Cost-effectiveness of an intervention to reduce emergency re-admissions to hospital among older patients

Background. The objective is to estimate the cost-effectiveness of an intervention that reduces hospital readmission among older people at high risk. A cost-effectiveness model to estimate the costs and health benefits of the intervention was implemented. Methodology/Principal Findings. The model used data from a randomised controlled trial conducted in an Australian tertiary metropolitan hospital. Participants were acute medical admissions aged >65 years with at least one risk factor for readmission: multiple comorbidities, impaired functionality, aged >75 years, 30 recent multiple admissions, poor social support, history of depression. The intervention was a comprehensive nursing and physiotherapy assessment and an individually tailored program of exercise strategies and nurse home visits with telephone follow-up; commencing in hospital and continuing following discharge for 24 weeks. The change to cost outcomes, including the costs of implementing the intervention and all subsequent use of health care services, and, the change to health benefits, represented by quality adjusted life years, were estimated for the intervention as compared to existing practice. The mean change to total costs and quality 38 adjusted life years for an average individual over 24 weeks participating in the intervention were: cost savings of $333 (95% Bayesian credible interval $-1,932:1,282) and 0.118 extra quality adjusted life years (95% Bayesian credible interval 0.1:0.136). The mean net41 monetary-benefit per individual for the intervention group compared to the usual care condition was $7,907 (95% Bayesian credible interval $5,959:$9,995) for the 24 week period. Conclusions/Significance. The estimation model that describes this intervention predicts cost savings and improved health outcomes. A decision to remain with existing practices causes unnecessary costs and reduced health. Decision makers should consider adopting this 46 program for elderly hospitalised patients.

Raman spectroscopic study of the mineral finnemanite Pb5(As3+O3)3Cl

The arsenite minerals finnemanite Pb5(As3+O3)3Cl been studied by Raman spectroscopy. The most intense Raman band at 871 cm-1 is assigned to the ν1 (AsO3)3- symmetric stretching vibration. Three Raman bands at 898, 908 and 947 cm-1 are assigned to the ν3 (AsO3)3- antisymmetric stretching vibration. The observation of multiple antisymmetric stretching vibrations suggest that the (AsO3)3- units are not equivalent in the molecular structure of finnemanite. Two Raman bands at 383 and 399 cm-1 are assigned to the ν2 (AsO3)3- bending modes. DFT calculations enabled the position of AsO32- symmetric stretching mode at 839 cm-1, the antisymmetric stretching mode at 813 cm-1, and the deformation mode at 449 cm-1 to be calculated. Raman bands are observed at 115, 145, 162, 176, 192, 216 and 234 cm-1 as well. The two most intense bands are observed at 176 and 192 cm-1. These bands are assigned to PbCl stretching vibrations and result from transverse/ longitudinal splitting. The bands at 145 and 162 cm-1 may be assigned to Cl-Pb-Cl bending modes.

Raman spectroscopic study of the hydroxy-arsenate mineral geminite Cu(AsO3OH)•H2O

The mineral geminite, an hydrated hydroxy-arsenate mineral of formula Cu(AsO3OH)•H2O, has been studied by Raman and infrared spectroscopy. Two minerals from different origins were investigated and the spectra proved quite similar. In the Raman spectra of geminite, four bands are observed at 813, 843, 853 and 885 cm-1. The assignment of these bands is as follows: (a) The band at 853 cm-1 is assigned to the AsO43- ν1 symmetric stretching mode (b) the band at 885 cm-1 is assigned to the AsO3OH2- ν1 symmetric stretching mode (c) the band at 843 cm-1 is assigned to the AsO43- ν3 antisymmetric stretching mode (d) the band at 813 cm-1 is ascribed to the AsO3OH2- ν3 antisymmetric stretching mode. Two Raman bands at 333 and 345 cm-1 are attributed to the ν2 AsO4 3- bending mode and a set of higher wavenumber bands are assigned to the ν4 AsO43- bending mode. A very complex set of overlapping bands is observed in both the Raman and infrared spectra. Raman bands are observed at 2288, 2438, 2814, 3152, 3314, 3448 and 3521 cm-1. Two Raman bands at 2288 and 2438 cm-1 are ascribed to very strongly hydrogen bonded water. The broader Raman bands at 3152 and 3314 cm-1 may be assigned to adsorbed water and not so strongly hydrogen bonded water in the molecular structure of geminate. Two bands at 3448 and 3521 cm-1 are assigned to the OH stretching vibrations of the (AsO3OH)2- units. Raman spectroscopy identified Raman bands attributable to AsO43- and AsO3OH2- units.

Potential soil carbon sequestration in overgrazed grassland ecosystems

Excessive grazing pressure is detrimental to plant productivity and may lead to declines in soil organic matter. Soil organic matter is an important source of plant nutrients and can enhance soil aggregation, limit soil erosion, and can also increase cation exchange and water holding capacities, and is, therefore, a key regulator of grassland ecosystem processes. Changes in grassland management which reverse the process of declining productivity can potentially lead to increased soil C. Thus, rehabilitation of areas degraded by overgrazing can potentially sequester atmospheric C. We compiled data from the literature to evaluate the influence of grazing intensity on soil C. Based on data contained within these studies, we ascertained a positive linear relationship between potential C sequestration and mean annual precipitation which we extrapolated to estimate global C sequestration potential with rehabilitation of overgrazed grassland. The GLASOD and IGBP DISCover data sets were integrated to generate a map of overgrazed grassland area for each of four severity classes on each continent. Our regression model predicted losses of soil C with decreased grazing intensity in drier areas (precipitation less than 333 mm yr(-1)), but substantial sequestration in wetter areas. Most (93%) C sequestration potential occurred in areas with MAP less than 1800 mm. Universal rehabilitation of overgrazed grasslands can sequester approximately 45 Tg C yr(-1), most of which can be achieved simply by cessation of overgrazing and implementation of moderate grazing intensity. Institutional level investments by governments may be required to sequester additional C.

Infant and young child feeding indicators and determinants of poor feeding practices in India : secondary data analysis of National Family Health Survey 2005–06

Background: In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. Objective. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. Methods: The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results: Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Conclusions: Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.

Adherence to fish oil intervention in patients with chronic kidney disease

Objective: With growing recognition of the role of inflammation in the development of chronic and acute disease, fish oil is increasingly used as a therapeutic agent, but the nature of the intervention may pose barriers to adherence in clinical populations. Our objective was to investigate the feasibility of using a fish oil supplement in hemodialysis patients. ---------- Design: This was a nonrandomized intervention study.---------- Setting: Eligible patients were recruited at the Hemodialysis Unit of Wesley Hospital, Brisbane, Queensland, Australia. Patients The sample included 28 maintenance hemodialysis patients out of 43 eligible patients in the unit. Exclusion criteria included patients regularly taking a fish oil supplement at baseline, receiving hemodialysis for less than 3 months, or being unable to give informed consent.---------- Intervention: Eicosapentaenoic acid (EPA) was administered at 2000 mg/day (4 capsules) for 12 weeks. Adherence was measured at baseline and weekly throughout the study according to changes in plasma EPA, and was further measured subjectively by self-report.---------- Results: Twenty patients (74%) adhered to the prescription based on changes in plasma EPA, whereas an additional two patients self-reported good adherence. There was a positive relationship between fish oil intake and change in plasma EPA. Most patients did not report problems with taking the fish oil. Using the baseline data, it was not possible to characterize adherent patients.---------- Conclusions: Despite potential barriers, including the need to take a large number of prescribed medications already, 74% of hemodialysis patients adhered to the intervention. This study demonstrated the feasibility of using fish oil in a clinical population.

The role of bricolage and resource constraints in high potential sustainability ventures

Sustainability decisions and their impacts may be among the greatest challenges facing the world in the 21st century (Davos 2000). Apart from adaptation on the part of established organizations these challenges are arguably going to require solutions developed by new actors However, young ventures have only recently begun generating research interest within sustainability literature (Shepherd et al. 2009). In particular, little is known about resource behaviours of these ventures and how they adapt to substantial resource constraints. One promising theory that has been identified as a way that some entrepreneurs manage constraints is bricolage: a construct defined as “making do by applying combinations of the resources at hand to new problems and opportunities” (Baker and Nelson 2005: 333). Bricolage may be critical as the means of continued venture success as these ventures are frequently developed in severe resource constraint, owing to higher levels of technical sophistication (Rothaermel and Deeds 2006). Further, they are often developed by entrepreneurs committed to personal and social goals of resourcefulness, including values that focus on conservation rather than consumption of resources (Shepherd et al. 2009). In this paper, using seven novel cases of high potential sustainability firms from CAUSEE we consider how constraints impact resource behaviours and further illustrate and extend bricolage domains previously developed by Baker and Nelson (2005) with recommendations for theory and practice provided.

Keeping in constant touch : the predictors of young Australians’ mobile phone involvement

Little is known about the psychological underpinnings of young people’s mobile phone behaviour. In the present research, 292 young Australians, aged 16–24 years, completed an online survey assessing the effects of self-identity, in-group norm, the need to belong, and self-esteem on their frequency of mobile phone use and mobile phone involvement, conceptualised as people’s degree of cognitive and behavioural association with their mobile phone. Structural equation modelling revealed that age (younger) and self-identity significantly predicted the frequency of mobile phone use. In contrast, age (younger), gender (female), self-identity and in-group norm predicted young people’s mobile phone involvement. Neither self-esteem nor the need to belong significantly predicted mobile phone behaviour. The present study contributes to our understanding of this phenomenon and provides an indication of the characteristics of young people who may become highly involved with their mobile phone.

Model and prototype for querying multiple linked scientific datasets

Scientists need to transfer semantically similar queries across multiple heterogeneous linked datasets. These queries may require data from different locations and the results are not simple to combine due to differences between datasets. A query model was developed to make it simple to distribute queries across different datasets using RDF as the result format. The query model, based on the concept of publicly recognised namespaces for parts of each scientific dataset, was implemented with a configuration that includes a large number of current biological and chemical datasets. The configuration is flexible, providing the ability to transparently use both private and public datasets in any query. A prototype implementation of the model was used to resolve queries for the Bio2RDF website, including both Bio2RDF datasets and other datasets that do not follow the Bio2RDF URI conventions.

Large-scale fabrication of H2(H2O)Nb2O6 and Nb2O5 hollow microspheres

Hollow micro-sized H2(H2O)Nb2O6 spheres constructed by nanocrystallites have been successfully synthesized via a bubble-template assisted hydrothermal process. In the reaction process, H2O2 acts as a bubble generator and plays a key role in the formation of the hollow structure. An in situ bubble-template mechanism has been proposed for the possible formation of the hollow structure. The spherelike assemblies of these H2(H2O)Nb2O6 nanoparticles have been transformed into their corresponding pseudohexagonal phase Nb2O5 through a moderate annealing dehydration process without destroying the hierarchical structure. Optical properties of the as-prepared hollow spheres were investigated. It is exciting that the absorption edge of the hollow Nb2O5 microspheres shifts about 18 nm to the violet compared with bulk powders in the UV/vis spectra, indicating its superior optical properties.

Teachers' work and pedagogy in an era of accountability

A great deal of educational policy proceeds as though teachers are malleable and ever-responsive to change. Some argue they are positioned as technicians who simply implement policy. However, how teachers go about their work and respond to reform agendas may be contingent upon many factors that are both biographical in nature and workplace related. In this paper we discuss the work of middle school teachers in low-socioeconomic communities from their perspectives. Referring to reflective interviews, meeting transcripts and an electronic reporting template, we examine how teacher participants in a school reform project describe their work - what they emphasise and what they down-play or omit. Using Foucaultian approaches to critical discourse analysis and insights from Dorothy Smith's (2005) Institutional Ethnography, we consider the 'discursive economy' (Carlson, 2005) in teachers' reported experiences of their everyday practices in northern suburbs schools in South Australia in which a democratic progressive discourse exists alongside corporate and disciplinary discourses.

Moving tele-monitoring and tele-treatment from promise to practice : a business model approach for a chronic lower back pain application

The availability of new information and communication technologies creates opportunities for new, mobile tele-health services. While many promising tele-health projects deliver working R&D prototypes, they often do not result in actual deployment. We aim to identify critical issues than can increase our understanding and enhance the viability of the mobile tele-health services beyond the R&D phase by developing a business model. The present study describes the systematic development and evaluation of a service-oriented business model for tele-monitoring and -treatment of chronic lower back pain patients based on a mobile technology prototype. We address challenges of multi-sector collaboration and disruptive innovation.

Correlations between designability and various structural characteristics of protein lattice models

Using six kinds of lattice types (4×4 ,5×5 , and6×6 square lattices;3×3×3 cubic lattice; and2+3+4+3+2 and4+5+6+5+4 triangular lattices), three different size alphabets (HP ,HNUP , and 20 letters), and two energy functions, the designability of proteinstructures is calculated based on random samplings of structures and common biased sampling (CBS) of proteinsequence space. Then three quantities stability (average energy gap),foldability, and partnum of the structure, which are defined to elucidate the designability, are calculated. The authors find that whatever the type of lattice, alphabet size, and energy function used, there will be an emergence of highly designable (preferred) structure. For all cases considered, the local interactions reduce degeneracy and make the designability higher. The designability is sensitive to the lattice type, alphabet size, energy function, and sampling method of the sequence space. Compared with the random sampling method, both the CBS and the Metropolis Monte Carlo sampling methods make the designability higher. The correlation coefficients between the designability, stability, and foldability are mostly larger than 0.5, which demonstrate that they have strong correlation relationship. But the correlation relationship between the designability and the partnum is not so strong because the partnum is independent of the energy. The results are useful in practical use of the designability principle, such as to predict the proteintertiary structure.