Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods-: A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results-: The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions-: First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Informal care for stroke survivors. Results from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Informal caregivers play an important role in the lives of stroke patients, but the cost of providing this care has not been estimated. The purpose of this study was to determine the nature and amount of informal care provided to stroke patients and to estimate the economic cost of that care.

Methods-: The primary caregivers of stroke patients registered in the North East Melbourne Stroke Incidence Study (NEMESIS) were interviewed at 3, 6, and 12 months after stroke, and the nature and amount of informal care provided were documented. The opportunity and replacement costs of informal care for all first-ever-in-a-lifetime strokes (excluding subarachnoid hemorrhages) that occurred in 1997 in Australia were estimated.

Results-: Among 3-month stroke survivors, 74% required assistance with activities of daily living and received informal care from family or friends. Two thirds of primary caregivers were women, and most primary caregivers (>90%) provided care during family or leisure time. Total first-year caregiver time costs for all first-ever-in-a-lifetime strokes were estimated to be A$21.7 million (opportunity cost approach) or A$42.5 million (replacement cost approach), and the present values of lifetime caregiver time costs were estimated to be A$171.4 million (opportunity cost approach) or A$331.8 million (replacement cost approach).

Conclusions-: Informal care for stroke survivors represents a significant hidden cost to Australian society. Because our community is rapidly aging, this informal care burden may increase significantly in the future.

Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Out of pocket costs to stroke patients during the first year after stroke - results from the North East Melbourne stroke incidence study

Non-reimbursed ‘out of pocket’ costs to stroke patients have not been included in existing cost of illness studies. We aimed to determine the nature and magnitude of ‘out of pocket’ costs to stroke patients during the first year after stroke. ‘Out of pocket’ costs during the first year after stroke were documented for 165 persons registered in a community-based stroke incidence study during 1996/1997. Virtually all cases reported some ‘out of pocket’ costs. The average cost over 12 months was A$1110. The highest cost items were home modifications, aids and equipment. The most commonly incurred expense was for prescription medications. Total ‘out of pocket’ costs incurred by first-ever stroke patients in Australia in 1997 were estimated to be A$29 million or 5% of the total cost of stroke. The majority of ‘out of pocket’ costs relate to post-acute care aimed at minimising disability and handicap rather than to ‘acute’ healthcare.

The health loss from ischemic stroke and intracerebral hemorrhage : evidence from the North East Melbourne Stroke Incidence Study (NEMESIS)

Background People suffering different types of stroke have differing demographic characteristics and survival. However, current estimates of disease burden are based on the same underlying assumptions irrespective of stroke type. We hypothesized that average Quality Adjusted Life Years (QALYs) lost from stroke would be different for ischemic stroke and intracerebral hemorrhage (ICH).

Methods We used 1 and 5-year data collected from patients with first-ever stroke participating in the North East Melbourne Stroke Incidence Study (NEMESIS). We calculated case fatality rates, health-adjusted life expectancy, and quality-of-life (QoL) weights specific to each age and gender category. Lifetime 'health loss' for first-ever ischemic stroke and ICH surviving 28-days for the 2004 Australian population cohort was then estimated. Multivariable uncertainty analyses and sensitivity analyses (SA) were used to assess the impact of varying input parameters e.g. case fatality and QoL weights.

Results Paired QoL data at 1 and 5 years were available for 237 NEMESIS participants. Extrapolating NEMESIS rates, 31,539 first-ever strokes were expected for Australia in 2004. Average discounted (3%) QALYs lost per first-ever stroke were estimated to be 5.09 (SD 0.20; SA 5.49) for ischemic stroke (n = 27,660) and 6.17 (SD 0.26; SA 6.45) for ICH (n = 4,291; p < 0.001). QALYs lost also differed according to gender for both subtypes (ischemic stroke: males 4.69 SD 0.38, females 5.51 SD 0.46; ICH: males 5.82 SD 0.67, females 6.50 SD 0.40).

Discussion People with ICH incurred greater loss of health over a lifetime than people with ischemic stroke. This is explained by greater stroke related case fatality at a younger age, but longer life expectancy with disability after the first 12 months for people with ICH. Thus, studies of disease burden in stroke should account for these differences between subtype and gender. Otherwise, in countries where ICH is more common, health loss for stroke may be underestimated. Similar to other studies of this type, the generalisability of the results may be limited. Sensitivity and uncertainty analyses were used to provide a plausible range of variation for Australia. In countries with demographic and life expectancy characteristics comparable to Australia, our QoL weights may be reasonably applicable.

Zooplankton abundance and community structure over a 4000 km transect in the North-east Atlantic

Zooplankton samples were collected by a high speed sampler, the U-Tow, in the north-east Atlantic between 61.6 and 36.7°N during June and July 1996, and were used to examine the causality of spatial distributions along a 4000 km transect. Peak zooplankton abundance and biovolume estimations were associated with a frontal system at 48–52°N, which separated hydrographically distinct water masses. The zooplankton assemblage was dominated by herbivorous/omnivorous taxa in the northern regions, and by carnivorous taxa in the southern regions. Arguments are developed to suggest that the switch in both the zooplankton size structure and trophic status, centred within the frontal region, are consistent with ‘bottom-up’ control of zooplankton size structure in this region of the Atlantic.

High colonization by native arbuscular mycorrhizal fungi (AMF) of rubber trees in small-holder plantations on low fertility soils in North East Thailand

Rubber tree is a very important crop in Thailand, representing an essential source of income for farmers. In the past two decades, rubber tree plantations have been greatly expanding in unfavorable areas, where climate conditions are difficult and soil fertility is very poor. To optimize latex yields, mineral fertilizers have been widely used. A better understanding of the roles of the biological compartment in soil fertility is essential to determine alternative management practices to sustain soil fertility and optimize latex yields. Arbuscular mycorrhizal fungi (AMF) are widely recognized as beneficial for plants, mainly through their role in improving plant nutrient uptake. The objective of this study was to assess the AMF populations in rubber tree plantations and the impact of both soil characteristics and plantation age on these communities. Our results showed that all rubber trees were highly colonized, regardless of the soil structure and nutrient contents. AMF colonization was not affected by the age of the trees, suggesting that maintaining the symbiosis is likely to be beneficial at all stages. A better understanding and management of the microbial communities would contribute to maintaining or restoring soil fertility, leading to a better tree growth and optimized latex yield.

Women’s health Goulburn North East community crime prevention plan – regional preventing violence against women and children strategy: summative evaluation report from the external evaluator, February 2016

This report presents the external evaluation of the Hume Regional Preventing Violence Against Women Strategy. This is one of 12 projects funded by the Department of Justice and Regulation in Victoria under its initiative to support primary prevention and early intervention-focused partnership projects that seek to prevent violence before it occurs or address the key contributing factors of violence against women and their children. The focus is on changing behaviours and attitudes that allow violence against women and children to continue. The lead agency in the project was Women’s Health Goulburn North East (WHGNE).The Hume regional strategy The focus of the project was to develop and implement a coordinated regional strategy that addresses the determinants of violence against women and builds the capacity of communities to take action to prevent such violence. At the outset it was envisaged that a key component of the strategy would be to undertake preventive activities that respond to identified gaps in the region.The first version of the strategy was completed in September 2013 and formally launched in November 2013. In October 2013, Courageous Conversations was identified as the brand to be used for activities in the strategy, including a charter and other resources. As the project evolved, the strategy was revised to reflect differing levels of engagement and progress with the different parts of the work and to identity explicitly the activities associated with the brand. A revised version of the regional strategy was produced in September 2014, with four aims:• promoting equal and respectful relationships between men and women;• working across local government, workplaces and sporting settings to coordinate a region-wide approach to preventing violence against women;• bringing about structural and systemic organisational change to promote gender equitable and non-violent cultures;• build the capacity of leaders in preventing violence against women.Different components of the activities carried out under the strategy included: partnership and capacity building; building gender equity in organisations; gender equity and masculinities training; bystander training; knowledge dissemination and the Courageous Conversations website.

Cultural diversity in the Australian classroom and the experience of Arab-Muslim students

Table of Contents : Preface Introduction 1. Building the Australia-India Relationship- Bruce Bennett 2. Plural Cultures, Monolithic Structures- Kapila Vatsyayan 3. The Homogenised Other: Cultural Diversity and Social Inequality- Alan Mayne 4. Deliberative Democracy and Modern Pluralism- Subrata Mukherjee 5. ‘A long and winding road’. From Cultural Homogeneity to a Multicultural Society: An Analysis of Inclusion and Exclusion in Australia- David Roberts 6. Limits of Multiculturalism in a Liberal Polity: Need for a Shared Identity-Sushila Ramaswamy 7. “Australia is a Multicultural Community –you’ll feel at home”:Cultural Diversity and the Promotion of Australia Internationally- Andrew Hassam 8. Accommodation of Cultural Diversity in India: Reflections on Past and Present- Abdulrahim P. Vijapur 9. Gandhian Ideas on Cultural Diversity and Unity in India- Sailaja Gullapalli 10. Multiculturalism: Australian and Indian Approach-Sonu Trivedi 11. Post Colonial Formation, Paradigm Consolidation and Economic Marginalization- S. Ram Vemuri 12. Dalits and Indigenous Australians: Affirmative Actions and Existing Realities- Swaraj Basu 13. Exploring a Critical Tradition in Communications Research: A Cultural Discourse- Amita Singh 14. Education and Empowerment: Dalits and the Demand for Modern Education in Colonial India- Shashi Bhushan Upadhyay 15. Recent Developments in Indian Migration to Australia (with Special Reference to Academics)- Graeme Hugo and Gouranga Lal Dasvarma 16. Cultural Diversity in the Australian Classroom and the Experience of Arab-Muslim Students- Sally Percival Wood 17. Working Australia Efficiency and Equity- Liz Hall 18. North-East India’s Cultural Diversity: Trends of Unrest and Marginalization- Sudhir Jacob George 19. Socio-economic Inequities of Tribal Communities in India- Priti Singh 20. Reinventing Australian Identity-D. Gopal 21. Identity and Rights of the Diaspora in the Post-colonial Era- R. Narayanan 22. Understanding Cultural Diversity: Reflections from the Americas- Satya R. Pattnayak Contributors Index

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.

Reworked Devonian (Givetian-Frasnian) spores from a Permian glacially-derived sequence at Bacchus Marsh, Victoria

Emphanisporites rotatus McGregor emend. McGregor 1973 is a distinctive Devonian spore with a known primary source age range in Australia spanning the upper Givetian to early Frasnian (Middle to Late Devonian). This is the first record of the species from Victoria. It occurs as a reworked element in an Early Permian assemblage belonging to the Granularisporites confluens Zone derived from glacigene diamictite in the Bacchus Marsh area. As the predominant direction of Permian ice movement recorded in the Bacchus Marsh district was south-west to north-east, it is possible that the reworked spores were transported from Antarctica.

Re-examination of the taxonomy of the macrobrachium australiense holthuis (Decapoda: Palaemonidae) species-complex: molecular evidence for a single species

The freshwater shrimp Macrobrachium australiense is distributed throughout the majority of inland, north-west, north-east and eastern drainages. Owing to the large amount of morphological divergence, both between and within catchments, this species has proven to be taxonomically difficult and, until recently, consisted of three separate species, each with subsequent subspecies. This study uses nucleotide sequences from the 16S rRNA mitochondrial gene region to investigate the genetic relationships between populations and confirm the taxonomic status of M. australiense. The results from sequencing an approximately 450-bp fragment from this gene region from M. australiense sampled from 12 locations across inland, eastern and northern Australia identified very little variation. The variation found between 16S M. australiense haplotypes is much less than that found between Macrobrachium species, indicating that it is in fact a single species. The results are concordant with a recent morphological revision of Australian species in which nominal taxa of the M. australiense complex were synonymised.