute a strong case for picrotoxin binding in the pore. We thus conclude that the picrotoxin-specific effects on the M2 - M3 loop are mediated allosterically. This suggests that the M2 - M3 loop responds differently to the occupation of different binding sites.

Change in physiotherapy management of children with cystic fibrosis in a large urban hospital

A retrospective audit was conducted in 1998 and 2000 to review the physiotherapy management of hospitalized children with cystic fibrosis (CF) at the Brisbane Royal Children's Hospital (RCH). The objective was to detect and explore possible changes in patient management in this time period and investigate whether these changes reflected changes in the current theory of CF management. All children over two years of age with CF admitted during 1998 and 2000 with pulmonary manifestation and who satisfied set criteria were included (n = 249). Relative frequency of each of six treatment modalities used were examined on two occasions, revealing some degree of change in practice reflecting the changes in current theory. There was a significant decrease in the frequency of usage of postural drainage with head-down tilt (p < 0.001), and autogenic drainage (p < 0.001) between 1998 and 2000. Modified postural drainage without head-down tilt (p < 0.001), and positive expiratory pressure devices (p < 0.001) were used more frequently in 2000 (p < 0.001). No significant changes were identified in the use of Flutter VRP1 (p = 0.145) and exercise (p = 0.763). No significant differences were found in population demographics or occurrence of concomitant factors that may influence patient management.

Change in woolgrower profits from adopting staple strength-enhancing management strategies

Wool tenderness is a significant problem in Australia, especially in areas where sheep graze under highly seasonal conditions. In this study, a profit function model is specified, estimated and simulated to assess the economic impact of staple strength-enhancing research on the profits of Australian woolgrowers. The model is based on a number of fundamental characteristics of the Australian wool industry and the staple-strength enhancing technology being assessed. The model consists of a system of demand and supply equations that are specified in terms of effective, rather than actual, prices. The interrelationships between the inputs and outputs are allowed for in the model in a manner that is consistent with theoretical restrictions. The adoption of the new feed management strategy results in a 4.4% increase in the expected profits of Australian wool producers in the short-run, and a 2.2% increase in expected profits in the long-run.