Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.

On reconsideration of IT governance structures to govern cloud computing services

There is an increase in the uptake of cloud computing services (CCS). CCS is adopted in the form of a utility, and it incorporates business risks of the service providers and intermediaries. Thus, the adoption of CCS will change the risk profile of an organization. In this situation, organisations need to develop competencies by reconsidering their IT governance structures to achieve a desired level of IT-business alignment and maintain their risk appetite to source business value from CCS. We use the resource-based theories to suggest that collaborative board oversight of CCS, competencies relating to CCS information and financial management, and a CCS-related continuous audit program can contribute to business process performance improvements and overall firm performance. Using survey data, we find evidence of a positive association between these IT governance considerations and business process performance. We also find evidence of positive association between business process performance improvements and overall firm performance. The results suggest that the suggested considerations on IT governance structures can contribute to CCS-related IT-business alignment and lead to anticipated business value from CCS. This study provides guidance to organizations on competencies required to secure business value from CCS.

Cloud computing services for the small and medium enterprises: Key considerations for sourcing sustainable business value

The concept of cloud computing services (CCS) is appealing to small and medium enterprises (SMEs). However, while there is a significant push by various authorities on SMEs to adopt the CCS, knowledge of the key considerations to adopt the CCS is very limited. We use the technology-organization-environment (TOE) framework to suggest that a strategic and incremental intent, understanding the organizational structure and culture, understanding the external factors, and consideration of the human resource capacity can contribute to sustainable business value from CCS. Using survey data, we find evidence of a positive association between these considerations and the CCS-related business objectives. We also find evidence of positive association between the CCS-related business objectives and CCS-related financial objectives. The results suggest that the proposed considerations can ensure sustainable business value from the CCS. This study provides guidance to SMEs on a path to adopting the CCS with the intention of a long-term commitment and achieving sustainable business value from these services.

Governing cloud computing services: Reconsideration of IT governance structures

There is an increase in the uptake of cloud computing services (CCS). CCS is adopted in the form of a utility, and it incorporates business risks of the service providers and intermediaries. Thus, the adoption of CCS will change the risk profile of an organization. In this situation, organizations need to develop competencies by reconsidering their IT governance structures to achieve a desired level of IT-business alignment and maintain their risk appetite to source business value from CCS. We use the resource-based theories to suggest that collaborative board oversight of CCS, competencies relating to CCS information and financial management, and a CCS-related continuous audit program can contribute to business process performance improvements and overall firm performance. Using survey data, we find evidence of a positive association between these IT governance considerations and business process performance. We also find evidence of positive association between business process performance improvements and overall firm performance. The results suggest that the suggested considerations on IT governance structures can contribute to CCS-related IT-business alignment and lead to anticipated business value from CCS. This study provides guidance to organizations on competencies required to secure business value from CCS.

Transcending disciplinary, cultural and national boundaries: Emergent technologies, new education landscape and the cloud workshop project

As technology continues to become more accessible, miniaturised and diffused into the environment, the potential of wearable technology to impact our lives in significant ways becomes increasingly viable. Wearables afford unique interaction, communication and functional capabilities between users, their environment as well as access to information and digital data. Wearables also demand an inter-disciplinary approach and, depending on the purpose, can be fashioned to transcend cultural, national and spatial boundaries. This paper presents the Cloud Workshop project based on the theme of ‘Wearables and Wellbeing; Enriching connections between citizens in the Asia-Pacific region’, initiated through a cooperative partnership between Queensland University of Technology (QUT), Hong Kong Baptist University (HKBU) and Griffith University (GU). The project was unique due to its inter-disciplinary, inter-cultural and inter-national scope that occurred simultaneously between Australia and Hong Kong.

Rationing in healthcare

Rationing healthcare in some form is inevitable, even in wealthy countries, because resources are scarce and demand for healthcare is always likely to exceed supply. This means that decision-makers must make choices about which health programs and initiatives should receive public funding and which ones should not. These choices are often difficult to make, particularly in Australia, because: - 1 Make explicit rationing based on a national decision-making tool (such as Multi-criteria Decision Analysis) standard process in all jurisdictions. - 2 Develop nationally consistent methods for conducting economic evaluation in health so that good quality evidence on the relative efficiency of various programs and initiatives is generated. - 3 Generate more economic evaluation evidence to inform rationing decisions. - 4 Revise national health performance indicators so that they include true health system efficiency indicators, such as cost-effectiveness. - 5 Apply the Comprehensive Management Framework used to evaluate items on the Medicare Benefits Schedule (MBS) to the Pharmaceutical Benefits Scheme (PBS) and the Prosthesis List to accelerate disinvestment from low-value drugs and prostheses. - 6 Seek agreement among Commonwealth, state and territory governments to work together to undertake work similar to the National Institute for Health and Care Excellence in the United Kingdom and the Canadian Agency for Drugs and Technologies in Health.

Making decisions about antibiotic use in the Australian primary healthcare sector

Background Australia has one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for self-resolving conditions. We need to better understand what drives general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill repeat antibiotic prescriptions. It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. This project investigates what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and how these individuals discount the future. Methods Factors will be gleaned from published literature and from semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future. Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing how key messages and public health campaigns are crafted, and clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

Rainfall changes over tropical montane cloud forests of southern Western Ghats, India

The southern Western Ghats tropical montane cloud forest sites (Gavi, Periyar, High wavys and Venniyar), which are characterized by frequent or seasonal cloud cover at the vegetation level, are considered one of the most threatened ecosystems in India and the world. Three out of four montane cloud forest sites studied in the southern Western Ghats had experienced diminishing trends of seasonal average and total rainfall, especially during summer monsoon season. The highest level of reduction for summer monsoon season was observed at Gavi rainforest station (>20 mm/14 years) in Kerala followed by Venniyar (>20 mm/20 years) site in Tamil Nadu. Average annual and total precipitation increased during the study period irrespective of the seasons over Periyar area, and the greatest values were recorded for season 2 (>25 mm/28 years). Positive trends for winter monsoon rainfall has been observed for three stations (Periyar, High wavys and Venniyar) except Gavi, and the trend was positive and significant (90%) for Periyar and High wavys. Increase in summer monsoon rainfall was observed for Periyar site and the trend was found to be significant (95%).

A cloud-based intelligent computing system for contextual exploration on personal sleep-tracking data using association rule mining

With the development of wearable and mobile computing technology, more and more people start using sleep-tracking tools to collect personal sleep data on a daily basis aiming at understanding and improving their sleep. While sleep quality is influenced by many factors in a person’s lifestyle context, such as exercise, diet and steps walked, existing tools simply visualize sleep data per se on a dashboard rather than analyse those data in combination with contextual factors. Hence many people find it difficult to make sense of their sleep data. In this paper, we present a cloud-based intelligent computing system named SleepExplorer that incorporates sleep domain knowledge and association rule mining for automated analysis on personal sleep data in light of contextual factors. Experiments show that the same contextual factors can play a distinct role in sleep of different people, and SleepExplorer could help users discover factors that are most relevant to their personal sleep.

Healthcare-Associated Infections in Pediatrics

Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery. The studies were carried out at the Hospital for Children and Adolescents of Helsinki University Central Hospital. Epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined and they were genotyped. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for the patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs in these patients. During 1999-2006, the overall annual BSI rate was 1.6/1,000 patient days (range by year, 1.2–2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. The NICU was overcrowded during the S. marcescens clusters. A negative correlation between C. parapsilosis BSIs and fluconazole use in the NICU was detected, and the isolates derived from a single initially susceptible strain became less susceptible to fluconazole over time. Eighty postoperative HAIs, including all severe infections, were detected during hospitalization after open-heart surgery; 34% of those HAIs were SSIs and 25% were BSIs. The postdischarge study found 65 infections that were likely to be associated with hospitalization. The majority (89%) of them were viral respiratory or gastrointestinal infections, and these often led to rehospitalizations. The annual hospital-wide BSI rates were stable, and the significant variation detected in some units could not be seen in overall rates. Further studies with data adequately adjusted for risk factors are needed to assess BSI rates in the patient groups with the highest rates (hematology, neonatology). The outbreak investigations showed that horizontal transmission was common in the NICU. Overcrowding and lapses in hand hygiene probably contributed to the spreading of the pathogens. Following long-term use of fluconazole in the NICU, resistance to fluconazole developed in C. parapsilosis. Almost one-fourth of the patients who underwent open-heart surgery acquired at least one HAI. All severe HAIs were detected during hospitalization. The postdischarge study found numerous viral infections, which often caused rehospitalization.

Aerosol size distribution and its connection to cloud droplet number concentration

In order to predict the current state and future development of Earth s climate, detailed information on atmospheric aerosols and aerosol-cloud-interactions is required. Furthermore, these interactions need to be expressed in such a way that they can be represented in large-scale climate models. The largest uncertainties in the estimate of radiative forcing on the present day climate are related to the direct and indirect effects of aerosol. In this work aerosol properties were studied at Pallas and Utö in Finland, and at Mount Waliguan in Western China. Approximately two years of data from each site were analyzed. In addition to this, data from two intensive measurement campaigns at Pallas were used. The measurements at Mount Waliguan were the first long term aerosol particle number concentration and size distribution measurements conducted in this region. They revealed that the number concentration of aerosol particles at Mount Waliguan were much higher than those measured at similar altitudes in other parts of the world. The particles were concentrated in the Aitken size range indicating that they were produced within a couple of days prior to reaching the site, rather than being transported over thousands of kilometers. Aerosol partitioning between cloud droplets and cloud interstitial particles was studied at Pallas during the two measurement campaigns, First Pallas Cloud Experiment (First PaCE) and Second Pallas Cloud Experiment (Second PaCE). The method of using two differential mobility particle sizers (DMPS) to calculate the number concentration of activated particles was found to agree well with direct measurements of cloud droplet. Several parameters important in cloud droplet activation were found to depend strongly on the air mass history. The effects of these parameters partially cancelled out each other. Aerosol number-to-volume concentration ratio was studied at all three sites using data sets with long time-series. The ratio was found to vary more than in earlier studies, but less than either aerosol particle number concentration or volume concentration alone. Both air mass dependency and seasonal pattern were found at Pallas and Utö, but only seasonal pattern at Mount Waliguan. The number-to-volume concentration ratio was found to follow the seasonal temperature pattern well at all three sites. A new parameterization for partitioning between cloud droplets and cloud interstitial particles was developed. The parameterization uses aerosol particle number-to-volume concentration ratio and aerosol particle volume concentration as the only information on the aerosol number and size distribution. The new parameterization is computationally more efficient than the more detailed parameterizations currently in use, but the accuracy of the new parameterization was slightly lower. The new parameterization was also compared to directly observed cloud droplet number concentration data, and a good agreement was found.

Understanding data flow and security requirements in wireless Body Area Networks for healthcare

The Body Area Network (BAN) is an emerging technology that focuses on monitoring physiological data in, on and around the human body. BAN technology permits wearable and implanted sensors to collect vital data about the human body and transmit it to other nodes via low-energy communication. In this paper, we investigate interactions in terms of data flows between parties involved in BANs under four different scenarios targeting outdoor and indoor medical environments: hospital, home, emergency and open areas. Based on these scenarios, we identify data flow requirements between BAN elements such as sensors and control units (CUs) and parties involved in BANs such as the patient, doctors, nurses and relatives. Identified requirements are used to generate BAN data flow models. Petri Nets (PNs) are used as the formal modelling language. We check the validity of the models and compare them with the existing related work. Finally, using the models, we identify communication and security requirements based on the most common active and passive attack scenarios.