The health and economic benefits of reducing intimate partner violence: an Australian example.

BACKGROUND: Intimate partner violence (IPV) has important impacts on the health of women in society. Our aim was to estimate the health and economic benefits of reducing the prevalence of IPV in the 2008 Australian female adult population. METHODS: Simulation models were developed to show the effect of a 5 percentage point absolute feasible reduction target in the prevalence of IPV from current Australian levels (27%). IPV is not measured in national surveys. Levels of psychological distress were used as a proxy for exposure to IPV since psychological conditions represent three-quarters of the disease burden from IPV. Lifetime cohort health benefits for females were estimated as fewer incident cases of violence-related disease and injury; deaths; and Disability Adjusted Life Years (DALYs). Opportunity cost savings were estimated for the health sector, paid and unpaid production and leisure from reduced incidence of IPV-related disease and deaths. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of females with moderate psychological distress (lifetime IPV exposure) against high or very high distress (current IPV exposure), and valued using the friction cost approach (FCA). The impact of improved health status on unpaid household production and leisure time were modelled from time use survey data. Potential costs associated with interventions to reduce IPV were not considered. Multivariable uncertainty analyses and univariable sensitivity analyses were undertaken. RESULTS: A 5 percentage point absolute reduction in the lifetime prevalence of IPV in the 2008 Australian female population was estimated to produce 6000 fewer incident cases of disease/injury, 74 fewer deaths, 5000 fewer DALYs lost and provide gains of 926,000 working days, 371,000 days of home-based production and 428,000 leisure days. Overall, AUD371 million in opportunity cost savings could be achievable. The greatest economic savings would be home-based production (AUD147 million), followed by leisure time (AUD98 million), workforce production (AUD94 million) and reduced health sector costs (AUD38 million). CONCLUSIONS: This study contributes new knowledge about the economic impact of IPV in females. The findings provide evidence of large potential opportunity cost savings from reducing the prevalence of IPV and reinforce the need to reduce IPV in Australia, and elsewhere.

Child and adolescent obesity: part of a bigger picture

The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Cost-effectiveness of recruitment methods in a population-based epidemiological study: the Melbourne Visual Impairment Project

The cost-effectiveness of five recruitment methods was evaluated to determine the best method of encouraging eligible persons to participate in the Melbourne Visual Impairment Project (a population-based epidemiological study). The evaluation was divided into two phases. Phase 1 included one of two types of initial contact, by direct personal contact or by telephone. Phase 2 involved recruiting residents after an attempt had been made by either the telephone or the doorstep approach, and included a second attempt by a field interviewer, subsequent attempts by senior field staff, and finally, financial incentives. The cost-effectiveness of each method was determined by dividing the approach's cost by the effectiveness ratio. We identified 269 eligible households with 356 eligible residents. An 89 per cent response rate was achieved at the examination centre, comprising 61 per cent from Phase 1 and 28 per cent from Phase 2. Although both recruitment methods in Phase 1 were equally cost-effective, there was a significant difference in the effectiveness of each method in actually recruiting residents. The doorstep method was more costly per attender but was far more effective at 76 per cent recruitment than the telephone method at 47 per cent (P < 0.001). We have demonstrated a practical two-stage approach (the doorstep method in Phase 1 and follow-up strategies in Phase 2) to population-based recruitment involving the middle to elderly age group that should be relevant to many epidemiological studies.

Financial model for investment recovery period in electronic health records implementations

Technology usage for better healthcare delivery is being emphasised in the USA and other advanced nations. Electronic health records (EHR) are being widely seen as improving operational efficiency and reducing medication errors in clinic practices and hospitals. Further, hospitals and clinics stand to gain incentives from the federal government if they implement EHRs and demonstrate meaningful use of EHRs. While numerous other aspects of HER implementations is found in literature, financial models have not been well studied. Before implementing EHR, one must take into consideration investment recovery period considering the costs, savings and possible tax incentives. In this paper, we develop financial model for computing investment recovery period in EHR implementations assuming constant patient visits. We further develop required growth rate formula if investments need to be recovered in fixed number of years. The model is illustrated with numerical example.

Population outcomes of three approaches to detection of congenital hearing loss

BACKGROUND: Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost.

METHODS: Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression.

RESULTS: Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected.

CONCLUSIONS: With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.

A Generalized hierarchical transactive energy management framework for residential microgrids

This work develops a transactive energy management system in order to automate the operation and efficiently utilize the energy generated from the solar PV unit and BESS in a single house as well as in the microgrid and provides cost-benefit analysis.

Reconsidering the estimation of the economic impact of cultural tourism

The assessment of the economic benefits of cultural events is necessary to inform decision-making. In many cases cultural events are designed to attract tourists and the injection of tourist spending to a local economy is one of the drivers for hosting events. From an economic perspective, the impact of staging an event can be measured using either an expenditure multiplier or a cost benefit analysis (CBA) approach. One of the difficulties with CBA is the data required to estimate the relevant benefit function. This paper addresses this limitation by illustrating how benefit functions can be parameterised with minimal data, thereby enhancing the possibility of using CBA. Our approach is illustrated with a case study of an exhibition held by a regional community in Australia. The case study compares economic impact assessments and finds using benefit estimates as we propose provides a useful method of estimating benefits with limited data.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

A cost/benefit approach to performance analysis

Most performance engineering approaches focus on understanding the use of runtime resources. However such approaches do not quantify the value being provided in return for the consumption of these resources. Without such a measure it is not possible to compare the e ciency of these components (that is whether the runtime cost is reasonable given the bene t being provided). We have created an empirical approach that measures the value being provided by a code path in terms of the visible data it generates for the rest of the application. Combining this with traditional performance cost data, creates an e ciency measure for every code path in the application. We have evaluated our approach using the DaCapo benchmark suite, demonstrating our analysis allows us to quantify the e ciency of the code in each benchmark and nd real optimisation opportunities, providing improvements of up to 36% in our case studies.

The media and the development of the tourism industry during the 20th and 21st centuries: an analysis of four noteworthy cases

The aim of this paper was to explore the role of the media within the context of tourism, specifically with regard to how the media has influenced the activities and perceptions of the tourism sector. In this paper, the term ‘media’ is referred to as mass communication, specifically with regard to newspapers, magazines and broadcasting. It is important to gain a better understanding of the ways in which the media has interacted with the tourism sector, as this information can provide practitioners and academics with insights as to how the media can best be employed to benefit stakeholders of the tourism industry. Lessons can be learned from the past so that the experience gained from it can contribute to best practice in the future. In this way, strategies can be developed to minimise the vulnerability of the tourism sector to damaging or erroneous portrayals of it and its activities in the media.
The case study method was used to explore the role of the media within the context of tourism. Four case studies provided insights on this topic. The four case studies were selected based on their diversity, within the context of the tourism sector, and because they covered a considerable period of time. These variables provided the researchers with a wide-ranging perspective on the topic.
The paper firstly focuses on the 1920’s Waiters’ Strike in the resort town of San Sebastián, Spain, and discusses the role of the media in relation to this event. The second case investigates the use of the media as a destination-marketing tool and reflects on an early manipulation of this process by the German authorities in the documentary Olympia, a film produced for the summer Olympics in 1936. The third case study reports on the manner in which the media has created tensions between connoisseurs of fine food and drink and hospitality industry professionals, and its subsequent implications on service quality. The final case investigates the role of the media in reducing demand for hospitality services in Melbourne on New Year’s Eve 2000.
Through an analysis of these diverse, but important case studies, it can be seen that the media has had, and continues to have, an impact on the development of the tourism industry in both positive and negative ways. The limitations of this research are discussed and recommendations are made for further research that will assist in developing a more comprehensive typology of the media’s role in tourism.

Multiple-criteria decision analysis for integrated catchment management

Implementation of integrated catchment management (ICM) is hampered by the lack of a conceptual framework for explaining how landowners select farming systems for their properties. Benefit–cost analysis (a procedure that estimates the costs and benefits of alternative actions or policies) has limitations in this regard, which might be overcome by using multiple-criteria decision analysis (MCDA). MCDA evaluates and ranks alternatives based on a landowner's preferences (weights) for multiple-criteria and the values of those criteria. A MCDA approach to ICM is superior to benefit–cost analysis which focuses only on the monetary benefits and costs, because it: 1) recognizes that human activities within a catchment are motivated by multiple and often competing criteria and/or constraints; 2) does not require monetary valuation of criteria; 3) allows trade-offs between criteria to be measured and evaluated; 4) explicitly considers how the spatial configuration of farming systems in a catchment influences the values of criteria; 5) is comprehensive, knowledge-based, and stakeholder oriented which greatly increases the likelihood of resolving catchment problems; and 6) allows consideration of the fairness and sustainability of land and water resource management decisions. A MCDA based on an additive, multiple-criteria utility function containing five economic and environmental criteria was used to score and rank five farming systems. The rankings were based on the average criteria weights for a sample of 20 farmers in a US catchment. The most profitable farming system was the lowest-ranked farming system. Three possible reasons for this result are evaluated. First, the MCDA method might cause respondents to express socially acceptable attitudes towards environmental criteria even when they are not important from a personal viewpoint. Second, the MCDA method could inflate the ranks of less profitable farming systems for the simple reason that it allows the respondent to assign non-zero weights to non-economic criteria. Third, the MCDA might provide a better framework for evaluating a landowner's selection of farming systems than the profit maximization model.

Web communities analysis and construction

Yanchun Zhang and his co-authors explain how to construct and analyse Web communities based on information like Web document contents, hyperlinks, or user access logs. Their approaches combine results from Web search algorithms, Web clustering methods, and Web usage mining. They also detail the necessary preliminaries needed to understand the algorithms presented, and they discuss several successful existing applications. Researchers and students in information retrieval and Web search find in this all the necessary basics and methods to create and understand Web communities. Professionals developing Web applications will additionally benefit from the samples presented for their own designs and implementations

The Pathways model of assault : a qualitative analysis of the assault offender and offence

Research on offending behavior rehabilitation suggests that offenders would gain the maximum benefit from programs that reflect the individual needs of different types of offender. Multivariate theories of offending behavior are thus required to inform individualized rehabilitation. The aim of the current study was to construct a multivariate model for the prolific offense of assault. Qualitative methodology was used to construct a descriptive model of assault for 25 adult assault offenders. The model incorporated the development of violent behavior, types of anger, violence motivation, and the assault offense. The model consisted of 14 categories, 10 of which allowed for individual differences in behavior. A total of 35 participant transcripts were then coded through the model where the individual differences occurred. Five main offense types were found. The characteristics of the types of assault offense gave indications for how rehabilitation may be targeted for each group.

Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials : meta-analysis

Objective To determine whether vertebroplasty is more effective than placebo for patients with pain of recent onset (≤6 weeks) or severe pain (score ≥8 on 0-10 numerical rating scale).

Design Meta-analysis of combined individual patient level data.

Setting Two multicentred randomised controlled trials of vertebroplasty; one based in Australia, the other in the United States.

Participants 209 participants (Australian trial n=78, US trial n=131) with at least one radiographically confirmed vertebral compression fracture. 57 (27%) participants had pain of recent onset (vertebroplasty n=25, placebo n=32) and 99 (47%) had severe pain at baseline (vertebroplasty n=50, placebo n=49).

Intervention Percutaneous vertebroplasty versus a placebo procedure.

Main outcome measure Scores for pain (0-10 scale) and function (modified, 23 item Roland-Morris disability questionnaire) at one month.

Results For participants with pain of recent onset, between group differences in mean change scores at one month for pain and disability were 0.1 (95% confidence interval −1.4 to 1.6) and 0.2 (−3.0 to 3.4), respectively. For participants with severe pain at baseline, between group differences for pain and disability scores at one month were 0.3 (−0.8 to 1.5) and 1.4 (−1.2 to 3.9), respectively. At one month those in the vertebroplasty group were more likely to be using opioids.

Conclusions Individual patient data meta-analysis from two blinded trials of vertebroplasty, powered for subgroup analyses, failed to show an advantage of vertebroplasty over placebo for participants with recent onset fracture or severe pain. These results do not support the hypothesis that selected subgroups would benefit from vertebroplasty.