Cost effectiveness of osseointegration

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. [1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland, in particular, have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on biomechanics aspects as well as the clinical benefits and safety of the procedure. [16-25] In principle, bone-anchored prostheses should eliminate lifetime expenses associated with sockets and, consequently, potentially alleviate the financial burden of amputation for governmental organizations. Sadly, publications focusing on cost-effectiveness are sparse. In fact, only one study published by Haggstrom et al (2012), reported that “despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses”.[26] Consequently, governmental organizations such as Queensland Artificial Limb Services (QALS) are facing a number of challenges while adjusting financial assistance schemes that should be fair and equitable to their clients fitted with bone-anchored prostheses. Clearly, more scientific evidence extracted from governmental databases is needed to further consolidate the analyses of financial burden associated with both methods of attachment (i.e., conventional sockets prostheses, bone-anchored prostheses). The purposes of the presentation will be: 1. To outline methodological avenues to assess the cost-effectiveness of bone-anchored prostheses compared to conventional sockets prostheses, 2. To highlight the potential obstacles and limitations in cost-effectiveness analyses of bone-anchored prostheses, 3. To present preliminary results of a cost-comparison analysis focusing on the comparison of the costs expressed in dollars over QALS funding cycles for both methods of attachment.

Evaluation framework to assess benefits and harms of bone-anchored prosthesis

Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb compared to socket-suspended prostheses. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. Clearly, the current momentum experienced worldwide is creating a need for a standardized evaluation framework to assess the benefits and safety of each procedure.

Preliminary analysis of self-report questionnaire with young drivers in Oman. Fourth report of the novice driver safety research in Oman project for the Research Council of Oman

This report document the recent progress (current as of December 2014) of the research project investigating novice driver safety in Oman. Included in this report is a summary of progress with publications to date, as well as description of the preliminary results of the first phase of the quantitative survey with young drivers. With regards to the publications which have resulted from this research, two journal articles have been published in print, one is under review, and a fourth is in the late stages of development for submission...

Assessing acculturation over time: A four-year prospective study of Asian American young adults

Acculturation is commonly defined as a dynamic and multidimensional process in which individuals and groups change over time when coming into contact with another culture. Despite the emphasis on acculturation as a process of change over time, few researchers have directly assessed this hypothesis. The current study first identifies and then examines "stable" and "dynamic" dimensions of acculturation within a 4-year prospective study of 433 first- and second-generation Chinese- and Korean-American college students. Separate growth model analyses revealed significant linear change for first-generation students toward greater U.S. acculturation. In comparison, tests of linear and quadratic change for second-generation students were not significant. When stratifying by gender, acculturation increased for women but there was no significant change in acculturation for men. While all students reported increases in alcohol consumption over the study period, changes in acculturation predicted changes in alcohol consumption only for women. Chinese men showed greater increases in alcohol consumption than Korean men but there was no effect for ethnicity among women. There was significant individual variability in the models, which underscores the importance of examining change prospectively through within and between person analyses. The findings highlight the importance of examining acculturation changes over time for different migrant groups with implications for further development of acculturation measures, research methodologies, and health interventions. More prospective research designs of acculturation are needed to examine changes in health behavior and overall adaptation across migrant groups at varying stages of development.

Encouraging Generosity: The Practice and organization of Fundraising Across Nations

The international collaboration in this book creates a unique opportunity to establish, discuss and draw conclusions about fundraising across nations. Based on the 26-country dataset provided by the authors in this volume, this chapter describes and analyzes for the first time the diverse fundraising environments around the world that are shaped by different historical, cultural, social, religious, political and economic conditions. It begins by noting the lack of research on fundraisers and fundraising in contrast to the extensive studies undertaken of donors, and argues that the demand side of charitable transactions is worthy of greater attention if a complete and dynamic understanding of giving is to be achieved. It then presents and discusses key themes related to fundraising in the countries represented in this book. A typology is suggested to impose order on the huge variety of fundraising approaches and stages of development in the organization of this activity around the world; this typology also strengthens understanding of the connection between asking and giving. After offering suggestions for future research in this area of study, the chapter ends by noting that despite global differences in the evolution of fundraising as a profession and the diversity of current contexts, fundraisers in every country face shared challenges that would benefit from greater exchange of knowledge and best practices.

Rehabilitation of individuals with bone-anchored prosthesis: State-of-the-art and challenges

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US.[1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland in particular have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on fragmented biomechanics aspects as well as the clinical benefits and safety of the procedure. However, very few publications have synthetized this information and provided an overview of the current developments in bone-anchored prostheses worldwide, let alone in Australia. The purposes of the presentation will be: 1. To provide an overview of the state-of-art developments in bone-anchored prostheses with as strong emphasis on the design of fixations, treatment, benefits, risks as well as future opportunities and challenges, 2. To present the current international developments of procedures for bone-anchored prostheses in terms of numbers of centers, number of cases and typical case-mix, 3. To highlight the current role Australia is playing as a leader worldwide in terms of growing population, broadest range of case-mix, choices of fixations, development of reimbursement schemes, unique clinical outcome registry for evidence-based practice, cutting-edge research, consumer demand and general public interest.

Cost-effectiveness of bone-anchored prosthesis: the Queensland experience

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. [1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland, in particular, have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on biomechanics aspects as well as the clinical benefits and safety of the procedure. In principle, bone-anchored prostheses should eliminate lifetime expenses associated with sockets and, consequently, potentially alleviate the financial burden of amputation for governmental organizations. Unfortunately, publications focusing on cost-effectiveness are sparse. In fact, only one study published by Haggstrom et al (2012), reported that “despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses”. Consequently, governmental organizations such as Queensland Artificial Limb Services (QALS) are facing a number of challenges while adjusting financial assistance schemes that should be fair and equitable to their clients fitted with bone-anchored prostheses. Clearly, more scientific evidence extracted from governmental databases is needed to further consolidate the analyses of financial burden associated with both methods of attachment (i.e., conventional sockets prostheses, bone-anchored prostheses). The purpose of the presentation will be to share the current outcomes of a cost-analysis study lead by QALS. The specific objectives will be: • To outline methodological avenues to assess the cost-effectiveness of bone-anchored prostheses compared to conventional sockets prostheses, • To highlight the potential obstacles and limitations in cost-effectiveness analyses of bone-anchored prostheses, • To present cohort results of a cost-effectiveness (QALY vs cost) including the determination of fair Incremental cost-effectiveness Ratios (ICER) as well as cost-benefit analysis focusing on the comparing costs and key outcome indicators (e.g., QTFA, TUG, 6MWT, activities of daily living) over QALS funding cycles for both methods of attachment.

Flow of metal into the flash gap in the last stages of a plane-strain closed-die forging operation

In closed-die forging the flash geometry should be such as to ensure that the cavity is completely filled just as the two dies come into contact at the parting plane. If metal is caused to extrude through the flash gap as the dies approach the point of contact — a practice generally resorted to as a means of ensuring complete filling — dies are unnecessarily stressed in a high-stress regime (as the flash is quite thin and possibly cooled by then), which reduces the die life and unnecessarily increases the energy requirement of the operation. It is therefore necessary to carefully determine the dimensions of the flash land and flash thickness — the two parameters, apart from friction at the land, which control the lateral flow. The dimensions should be such that the flow into the longitudinal cavity is controlled throughout the operation, ensuring complete filling just as the dies touch at the parting plane. The design of the flash must be related to the shape and size of the forging cavity as the control of flow has to be exercised throughout the operation: it is possible to do this if the mechanics of how the lateral extrusion into the flash takes place is understood for specific cavity shapes and sizes. The work reported here is part of an ongoing programme investigating flow in closed-die forging. A simple closed shape (no longitudinal flow) which may correspond to the last stages of a real forging operation is analysed using the stress equilibrium approach. Metal from the cavity (flange) flows into the flash by shearing in the cavity in one of the three modes considered here: for a given cavity the mode with the least energy requirement is assumed to be the most realistic. On this basis a map has been developed which, given the depth and width of the cavity as well as the flash thickness, will tell the designer of the most likely mode (of the three modes considered) in which metal in the cavity will shear and then flow into the flash gap. The results of limited set of experiments, reported herein, validate this method of selecting the optimum model of flow into the flash gap.

Recruitment and loss of juvenile stages of Helicoverpa spp. (Lepidoptera: Noctuidae) on contaminant plants in chickpea crops

The hypothesis that contaminant plants growing amongst chickpea serve as Helicoverpa sinks by diverting oviposition pressure away from the main crop was tested under field conditions. Gain (recruitment) and loss (presumed mortality) of juvenile stages of Helicoverpa spp. on contaminant faba bean and wheat plants growing in chickpea plots were quantified on a daily basis over a 12-d period. The possibility of posteclosion movement of larvae from the contaminants to the surrounding chickpea crop was examined. Estimated total loss of the census population varied from 80 to 84% across plots and rows. The loss of brown eggs (40–47%) contributed most to the overall loss estimate, followed by loss of white eggs (27–35%) and larvae (6–9%). The cumulative number of individuals entering the white and brown egg and larval stages over the census period ranged from 15 to 58, 10–48 and 1–6 per m row, respectively. The corresponding estimates of mean stage-specific loss, expressed as a percentage of individuals entering the stage, ranged from 52 to 57% for white eggs, 87–108% for brown eggs and 71–87% for first-instar larvae. Mean larval density on chickpea plants in close proximity to the contaminant plants did not exceed the baseline larval density on chickpea further away from the contaminants across rows and plots. The results support the hypothesis that contaminant plants in chickpea plots serve as Helicoverpa sinks by diverting egg pressure from the main crop and elevating mortality of juvenile stages. Deliberate contamination of chickpea crops with other plant species merits further investigation as a cultural pest management strategy for Helicoverpa spp.

Antibody response against endogenous stages of an attenuated strain of Eimeria tenella

The application of attenuated vaccines for the prevention of chicken coccidiosis has increased exponentially in recent years. In Eimeria infections, protective immunity is thought to rely on a strong cell mediated response with antibodies supposedly playing a minor role. However, under certain conditions antibodies seem to be significant in protection. Furthermore, antibodies could be useful for monitoring natural exposure of flocks to Eimeria spp. and for monitoring the infectivity of live vaccines. Our objective was to investigate the chicken antibody response to the different parasite lifecycle stages following infection with an attenuated strain of Eimeria tenella. Western blotting analysis of parasite antigens prepared from the lining of caeca infected with the attenuated strain of E. tenella revealed two dominant antigens of 32 and 34 kDa, apparently associated with trophozoites and merozoites that were present at high concentrations between 84 and 132 h post-infection. When cryosections of caeca infected with E. tenella were probed with IgY purified from immune birds the most intense reaction was observed with the asexual stages. Western blotting analysis of proteins of purified sporozoites and third generation merozoites and absorption of stage-specific antibodies from sera suggested that a large proportion of antigens is shared by the two stages. The time-courses of the antibody response to sporozoite and merozoite antigens were similar but varied depending on the inoculation regime and the degree of oocyst recirculation.

Boundaries in Action : An Activity-theoretical Study of Development, Learning, and Change in Health Care Organization for Patients with Multiple and Chronic Illnesses

This study examines boundaries in health care organizations. Boundaries are sometimes considered things to be avoided in everyday living. This study suggests that boundaries can be important temporally and spatially emerging locations of development, learning, and change in inter-organizational activity. Boundaries can act as mediators of cultural and social formations and practices. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of 26 patients with multiple and chronic illnesses was improved. The project used the Change Laboratory method that represents a research assisted method for developing work. The research questions of the study are: (1) What are the boundary dynamics of development, learning, and change in health care for patients with multiple and chronic illnesses? (2) How do individual patients experience boundaries in their health care? (3) How are the boundaries of health care constructed and reconstructed in social interaction? (4) What are the dynamics of boundary crossing in the experimentation with the new tools and new practice? The methodology of the study, the ethnography of the multi-organizational field of activity, draws on cultural-historical activity theory and anthropological methods. The ethnographic fieldwork involves multiple research techniques and a collaborative strategy for raising research data. The data of this study consists of observations, interviews, transcribed intervention sessions, and patients' health documents. According to the findings, the care of patients with multiple and chronic illnesses emerges as fragmented by divisions of a patient and professionals, specialties of medicine and levels of health care organization. These boundaries have a historical origin in the Finnish health care system. As an implication of these boundaries, patients frequently experience uncertainty and neglect in their care. However, the boundaries of a single patient were transformed in the Change Laboratory discussions among patients, professionals and researchers. In these discussions, the questioning of the prevailing boundaries was triggered by the observation of gaps in inter-organizational care. Transformation of the prevailing boundaries was achieved in implementation of the collaborative care agreement tool and the practice of negotiated care. However, the new tool and practice did not expand into general use during the project. The study identifies two complementary models for the development of health care organization in Finland. The 'care package model', which is based on productivity and process models adopted from engineering and the 'model of negotiated care', which is based on co-configuration and the public good.

Effect of foliar herbicides on the germination and viability of Siam weed (Chromolaena odorata) seeds located on plants at the time of application.

This paper reports a field study undertaken to determine if the foliar application of herbicides fluroxypyr (150 mL 100 L-1 a.i.) and metsulfuron-methyl (12 g 100 L-1 a.i.) were capable of reducing the germination and viability of Chromolaena odorata (L.) R.M.King & H.Rob. (Siam weed) seeds at three different stages of maturity. After foliar application of fluroxypyr germination of mature seeds was reduced by 88% and intermediate and immature seeds were reduced by 100%, compared to the control. Fluroxypyr also reduced the viability of mature, intermediate and immature seeds by 79, 89 and 67% respectively, compared to the control. Metsulfuron-methyl reduced germination of intermediate and immature seeds by 53 and 99% respectively compared to the control. Viability was also reduced by 74 and 96% respectively, compared to the control. Mature seeds were not affected by metsulfuron-methyl as germination and viability increased by 2% and 1% respectively, as compared to the control. These results show that these herbicides are capable of reducing the amount of viable seed entering the seed bank. However depending on the treatment and stage of seed development a percentage of seeds on the plants will remain viable and contribute to the seed bank. This information is of value to Siam weed eradication teams as plants are most easily located and subsequently treated at the time of flowering. Knowledge of the impact of control methods on seeds at various stages of development will help determine the most suitable chemical control option for a given situation.

The first five days: field and laboratory investigations during the early stages of the equine influenza outbreak in Australia, 2007.

Until August 2007, Australia was one of only three countries internationally recognised to be free of equine influenza (EI). This report documents the diagnosis of the first cases of EI in Australian horses and summarises the investigations that took place over the next 5 days. During that time, a multifocal outbreak was identified across eastern New South Wales and south-eastern Queensland. The use of an influenza type A pan-reactive real-time reverse transcription polymerase chain reaction allowed rapid confirmation of suspect cases of EI.