The impact of court delays on the prosecutor and the defendant: an economic analysis

One important aspect of the economic theory of criminal court delay is to understand how the prosecutor and the defendant make their decisions, and how these respond to changes in trial delay. If both parties jointly maximise expected utility, trial delay may increase or decrease the number of trials, depending upon the decision makers' attitudes towards risk. The main policy implication is that providing the criminal courts with more resources in the form of additional judges and court capacity may lengthen the trial queue rather than shorten it. This is a counterintuitive result contrary to popular belief.

Socially optimal criminal court waiting times : a partial investigation

Criminal courts provide a forum for conducting prosecutions with a guilty plea or a trial. Since queues are used as the basis for rationing scarce court facilities delays are inevitable, however courts are invariably criticised as being inefficient as a consequence. This focus on court delay defined as the time elapsing between the listing of the case in the court list and its final disposition is misleading. Rather, attention should be drawn to the considerably longer period between the initiation of proceedings and the conclusion of the case. In the case of defendants not granted bail, this pre-trial delay confers both costs and benefits on society and this observation can be used to ascertain socially optimal pre-trial waits.

Valuing criminal court services

Criminal courts fundamentally provide a forum for conducting prosecutions with a guilty plea or a trial. At present, there is no generally accepted  methodology for estimating the monetary value of those services. The  purpose of this paper is to attempt to fill this gap by proposing a  methodology predicated on the joint optimising decisions of society and the defendant, who are the two stakeholders in any criminal case. The technique can also be potentially used to evaluate both theoretically and empirically the impact of court delay reduction programs on social welfare, and the specification of socially optimal court waiting times.

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

Quality of life and depression among older patients waiting for joint replacement surgery

Purpose: Older patients waiting for joint replacement surgery in many western countries experience lengthy waits for their surgery. Although these patients suffer with mobility problems the nature of the disability associated with waiting for surgery is unclear. The purpose of this study was to determine health-related quality of life and symptoms of depression in persons waiting for their initial orthopaedic consultation following referral for total knee or total hip replacement surgery.

Methods: All patients who were waiting for an initial orthopaedic consultation for lower-limb joint replacement as at 25 August 2005 were surveyed. Participants were mailed questionnaires concerning demographic information, medical history, health-related quality of life (the Assessment of Quality of Life (AQoL) instrument), and symptoms of depression (Center for Epidemiologic Studies – Depression (CES-D) Scale).

Results: The 84 respondents (response rate 64%) had a mean age of 68.3 (SD 11.5 years), and 60% or respondents were women. Respondents reported an average of 1.6 (SD 0.9) medical conditions, and 85% reported osteoarthritis.} The average health-related quality of life was low (mean AQoL 0.38; SD 0.27), and near death-equivalent or worse than death-equivalent health-related quality of life (AQoL<0.1 of a maximum possible 1.0) was reported by 23% of the participants.The mean depression scale score was 16.5 (SD 11.1), and symptoms of depression (CES-D>16 of a maximum possible 60) were reported by 35% of the sample. There was a strong correlation between health-related quality of life and depression (r=–0.6).

Conclusions: Almost a third of patients waiting to see an orthopaedic surgeon about joint replacement surgery for their hip or knee had symptoms of depression. Geriatric rehabilitation services often provide interventions to these patients. The very poor quality of life reported suggests that more than exercise and strengthening will be needed to reduce disability.

Designing optimal fault tolerant Jacobian for robotic manipulators

Fault tolerance of robotic manipulators is determined based on the fault tolerance measures. In this study a Jacobian of a 7DOF optimal fault tolerant manipulator is designed based on optimality of worse case relative manipulability and worse case dexterity from geometric perspective instead of numerical solution of constrained optimisation problem or construction of optimal Jacobean through a desired null space. The proposed Jacobean matrix is optimal and equally fault tolerant for a single joint failure within any joint of the manipulators.

Joint velocity redistribution for fault tolerant manipulators

If the end-effector of a robotic manipulator moves on a specified trajectory, then for the fault tolerant operation, it is required that the end-effector continues the trajectory with a minimum velocity jump when a fault occurs within a joint. This problem is addressed in the paper. A way to tolerate the fault is to find new joint velocities for the faulty manipulator in which results into the same end-effector velocity provided by the healthy manipulator. The aim of this study is to find a strategy which optimally redistributes the joint velocities for the remained healthy joints of the manipulators. The optimality is defined by the minimum end-effector velocity jump. A solution of the problem is presented and it is applied to a robotics manipulator. Then through a case study and a simulation study it is validated. The paper shows that if would be possible the joint velocity redistribution results into a zero velocity jump.

A class of optimal fault tolerant Jacobian for minimal redundant manipulators based on symmetric geometries

Design of locally optimal fault tolerant manipulators has been recently addressed via using the constraints of the desired null space for the Jacobian matrix of the manipulators. In the present paper the Jacobian matrices for optimal fault tolerance are presented based on geometric properties of column vectors instead of the null space. They are equally fault tolerant to a single joint failure from the worst-case relative manipulability and worst-case dexterity points of view. The optimality is achieved through a symmetric distribution of points on spheres.

Optimal fault tolerant Jacobian matrix generators for redundant manipulators

The design of locally optimal fault-tolerant manipulators has been previously addressed via adding constraints on the bases of a desired null space to the design constraints of the manipulators. Then by algebraic or numeric solution of the design equations, the optimal Jacobian matrix is obtained. In this study, an optimal fault-tolerant Jacobian matrix generator is introduced from geometric properties instead of the null space properties. The proposed generator provides equally fault-tolerant Jacobian matrices in R3 that are optimally fault tolerant for one or two locked joint failures. It is shown that the proposed optimal Jacobian matrices are directly obtained via regular pyramids. The geometric approach and zonotopes are used as a novel tool for determining relative manipulability in the context of fault-tolerant robotics and for bringing geometric insight into the design of optimal fault-tolerant manipulators.

Optimal fault-tolerant robotic manipulators

This thesis addresses “Optimal Fault-Tolerant Robotic Manipulators” for locked-joint failures and consists of three components. It begins by investigating the regions of workspace where the manipulator can operate with high reliability. It then continues with an efficient deployment of kinematic redundancies for fault-tolerant operation. Finally, it presents a novel method for design of optimal fault-tolerant manipulators.

Joint learning and dictionary construction for pattern recognition

We propose a joint representation and classification framework that achieves the dual goal of finding the most discriminative sparse overcomplete encoding and optimal classifier parameters. Formulating an optimization problem that combines the objective function of the classification with the representation error of both labeled and unlabeled data, constrained by sparsity, we propose an algorithm that alternates between solving for subsets of parameters, whilst preserving the sparsity. The method is then evaluated over two important classification problems in computer vision: object categorization of natural images using the Caltech 101 database and face recognition using the Extended Yale B face database. The results show that the proposed method is competitive against other recently proposed sparse overcomplete counterparts and considerably outperforms many recently proposed face recognition techniques when the number training samples is small.

A randomised trial of robotic and open prostatectomy in men with localised prostate cancer

Background
Prostate cancer is the most common male cancer in the Western world however there is ongoing debate about the optimal treatment strategy for localised disease. While surgery remains the most commonly received treatment for localised disease in Australia more recently a robotic approach has emerged as an alternative to open and laparoscopic surgery. However, high level data is not yet available to support this as a superior approach or to guide treatment decision making between the alternatives. This paper presents the design of a randomised trial of Robotic and Open Prostatectomy for men newly diagnosed with localised prostate cancer that seeks to answer this question.

Methods
200 men per treatment arm (400 men in total) are being recruited after diagnosis and before treatment through a major public hospital outpatient clinic and randomised to 1) Robotic Prostatectomy or 2) Open Prostatectomy. All robotic prostatectomies are being performed by one surgeon and all open prostatectomies are being performed by one other surgeon. Outcomes are being measured pre-operatively and at 6 weeks and 3, 6, 12 and 24 months post-surgery. Oncological outcomes are being related to positive surgical margins, biochemical recurrence +/ the need for further treatment. Non-oncological outcome measures include: pain, physical and mental functioning, fatigue, summary (preference-based utility scores) and domain-specific QoL (urinary incontinence, bowel function and erectile function), cancer specific distress, psychological distress, decision-related distress and time to return to usual activities. Cost modelling of each approach, as well as full economic appraisal, is also being undertaken.

Discussion
The study will provide recommendations about the relative benefits of Robotic and Open Prostatectomy to support informed patient decision making about treatment for localised prostate cancer; and to assist in treatment services planning for this patient group. Trial Registration ACTRN12611000661976

Cluster randomized controlled trial of a peer support program for people with diabetes: study protocol for the Australasian peers for progress study

Background
Well managed diabetes requires active self-management in order to ensure optimal glycaemic control and appropriate use of available clinical services and other supports. Peer supporters can assist people with their daily diabetes self-management activities, provide emotional and social support, assist and encourage clinical care and be available when needed.
Methods
A national database of Australians diagnosed with type 2 diabetes is being used to invite people in pre-determined locations to participate in community-based peer support groups. Peer supporters are self-identified from these communities. All consenting participants receive diabetes self-management education and education manual prior to randomization by community to a peer support intervention or usual care. This multi-faceted intervention comprises four interconnected components for delivering support to the participants. (1) Trained supporters lead 12 monthly group meetings. Participants are assisted to set goals to improve diabetes self-management, discuss with and encourage each other to strengthen linkages with local clinical services (including allied health services) as well as provide social and emotional support. (2) Support through regular supporter-participant or participant-participant contact, between monthly sessions, is also promoted in order to maintain motivation and encourage self-improvement and confidence in diabetes self-management. (3) Participants receive a workbook containing diabetes information, resources and community support services, key diabetes management behaviors and monthly goal setting activity sheets. (4) Finally, a password protected website contains further resources for the participants. Supporters are mentored and assisted throughout the intervention by other supporters and the research team through attendance at a weekly teleconference. Data, including a self-administered lifestyle survey, anthropometric and biomedical measures are collected on all participants at baseline, 6 and 12 months. The primary outcome is change in cardiovascular disease risk using the UKPDS risk equation. Secondary outcomes include biomedical, quality of life, psychosocial functioning, and other lifestyle measures. An economic evaluation will determine whether the program is cost effective.
Discussion
This manuscript presents the protocol for a cluster randomized controlled trial of group-based peer support for people with type 2 diabetes in a community setting. Results from this trial will contribute evidence about the effectiveness of peer support in achieving effective self-management of diabetes.

Estradiol for treatment-resistant schizophrenia: a large-scale randomized-controlled trial in women of child-bearing age

Many women with schizophrenia remain symptomatic despite optimal use of current therapies. While previous studies suggest that adjunctive oestrogen therapy might be effective, large-scale clinical trials are required before clinical applications are possible. This study is the first large-scale randomized-controlled trial in women with treatment-resistant schizophrenia. This Definitive Oestrogen Patch Trial was an 8-week, three-arm, double-blind, randomized-controlled trial conducted between 2006 and 2011. The 183 female participants were aged between 18 and 45 (mean=35 years), with schizophrenia or schizoaffective disorder and ongoing symptoms of psychosis (Positive and Negative Syndrome Scale, PANSS score>60) despite a stable dose of antipsychotic medication for at least 4 weeks. Mean duration of illness was more than 10 years. Participants received transdermal estradiol 200 μg, transdermal estradiol 100 μg or an identical placebo patch. For the 180 women who completed the study, the a priori outcome measure was the change in PANSS score measured at baseline and days 7, 14, 28 and 56. Cognition was assessed at baseline and day 56 using the Repeatable Battery of Neuropsychological Status. Data were analysed using latent growth curve modelling. Both estradiol groups had greater decreases in PANSS positive, general and total symptoms compared with the placebo group (P<0.01), with a greater effect seen for 200 μg than 100 μg estradiol. The largest effect size was for the positive subscale of PANSS in the estradiol 200 μg treatment group (effect size 0.44, P<0.01). This study shows estradiol is an effective and clinically significant adjunctive therapy for women with treatment-resistant schizophrenia, particularly for positive symptoms.Molecular Psychiatry advance online publication, 15 April 2014; doi:10.1038/mp.2014.33.