Is phase-specific, community-oriented treatment of early psychosis- an economically viable method of improving outcome?

Objective: The Early Psychosis Prevention and Intervention Centre (EPPIC) provides a comprehensive 'real-world' model of early intervention to young people experiencing an emerging psychotic disorder. A prospective study has already provided evidence of improved clinical outcome at 12 months after entry. The present study examined whether the service was also cost-effective.

Method: A cost-effectiveness analysis compared EPPIC with its immediate precursor service, from the perspective of the government funding agency. Only direct costs were included.

Results: EPPIC proved to be more cost-effective. The weighted average cost per patient for the first 12 months was cheaper (by äD 7110 per patient), while treatment outcomes were superior. The savings were due to the marked reduction in in-patient costs outweighing substantial increases in the costs of community care.

Conclusion: These results, while encouraging in terms of the further development of integrated, phase-specific intervention programmes for early psychosis, are not conclusive, and further research is required.

A model for stakeholder interactions in hospitals : towards understanding the patient flow process

The aim of this research is to understand how stakeholder interactions can facilitate the patient flow process within a hospital. An analysis of the findings reveals that nurses are in a perfect position to be a conduit between doctors and managers. This is due to several factors including the nurses understanding of both the clinical and control worlds, as well as nurses ability to form networks based on their pivotal characteristics. As a result of these findings, a model for better understanding stakeholder relationships is developed. In this research, a mixed methods approach was used by undertaking a cultural assessment via survey questionnaire, complemented by observations of interactions between organisational actors, including formal semi-structured interviews and reflections of many hours of observation. Glouberman and Mintzberg’s four world’s models is used as a foundation for the arguments of this paper. Mitchell, Agle and Wood’s (1997) model is used to discuss the three stakeholder groups of this research including doctors, nurses, and managers.

A syntactic two-component encoding model for the trajectories of human actions

Human actions have been widely studied for their potential application in various areas such as sports, pervasive patient monitoring, and rehabilitation. However, challenges still persist pertaining to determining the most useful ways to describe human actions at the sensor, then limb and complete action levels of representation and deriving important relations between these levels each involving their own atomic components. In this paper, we report on a motion encoder developed for the sensor level based on the need to distinguish between the shape of the sensor's trajectory and its temporal characteristics during execution. This distinction is critical as it provides a different encoding scheme than the usual velocity and acceleration measures which confound these two attributes of any motion. At the same time, we eliminate noise from sensors by comparing temporal and spatial indexing schemes and a number of optimal filtering models for robust encoding. Results demonstrate the benefits of spatial indexing and separating the shape and dynamics of a motion, as well as its ability to decompose complex motions into several atomic ones. Finally, we discuss how this specific type of sensor encoder bears on the derivation of limb and complete action descriptions.

Competitive inhibition of survivin using a cell-permeable recombinant protein induces cancer-specific apoptosis in colon cancer model

Endogenous survivin expression has been related with cancer survival, drug resistance, and metastasis. Therapies targeting survivin have been shown to significantly inhibit tumor growth and recurrence. We found out that a cell-permeable dominant negative survivin (SurR9-C84A, referred to as SR9) competitively inhibited endogenous survivin and blocked the cell cycle at the G1/S phase. Nanoencapsulation in mucoadhesive chitosan nanoparticles (CHNP) substantially increased the bioavailability and serum stability of SR9. The mechanism of nanoparticle uptake was studied extensively in vitro and in ex vivo models. Our results confirmed that CHNP-SR9 protected primary cells from autophagy and successfully induced tumor-specific apoptosis via both extrinsic and intrinsic apoptotic pathways. CHNP-SR9 significantly reduced the tumor spheroid size (three-dimensional model) by nearly 7-fold. Effects of SR9 and CHNP-SR9 were studied on 35 key molecules involved in the apoptotic pathway. Highly significant (4.26-fold, P≤0.005) reduction in tumor volume was observed using an in vivo mouse xenograft colon cancer model. It was also observed that net apoptotic (6.25-fold, P≤0.005) and necrotic indexes (3.5-fold, P≤0.05) were comparatively higher in CHNP-SR9 when compared to void CHNP and CHNP-SR9 internalized more in cancer stem cells (4.5-fold, P≤0.005). We concluded that nanoformulation of SR9 did not reduce its therapeutic potential; however, nanoformulation provided SR9 with enhanced stability and better bioavailability. Our study presents a highly tumor-specific protein-based cancer therapy that has several advantages over the normally used chemotherapeutics.

A model driven approach to care planning systems for consumer engagement in chronic disease management

This work demonstrates a model-driven approach to the development of care plan systems, amenable to: (a) a flexible and extensible definition of care plan scope; and (b) deployment of care plan viewing and tracking functionality to a wide range of physical computing devices. The approach utilises a care plan domain model from which guideline implementers formulate care plan templates aligning to specific clinical guidelines. A clinical end user would subsequently constrain that template (e.g., selecting a subset of available activities and specific targets) to create a care plan instance for an individual patient. An XML care plan visualisation definition created using the Marama tool is transformed to OpenLaszlo script from which Shockwave Flash objects can be compiled, creating Flash applications that run on a variety of hardware for both clinical and patient users. The approach is illustrated with respect to an overweight and obesity guideline.