Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting

Introduction:
Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials.
Methods:
We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer.
Results:
For male smokers aged 60–64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was $57,325 per life-year saved and $105,090 per QALY saved. For females aged 60–64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was $51,001 per life-year saved and $88,583 per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of $50,000 per life-year saved as the threshold to define a “cost-effective” intervention.
Conclusion:
The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.

Trends, fads and futures : computers in learning in tertiary education, 1983-2002

ASCILITE, the Australasian Society for Computers in Learning in Tertiary Education, is a professional society focusing on computers in learning in tertiary education that has been sponsoring conferences for its membership since 1986. Prior to this, three earlier conferences formed the genesis of ASCILITE. Over that period there have been significant changes in pedagogy and technology but few attempts, if any, have been made to analyse the ways in which conference proceedings have reflected these changes and shifts. The purpose of this research paper is to review the ASCILITE proceedings and provide an analysis of “trends, fads and futures” to reflect on past initiatives, propose potential directions and assist the society identify strategic directions. In addition, the analysis will provide a basis from which further research can be justified in terms of better understanding “computers in learning in tertiary education”.

Improvement on delay dependent absolute stability of Lurie control systems with multiple time delays

Absolute stability of Lurie control systems with multiple time-delays is studied in this paper. By using extended Lyapunov functionals, we avoid the use of the stability assumption on the main operator and derive improved stability criteria, which are strictly less conservative than the criteria in [2,3].

Application of epidemiology to change health policy : defining age-related thresholds of bone mineral density for primary prevention of fracture

In Australia, benefits for antifracture therapies have been available for patients with osteoporosis and a prior fracture. No benefits were available to those with no prior fracture. We aimed to define, in women with no prior fracture, age-related thresholds of bone mineral density (BMD) associated with fracture risk equivalent to that of women with prior fracture and osteoporosis. A case-control study of women (≥50 yr) was conducted, including 291 fracture cases and 823 controls. BMD was measured at the proximal femur and posterior anterior (PA) spine. A fracture risk score (FRS) for the group with no prior fracture was calculated with discriminant analysis. The thresholds for equivalent fracture risk between those with no prior fracture and those with prior fracture were assessed using logistic regression. Increasing the FRS to +0.98 in women with no prior fracture resulted in equivalent odds of sustaining a fracture to those with prior fracture and osteoporosis. The corresponding T-score thresholds at the spine were −4.6 at 50 yr, −3.9 at 60 yr, −3.1 at 70 yr, and −2.4 at 80 yr. The femoral neck T-score thresholds were lower by 0.5 standard deviation. The high-risk individuals defined by this study should be considered for primary fracture prevention therapy.

Visible light activated TiO2/microcrystalline cellulose nanocatalyst to destroy organic contaminants in water

Hybrid TiO2/microcrystalline cellulose (MC) nanophotocatalyst was prepared in situ by a facile and simple synthesis utilizing benign precursors such as MC and TiCl4. The as-prepared nanocomposite was characterized by XRD, XPS, BET surface area analyzer, UV–vis DRS and TGA. Surface morphology was assessed by the means of SEM and HR-TEM. Statistics-based factorial design (FD) was adopted to investigate the effect of precursors concentrations and therefore to optimize the nanocomposite synthesis through catalytic adsorption of methylene blue (MB) from aqueous solutions. The results indicated that TiO₂/MC nanocomposites were photocatalytically active in diminishing 40–90% of MB in 4 h.

Radioprotective activity of Polyalthia longifolia standardized extract against x-ray radiation injury in mice

The radioprotective effect of Polyalthia longifolia was studied in mice. P. longifolia treatment showed improvement in mice survival compared to 100% mortality in the irradiated mice. Significant increases in hemoglobin concentration, and red blood cell, white blood cell and platelet counts were observed in the animals pretreated with leaf extract. Pre-irradiation administration of P. longifolia leaf extract also increased the CFU counts of the spleen colony and increased the relative spleen size. A dose-dependent decrease in lipid peroxidation levels was observed in the animals pretreated with P. longifolia. However, although the animals pretreated with P. longifolia exhibited a significant increase in superoxide dismutase and catalase activity, the values remained below normal in both liver and the intestine. Pre-irradiation administration of P. longifolia also resulted in the regeneration of the mucosal crypts and villi of the intestine. Moreover, pretreatment with P. longifolia leaf extract also showed restoration of the normal liver cell structure and a significant reduction in the elevated levels of ALT, AST and bilirubin. These results suggested the radioprotective ability of P. longifolia leaf extract, which is significant for future investigation for human applications in developing efficient, economically viable, non-toxic natural and clinically acceptable novel radioprotectors.

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning

BACKGROUND: High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. OBJECTIVES: To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. DESIGN AND SETTING: Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. PARTICIPANTS: A population of 489 final-year nursing students in programs of study leading to license to practice. METHODS: Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. RESULTS: Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001. DISCUSSION: The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. CONCLUSION: The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.

Development of a novel cellulose/duck feather composite fibre regenerated in ionic liquid

By blending cellulose and duck feather in the common solvent 1-allyl-3-methylimidazoloium chloride, a regenerated composite fibre has been developed with improved fibres over regenerated cellulose fibres (RCF). The mechanical properties of composite fibre was shown to be better than RCF with a 63.7% improvement in tensile strain. Here, we thoroughly characterise the composite fibre and show that the composite fibre has many advantages over RCFs both from a spinning perspective and as a regenerated fibre.

Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study

BACKGROUND: Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention. METHODS: The Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of ≥34 in men and ≥38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452. FINDINGS: Between Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10,511 vs conventional treatment $10,680; adjusted mean difference -$225 [95% CI -2080 to 1631]; p=0·812), but were lower in the surgery group in the prediabetes ($10,194 vs $13,186; -$3329 [-5722 to -937]; p=0·007) and diabetes ($14,346 vs $19,511; -$5487 [-7925 to -3049]; p<0·0001) subgroups than in the conventional treatment group. Compared with the conventional treatment group, we noted greater inpatient costs in the surgery group for the euglycaemic ($51,225 vs $25,313; $22,931 [19,001-26,861]; p<0·0001), prediabetes ($58,699 vs $32,861; $27,152 [18,736-35,568]; p<0·0001), and diabetes ($61,569 vs $47,569; 18,697 [9992-27,402]; p<0·0001) subgroups. We noted no differences in outpatient costs. Total health-care costs were higher in the surgery group in the euglycaemic ($71,059 vs $45,542; $22,390 [17,358-27,423]; p<0·0001) and prediabetes ($78,151 vs $54,864; $26,292 [16,738-35,845]; p<0·0001) subgroups than in the conventional treatment group, whereas we detected no difference between treatment groups in patients with diabetes ($88,572 vs $79,967; $9081 [-1419 to 19,581]; p=0·090). INTERPRETATION: Total health-care costs were higher for patients with euglycaemia or prediabetes in the surgery group than in the conventional treatment group, but we detected no difference between the surgery and conventional treatment groups for patients with diabetes. Long-term health-care cost results support prioritisation of patients with obesity and type 2 diabetes for bariatric surgery. FUNDING: AFA Försäkring and Swedish Scientific Research Council.

Study of lithium conducting single ion conductor based on polystyrene sulfonate for lithium battery application

The effect of processing history and morphology is of particular importance for lithium-ion electrolytes for achieving higher ionic conductivities. In this study, single ion conducting poly (4-lithium styrene sulfonic acid) was synthesized by neutralization reaction from polystyrene sulfonic acid, and the effect of morphology and processing method was studied by comparing pelletized, electrospun and gel samples. The PSSLi gels displayed best ionic conductivity, while the pelletized samples showed the worst ionic conductivity. Although electrospinning led to a free standing electrolyte, the lower amount of solvent phase led to lower ionic conductivity when compared to the PSSLi gel. The ionic conductivity at room temperature improved from 6.6 × 10−5 S/cm to 1.4 × 10−3 S/cm by optimizing the processing methodology and the lithium ion concentration. The results show that PSSLi based single ion conducting lithium (SICL) gels are a promising candidate for lithium ion battery application.

Comparison of antimicrobial activity, phytochemical profile and minerals composition of garlic Allium sativum and Allium tuberosum

Allium species are considered to be one of the world's oldest cultivated vegetables. Most commonly used species of garlic in Pakistan and India is Allium sativum, while Allium tuberosum is mainly consumed and cultivated in China, Southeast Asia, and North-east part of India. The present study was conducted to compare the antimicrobial activity, nutritional value and antioxidant profile of Allium sativum and Allium tuberosum. The outcome indicates that Allium tuberosum have slightly higher antimicrobial activity, higher mineral profile, and enriched in antioxidants in comparison with Allium sativum. The highest antimicrobial activity of Allium tuberosum was noticed against Staphylococcus aureus and Bacillus subtilis with 43.9 and 40.7 mm zone of inhibition using 100% extract. Allium tuberosum contains high contents of calcium (28.662±.00mg/100 g), potassium (10.62±0.50) and zinc (59.00±1.00). Allium tuberosum also showed higher antioxidant activity (0.24±0.03 mg vitamin C equivalent (VCE)/g fresh weight in ferric reducing antioxidant power assay, 0.18±0.02 mg VCE/g fresh weight in 2,2-diphenyl-1-picrylhydrazyl assay and 1.09±0.12 mg VCE/g fresh weight in 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) assay) in comparison with Allium sativum.