Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings

Objectives:
To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation setting versus an alternative setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes.

Data Sources:
Electronic databases from the earliest possible date until May 2011. All languages were included.

Study Selection
Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation with an alternative. There were 29 included trials with 6746 participants.

Data Extraction
Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation.

Data Synthesis:
Results were synthesized using standardized mean differences (SMDs) and meta-analyses for the primary outcome of cost. The Grading of Recommendations Assessment, Development, and Evaluation was applied to assess for risk of bias across studies for meta-analyses. There was high-quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke (pooled SMD [δ]=−.28; 95% confidence interval [CI], −.47 to −.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients poststroke (δ=.31; 95% CI, .15–.48), with improvement to patient outcomes. These results were not replicated in 2 individual trials with a geriatric and a mixed cohort, where costs did not differ between general acute care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of a stroke or orthopedic population, reported less cost for an intensive inpatient rehabilitation program compared with usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses.

Conclusions:
Based on this systematic review and meta-analyses, a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients, inpatient rehabilitation may be the most cost-effective method of providing rehabilitation; yet, for other patients, rehabilitation in the home or community may be the most cost-effective model of care. To achieve cost-effective outcomes, the ideal combination of rehabilitation services and patient inclusion criteria, as well as further data for nonstroke populations, warrants further research.

Evaluation of management scenarios for controlling eutrophication in a shallow tropical urban lake

Urban lakes are typically smaller, shallower, and more exposed to human activities than natural lakes. Although the effects of harmful algal blooms (HABs) associated with eutrophication in urban lakes has become a growing concern for water resources management and environmental protection, studies focussing on this topic in relation to urban lakes are rare and knowledge of the ecological dynamics and effective management strategies for controlling eutrophication in urban lakes is lacking. This study applied an integrated three-dimensional hydrodynamics-ecological model for a small shallow tropical urban lake in Singapore and evaluated various management scenarios to control eutrophication in the lake. It is found that in-lake treatment techniques including artificial destratification, sediment manipulation and algaecide addition are either ineffective or possess environmental concerns; while watershed management strategies including hydraulic flushing and inflow nutrients reduction are more effective and have posed less environmental concerns. In this study, inflow phosphorus reduction was found to be the best strategy after evaluating the advantages and drawbacks of the management strategies studied. Runoff from the watershed exerts significant influence on urban lakes and thus an integrated water resources management at the watershed level is critical for the control of eutrophication

Evaluation of University of Queensland Library Spaces: three case studies at St Lucia Campus

Introduction: The paper reports on an evaluation study of spaces in the Social Sciences and Humanities (SSHL), Biological Sciences (BSL) and Walter Harrison Law (WHLL) Libraries of the University of Queensland (UQ). The study was part of an evaluation of the quality and patterns of use of spaces in UQ libraries, which aimed to propose recommendations for future improvements and decision-making. This paper presents a study of areas of weakness in existing SSHL spaces, and impacts of the refurbishment of spaces at BSL and WHLL on students’ experiences. The findings evidence a link between students’ learning experiences and the quality of library spaces.Methods: An online survey, “Students’ Experiences and Perceptions of Library Physical Spaces”, was designed to collect data from students. The survey questions addressed seven topics: (1) overall satisfaction with spaces in the UQ Libraries; (2) welcoming nature of the library entry; (3) lighting; (4) acoustics; (5) furniture; (6) wayfinding; and (7) preferences for different space types in the library.Results: 1505 students completed the surveys, with 1098 responses recorded to open-ended questions on why students visited the libraries and the physical characteristics of the spaces that influenced their experiences. Quantitative and qualitative analysis of the data elucidated key design challenges and considerations. In particular, the data suggested that the provision of individual quiet study spaces remains an important role of academic libraries, with Studying Alone identified as the most important reason for student visits.Conclusions: The findings highlight the importance of individual study spaces and propose a number of recommendations in relation to physical space design and management.Relevance: Academic libraries face the challenge to keep pace with change in relation to students’ demographics, pedagogy and technology. In doing so, it is important to have an understanding of the evolving patterns of students’ learning behaviours, space uses and preferences through ongoing evaluation of library spaces.

New palladium(II) complexes with pyrazole ligands Part II. Synthesis, spectral and thermal studies, and antitumor evaluation

This study describes the synthesis, IR, (1)H, and (13)C{(1)H} NMR spectroscopic as well the thermal characterization of the new palladium(II) pyrazolyl complexes [PdCl(2)(HmPz)(2)] 1, [PdBr(2)(HmPz)(2)] 2, [PdI(2)(HmPz)(2)] 3, [Pd(SCN)(2)(HmPz)(2)] 4 {HmPz = 4-methylpyrazole}. The residues of the thermal decomposition were identified as Pd(0) by X-ray powder diffraction. From the initial decomposition temperatures, the thermal stability of the complexes can be ordered in the sequence: 1 > 2 > 4 a parts per thousand 3. The cytotoxic activities of the complexes and the ligand were investigated against two murine cancer cell lines: mammary adenocarcinoma (LM3) and lung adenocarcinoma (LP07) and compared to cisplatin under the same experimental conditions.

New palladium(II) complexes with pyrazole ligands Part I. Synthesis, spectral and thermal studies, and antitumor evaluation

The pyrazole ligand 3,5-dimethyl-4-iodopyrazole (HdmIPz) has been used to obtain a series of palladium(II) complexes (1-4) of the type [PdX(2)(HdmIPz)(2)] {X = Cl(-) (1); Br(-) (2); I(-) (3); SCN(-) (4)}. All compounds have been isolated, purified, and characterized by means of elemental analysis, IR spectroscopy, (1)H and (13)C{(1)H}-NMR experiments, differential thermal analysis (DTA), and thermogravimetry (TG). The TG/DTA curves showed that the compounds released ligands in the temperature range 137-605 A degrees C, yielding metallic palladium as final residue. The complexes and the ligand together with cisplatin have been tested in vitro by MTT assay for their cytotoxicity against two murine cancer cell lines: mammary adenocarcinoma (LM3) and lung adenocarcinoma (LP07).

Pharmacological Evaluation and Preliminary Pharmacokinetics Studies of a New Diclofenac Prodrug without Gastric Ulceration Effect

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A quantitative and qualitative evaluation of reports of clinical trials published in six Brazilian dental journals indexed in the Scientific Electronic Library Online (SciELO)

Introduction: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals many of which provide open access to full-text articles. This library includes a number of dental journals some of which may include reports of clinical trials in English, Portuguese and/or Spanish. Thus, SciELO could play an important role as a source of evidence for dental healthcare interventions especially if it yields a sizeable number of high quality reports. Objective: The aim of this study was to identify reports of clinical trials by handsearching of dental journals that are accessible through SciELO, and to assess the overall quality of these reports. Material and methods: Electronic versions of six Brazilian dental Journals indexed in SciELO were handsearched at www.scielo.br in September 2008. Reports of clinical trials were identified and classified as controlled clinical trials (CCTs - prospective, experimental studies comparing 2 or more healthcare interventions in human beings) or randomized controlled trials (RCTs - a random allocation method is clearly reported), according to Cochrane eligibility criteria. Criteria to assess methodological quality included: method of randomization, concealment of treatment allocation, blinded outcome assessment, handling of withdrawals and losses and whether an intention-to-treat analysis had been carried out. Results: The search retrieved 33 CCTs and 43 RCTs. A majority of the reports provided no description of either the method of randomization (75.3%) or concealment of the allocation sequence (84.2%). Participants and outcome assessors were reported as blinded in only 31.2% of the reports. Withdrawals and losses were only clearly described in 6.5% of the reports and none mentioned an intention-to-treat analysis or any similar procedure. Conclusions: The results of this study indicate that a substantial number of reports of trials and systematic reviews are available in the dental journals listed in SciELO, and that these could provide valuable evidence for clinical decision making. However, it is clear that the quality of a number of these reports is of some concern and that improvement in the conduct and reporting of these trials could be achieved if authors adhered to internationally accepted guidelines, e. g. the CONSORT statement.

Evaluation of different protocols for anatomical studies in Parmeliaceae (lichenized Ascomycota)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of economic impact of external eauivalent models used in reactive OPF studies for interconnected systems

Reactive-optimisation procedures are responsible for the minimisation of online power losses in interconnected systems. These procedures are performed separately at each control centre and involve external network representations. If total losses can be minimised by the implementation of calculated local control actions, the entire system benefits economically, but such control actions generally result in a certain degree of inaccuracy, owing to errors in the modelling of the external system. Since these errors are inevitable, they must at least be maintained within tolerable limits by external-modelling approaches. Care must be taken to avoid unrealistic loss minimisation, as the local-control actions adopted can lead the system to points of operation which will be less economical for the interconnected system as a whole. The evaluation of the economic impact of the external modelling during reactive-optimisation procedures in interconnected systems, in terms of both the amount of losses and constraint violations, becomes important in this context. In the paper, an analytical approach is proposed for such an evaluation. Case studies using data from the Brazilian South-Southeast system (810 buses) have been carried out to compare two different external-modelling approaches, both derived from the equivalent-optimal-power-flow (EOPF) model. Results obtained show that, depending on the external-model representation adopted, the loss representation can be flawed. Results also suggest some modelling features that should be adopted in the EOPF model to enhance the economy of the overall system.

Evaluation of serological tests for the diagnosis of Neospora caninum infection in dogs: Optimization of cut off titers and inhibition studies of cross-reactivity with Toxoplasma gondii

Diagnosis of Neospora caninum infection in dogs is based on serological assays such as the indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assays (ELISA). This study evaluated two serological tests (IFAT and ELISA) for the detection of IgG antibodies to N. caninum in 300 serum samples of dogs through the optimization of cut off titers by using the two-graph receiveroperating characteristic (TG-ROC) curve. In addition, the identification of major cross-reactive antigens with Toxoplasma gondii was investigated by inhibition ELISA and immunoblotting (IB) assays. IFAT and ELISA results showed 74% agreement, with a good negative concordance (P-neg=0.83), but a poor positive concordance (P-pos=0.42). The great majority (86%) of sera with positive concordant results (IFAT+/ELISA+) recognized at least two out of three N. caninum immunodominant antigens, particularly the 29-32 and 35-37 kDa bands. Optimization of cut off titers in IFAT and ELISA was performed considering the reactivity to at least two out of three N. caninum immunodominant antigens as infection markers, obtaining a titer of 50 for IFAT and 200 for ELISA. Seropositivity to N. caninuin was significantly associated with T gondii-seropositive samples, particularly in ELISA (55.4%). Inhibition ELISA curves for N. caninum showed a partial heterologous inhibition, indicating some degree of cross-reactivity between N. caninum and T gondii antigens. Inhibition IB assays showed a moderate heterologous inhibition for N. caninum antigens above 45-50 kDa. These results indicate that ELISA should be used critically when crude tachyzoite antigen preparations are employed, due to possible cross-reactivity with other related parasites as T gondii. Also, the cut off dilution of 1:50 in IFAT showed to be the most appropriated for N. caninum serology in dogs. Therefore, we suggest that N. caninum immunodominant antigens, specially the 17 and 29-32 kDa proteins, should be selected markers in serological assays for canine neosporosis. (c) 2006 Elsevier B.V. All rights reserved.

Recommended Guidelines for the Conduct and Evaluation of Prognostic Studies in Veterinary Oncology

There is an increasing need for more accurate prognostic and predictive markers in veterinary oncology because of an increasing number of treatment options, the increased financial costs associated with treatment, and the emotional stress experienced by owners in association with the disease and its treatment. Numerous studies have evaluated potential prognostic and predictive markers for veterinary neoplastic diseases, but there are no established guidelines or standards for the conduct and reporting of prognostic studies in veterinary medicine. This lack of standardization has made the evaluation and comparison of studies difficult. Most important, translating these results to clinical applications is problematic. To address this issue, the American College of Veterinary Pathologists' Oncology Committee organized an initiative to establish guidelines for the conduct and reporting of prognostic studies in veterinary oncology. The goal of this initiative is to increase the quality and standardization of veterinary prognostic studies to facilitate independent evaluation, validation, comparison, and implementation of study results. This article represents a consensus statement on the conduct and reporting of prognostic studies in veterinary oncology from veterinary pathologists and oncologists from around the world. These guidelines should be considered a recommendation based on the current state of knowledge in the field, and they will need to be continually reevaluated and revised as the field of veterinary oncology continues to progress. As mentioned, these guidelines were developed through an initiative of the American College of Veterinary Pathologists' Oncology Committee, and they have been reviewed and endorsed by the World Small Animal Veterinary Association.

Evaluation of two genera of benthic foraminifera for down-core paleotemperature studies in the western south atlantic

Neste estudo, compara-se a composição de isótopos de oxigênio de dois gêneros de foraminíferos bentônicos (Uvigerina e Cibicidoides) de amostras de topo de testemunho com a composição isotópica moderna da água do mar (d¹⁸O). Baseados em uma nova relação entre d¹⁸O e salinidade para a latitude média do Atlântico Sul ocidental, estimou-se a composição isotópica da calcita em equilíbrio (d¹⁸O_eq) a partir de duas equações diferentes: (1) O'Neil et al. (1969), modificada por McCorkle et al. (1997) e (2) Kim & O'Neil (1997). Utilizando (1), a pequena diferença entre d¹⁸O_eq e d¹⁸O de Uvigerina sugere que este gênero precipita as suas testas próximo ao equilíbrio com a água. Já os dados de d¹⁸O de Cibicidoides são 0,82 ‰ menores que a composição isotópica prevista. Ao contrário, utilizando (2) os dados de d¹⁸O de Cibicidoides mostram uma concordância excelente com a composição isotópica esperada, enquanto que os dados de d¹⁸O de Uvigerina são 0,69 ‰ maiores que os valores de equilíbrio previstos. A partir das evidências apresentadas neste trabalho e em estudos prévios sugerimos a utilização do gênero Cibicidoides e a aplicação da equação de Kim & O'Neil (1997) para pesquisas de paleotemperatura. Na ausência de suficientes espécimens de Cibicidoides sugerimos a utilização de d¹⁸O deUvigerina aplicando um fator de correção de -0,69 ‰.

New strategies for planning and performance evaluation of wireless networks: case studies based on the cross-layer approach

The use of wireless local area networks, called WLANs, as well as the proliferation of the use of multimedia applications have grown rapidly in recent years. Some factors affect the quality of service (QoS) received by the user and interference is one of them. This work presents strategies for planning and performance evaluation through an empirical study of the QoS parameters of a voice over Internet Protocol (VoIP) application in an interference network, as well as the relevance in the design of wireless networks to determine the coverage area of an access point, taking into account several parameters such as power, jitter, packet loss, delay, and PMOS. Another strategy is based on a hybrid approach that considers measuring and Bayesian inference applied to wireless networks, taking into consideration QoS parameters. The models take into account a cross layer vision of networks, correlating aspects of the physical environment, on the signal propagation (power or distance) with aspects of VoIP applications (e.g., jitter and packet loss). Case studies were carried out for two indoor environments and two outdoor environments, one of them displaying main characteristics of the Amazon region (e.g., densely arboreous environments). This last test bed was carried out in a real system because the Government of the State of Pará has a digital inclusion program called NAVEGAPARÁ.