Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Exploring the role of energy, trade and financial development in explaining economic growth in South Africa: A revisit

South Africa is an emerging and industrializing economy which is experiencing remarkable progress. We contend that amidst the developments in the economy, the role of energy, trade openness and financial development are critical. In this article, we revisit the pivotal role of these factors. We use the ARDL bounds [72], the Bayer and Hanck [11] cointegration techniques, and an extended Cobb–Douglas framework, to examine the long-run association with output per worker over the sample period 1971–2011. The results support long-run association between output per worker, capital per worker and the shift parameters. The short-run elasticity coefficients are as follows: energy (0.24), trade (0.07), financial development (−0.03). In the long-run, the elasticity coefficients are: trade openness (0.05), energy (0.29), and financial development (−0.04). In both the short-run and the long-run, we note the post-2000 period has a marginal positive effect on the economy. The Toda and Yamamoto [91] Granger causality results show that a unidirectional causality from capital stock and energy consumption to output; and from capital stock to trade openness; a bidirectional causality between trade openness and output; and absence (neutrality) of any causality between financial development and output thus indicating that these two variables evolve independent of each other.

How Australian construction contractors responded to the economic downturn

The Global Financial Crisis (GFC) in 2008 had a significant impact on the world economy and the construction industry was no exception. This study investigates the major impacts of the 2008 GFC on the Australian construction industry and, in particular how the Australian construction contractors responded to the economic downturn. A total of 35 senior managers from the Top 100 Australian construction companies were interviewed. The findings indicate that construction companies, particularly the large ones were not affected in any significant way but are expecting some difficult financial times over the next few years and are taking actions to minimize the upcoming adverse impacts. The most common strategy adopted by Australian construction contractors is to concentrate on core business while avoiding aimless bidding. Similarly, great focus is placed on retaining human resources in order to maintain the skill set so that the company can respond quickly when market conditions improves. The research findings will provide construction contractors with insights on how to establish and sustain competitive advantages during economic slowdown and become more resilient in the future.

Cycling for transport and recreation: Associations with the socio-economic, natural and built environment

This study examined associations between objective environmental attributes and, separately, transport (TC) and recreational cycling (RC). Environmental attributes were more strongly associated with TC than RC. Distances to areas with the best bicycle infrastructure and urban amenities may be key environmental factors influencing TC but not RC. Government investments in bicycle infrastructure within inner Brisbane appear to have resulted in more TC than in outer areas and to appeal to residents of both the most and least disadvantaged neighbourhoods. Extending this infrastructure to residents living in disadvantaged and advantaged neighbourhoods outside the CBD could expand TC participation.

Crowdfunding and independent screen content production in Australia: A direct economic relationship between producer and audience

This thesis examines the significance of crowdfunding for Australian filmmakers and provides an empirical basis to current claims about the role of crowdfunding in the film production and policy sectors. It has found that crowdfunding is a small but growing source of supplementary finance which is opening up new possibilities for Australian independent screen content producers. This project also highlights the discussion within Australian film policy circles that is opening the way for crowdfunding to potentially become a larger and more formalised component of current and emerging policy initiatives.

Neighborhood diversity, economic health and the role of the arts

Policymakers pursue a range of strategies aimed at diversifying neighborhoods despite research indicating the complicated and potentially damaging results of these efforts. One increasingly common approach is to incorporate the arts into planning efforts in the hope of enhancing diversity and catalyzing positive neighborhood change. Using data from the Cultural Data Project, we determine where newly established New York City art organizations locate in terms of neighborhood racial, income and industry diversity. We then analyze how diverse contexts interact with an arts presence to impact neighborhood economic health over time. We find that neighborhoods with high levels of racial diversity and low levels of income and industry diversity benefit most from an arts presence. However, the arts are attracted predominately to neighborhoods with moderate levels of racial diversity and high levels of income and industry diversity. This complicates the use of the arts as a tool in urban revitalization policy.

Effective Use in Livestock Feeds of Mouldy and Weather-damaged Grain Containing Mycotoxins-Case Histories and Economic Assessments Pertaining to Pig and Poultry Industries of Queensland

Mould growth in field crops or stored grain reduces starch and lipid content, with consequent increases in fibre, and an overall reduction in digestible energy; palatability is often adversely affected. If these factors are allowed for, and mycotoxin concentrations are low, there are sound economic reasons for using this cheaper grain. Mycotoxins are common in stock feed but their effects on animal productivity are usually slight because either the concentration is too low or the animal is tolerant to the toxin. In Australia, aflatoxins occur in peanut by-products and in maize and sorghum if the grain is moist when stored. Zearalenone is found in maize and in sorghum and wheat in wetter regions. Nivalenol and deoxynivalenol are found in maize and wheat but at concentrations that rarely affect pigs, with chickens and cattle being even more tolerant. Other mycotoxins including cyclopiazonic acid, T-2 toxin, cytochalasins and tenuazonic acid are produced by Australian fungi in culture but are not found to be significant grain contaminants. Extremely mouldy sorghum containing Alternaria and Fusarium mycotoxins decreased feed conversion in pigs and chickens by up to 14%. However, E moniliforme- and Diplodia maydis-infected maize produced only slight reductions in feed intake by pigs and Ustilago- infected barley produced no ill effects. Use of these grains would substantially increase profits if the grain can be purchased cheaply.

Economic analyses of options for weedy Sporobolus grass management

Weedy Sporobolus grasses have low palatability for livestock, with infestations reducing land condition and pastoral productivity. Control and containment options are available, but the cost of weed control is high relative to the extra return from livestock, thus, limiting private investment. This paper outlines a process for analysing the economic consequences of alternative management options for weedy Sporobolus grasses. This process is applicable to other weeds and other pastoral degradation or development issues. Using a case study property, three scenarios were developed. Each scenario compared two alternative management options and was analysed using discounted cash flow analysis. Two of the scenarios were based on infested properties and one scenario was based on a currently uninfested property but highly likely to become infested without active containment measures preventing weed seed transport and seedling establishment. The analysis highlighted why particular weedy Sporobolus grass management options may not be financially feasible for the landholder with the infestation. However, at the regional scale, the management options may be highly worthwhile due to a reduction in weed seed movement and new weed invasions. Therefore, to encourage investment by landholders in weedy Sporobolus grass management the investment of public money on behalf of landholders with non-infested properties should be considered.

An effective, economic way of monitoring menstrual cycle hormones in at risk female athletes

PURPOSE: Female athletes, in response to intensive training, competition stress and a lean, athletic physique, are at increased risk of altered hypothalamic-pituitary ovarian (HPO) axis function associated with menstrual cycle disturbance and reduced secretion of the ovarian hormones estrogen and progesterone. Because there is evidence suggesting possible detrimental effects on skeletal health associated with deficiencies in these hormones, a suitable means to asses ovarian hormone concentrations in at risk athletes is needed. The aim of this study was to evaluate a simple, economical means to monitor the ovarian hormone production in athletes, in the setting of intensive training. METHODS: Subjects comprised 14 adolescent rowers, 12 lightweight rowers, and two groups of 10 matched control subjects. Ovarian function was monitored during the competition season by estimation of urinary excretion of estrone glucuronide (E1G) and pregnanediol glucuronide (PdG), enabling the menstrual cycles to be classified as ovulatory or anovulatory. RESULTS: Results indicated 35% and 75% of schoolgirl and lightweight rowers had anovulatory menstrual cycles, respectively. These findings were highlighted by significantly lower excretion of E1G and PdG during phases of intensive training in both the lightweight and schoolgirl rowers, compared with the control subjects. CONCLUSION: It was concluded that the urinary E1G and PdG assays were an effective means to assess the influence of intense training on ovarian hormone concentrations in at risk athletes. It is recommended that this technique be applied more widely as a means of early detection of athletes with low estrogen and progesterone levels, in an attempt to avoid detrimental influences on skeletal health.

A survey of management and economic impact of weeds in dryland cotton cropping systems of subtropical Australia

In dryland cotton cropping systems, the main weeds and effectiveness of management practices were identified, and the economic impact of weeds was estimated using information collected in a postal and a field survey of Southern Queensland and northern New South Wales. Forty-eight completed questionnaires were returned, and 32 paddocks were monitored in early and late summer for weed species and density. The main problem weeds were bladder ketmia (Hibiscus trionum), common sowthistle (Sonchus oleraceus), barnyard grasses (Echinochloa spp.), liverseed grass (Urochloa panicoides) and black bindweed (Fallopia convolvulus), but the relative importance of these differed with crops, fallows and crop rotations. The weed flora was diverse with 54 genera identified in the field survey. Control of weed growth in rotational crops and fallows depended largely on herbicides, particularly glyphosate in fallow and atrazine in sorghum, although effective control was not consistently achieved. Weed control in dryland cotton involved numerous combinations of selective herbicides, several non-selective herbicides, inter-row cultivation and some manual chipping. Despite this, residual weeds were found at 38-59% of initial densities in about 3-quarters of the survey paddocks. The on-farm financial costs of weeds ranged from $148 to 224/ha.year depending on the rotation, resulting in an estimated annual economic cost of $19.6 million. The approach of managing weed populations across the whole cropping system needs wider adoption to reduce the weed pressure in dryland cotton and the economic impact of weeds in the long term. Strategies that optimise herbicide performance and minimise return of weed seed to the soil are needed. Data from the surveys provide direction for research to improve weed management in this cropping system. The economic framework provides a valuable measure of evaluating likely future returns from technologies or weed management improvements.

Fundamental Principles and Rights At Work: Value, Viability, Incidence and Importance as Elements For Economic Progress and Social Justice

Working Paper prepared for the ILO by Maria Luz Vega Ruiz and Daniel Martinez, focusing on the rights at work in Latin America and the Caribbean.

Economic analyses and policy implications for microalgae biofuels in Australia

The benefits of microalgae biofuels over first and second generation counterparts suggest it has potential as a major biofuel feedstock in Australia. However, the high costs of cultivation and processing has been a major drawback for investors and policymakers. This presentation outlines the economic potential for microalgae biofuels: firstly, through production of microalgae co-products (e.g feed and fertiliser); and secondly, deriving what consumers are willing to pay for microalgae biofuels based on external benefits. These findings will assist decision-makers in both private and public sectors and inform policy development with respect to microalgae as a feedstock for biofuels and other products. This study adds an economics perspective to the current technical literature which has been dominated by biochemical, engineering and financial valuation studies.