Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

An economic evaluation of the Safe Motherhood programme in Guangxi, China

Maternal and infant mortality is a global health issue with a significant social and economic impact. Each year, over half a million women worldwide die due to complications related to pregnancy or childbirth, four million infants die in the first 28 days of life, and eight million infants die in the first year. Ninety-nine percent of maternal and infant deaths are in developing countries. Reducing maternal and infant mortality is among the key international development goals. In China, the national maternal mortality ratio and infant mortality rate were reduced greatly in the past two decades, yet a large discrepancy remains between urban and rural areas. To address this problem, a large-scale Safe Motherhood Programme was initiated in 2000. The programme was implemented in Guangxi in 2003. Interventions in the programme included both demand-side and supply side-interventions focusing on increasing health service use and improving birth outcomes. Little is known about the effects and economic outcomes of the Safe Motherhood Programme in Guangxi, although it has been implemented for seven years. The aim of this research is to estimate the effectiveness and cost-effectiveness of the interventions in the Safe Motherhood Programme in Guangxi, China. The objectives of this research include: 1. To evaluate whether the changes of health service use and birth outcomes are associated with the interventions in the Safe Motherhood Programme. 2. To estimate the cost-effectiveness of the interventions in the Safe Motherhood Programme and quantify the uncertainty surrounding the decision. 3. To assess the expected value of perfect information associated with both the whole decision and individual parameters, and interpret the findings to inform priority setting in further research and policy making in this area. A quasi-experimental study design was used in this research to assess the effectiveness of the programme in increasing health service use and improving birth outcomes. The study subjects were 51 intervention counties and 30 control counties. Data on the health service use, birth outcomes and socio-economic factors from 2001 to 2007 were collected from the programme database and statistical yearbooks. Based on the profile plots of the data, general linear mixed models were used to evaluate the effectiveness of the programme while controlling for the effects of baseline levels of the response variables, change of socio-economic factors over time and correlations among repeated measurements from the same county. Redundant multicollinear variables were deleted from the mixed model using the results of the multicollinearity diagnoses. For each response variable, the best covariance structure was selected from 15 alternatives according to the fit statistics including Akaike information criterion, Finite-population corrected Akaike information criterion, and Schwarz.s Bayesian information criterion. Residual diagnostics were used to validate the model assumptions. Statistical inferences were made to show the effect of the programme on health service use and birth outcomes. A decision analytic model was developed to evaluate the cost-effectiveness of the programme, quantify the decision uncertainty, and estimate the expected value of perfect information associated with the decision. The model was used to describe the transitions between health states for women and infants and reflect the change of both costs and health benefits associated with implementing the programme. Result gained from the mixed models and other relevant evidence identified were synthesised appropriately to inform the input parameters of the model. Incremental cost-effectiveness ratios of the programme were calculated for the two groups of intervention counties over time. Uncertainty surrounding the parameters was dealt with using probabilistic sensitivity analysis, and uncertainty relating to model assumptions was handled using scenario analysis. Finally the expected value of perfect information for both the whole model and individual parameters in the model were estimated to inform priority setting in further research in this area.The annual change rates of the antenatal care rate and the institutionalised delivery rate were improved significantly in the intervention counties after the programme was implemented. Significant improvements were also found in the annual change rates of the maternal mortality ratio, the infant mortality rate, the incidence rate of neonatal tetanus and the mortality rate of neonatal tetanus in the intervention counties after the implementation of the programme. The annual change rate of the neonatal mortality rate was also improved, although the improvement was only close to statistical significance. The influences of the socio-economic factors on the health service use indicators and birth outcomes were identified. The rural income per capita had a significant positive impact on the health service use indicators, and a significant negative impact on the birth outcomes. The number of beds in healthcare institutions per 1,000 population and the number of rural telephone subscribers per 1,000 were found to be positively significantly related to the institutionalised delivery rate. The length of highway per square kilometre negatively influenced the maternal mortality ratio. The percentage of employed persons in the primary industry had a significant negative impact on the institutionalised delivery rate, and a significant positive impact on the infant mortality rate and neonatal mortality rate. The incremental costs of implementing the programme over the existing practice were US $11.1 million from the societal perspective, and US $13.8 million from the perspective of the Ministry of Health. Overall, 28,711 life years were generated by the programme, producing an overall incremental cost-effectiveness ratio of US $386 from the societal perspective, and US $480 from the perspective of the Ministry of Health, both of which were below the threshold willingness-to-pay ratio of US $675. The expected net monetary benefit generated by the programme was US $8.3 million from the societal perspective, and US $5.5 million from the perspective of the Ministry of Health. The overall probability that the programme was cost-effective was 0.93 and 0.89 from the two perspectives, respectively. The incremental cost-effectiveness ratio of the programme was insensitive to the different estimates of the three parameters relating to the model assumptions. Further research could be conducted to reduce the uncertainty surrounding the decision, in which the upper limit of investment was US $0.6 million from the societal perspective, and US $1.3 million from the perspective of the Ministry of Health. It is also worthwhile to get a more precise estimate of the improvement of infant mortality rate. The population expected value of perfect information for individual parameters associated with this parameter was US $0.99 million from the societal perspective, and US $1.14 million from the perspective of the Ministry of Health. The findings from this study have shown that the interventions in the Safe Motherhood Programme were both effective and cost-effective in increasing health service use and improving birth outcomes in rural areas of Guangxi, China. Therefore, the programme represents a good public health investment and should be adopted and further expanded to an even broader area if possible. This research provides economic evidence to inform efficient decision making in improving maternal and infant health in developing countries.

The structure of the mineral leogangite Cu10(OH)6(SO4)(AsO4)4•8H2O–implications for arsenic accumulation and removal

The objective of this research is to determine the molecular structure of the mineral leogangite. The formation of the types of arsenosulphate minerals offers a mechanism for arsenate removal from soils and mine dumps. Raman and infrared spectroscopy have been used to characterise the mineral. Observed bands are assigned to the stretching and bending vibrations of (SO4)2- and (AsO4)3- units, stretching and bending vibrations of hydrogen bonded (OH)- ions and Cu2+-(O,OH) units. The approximate range of O-H...O hydrogen bond lengths is inferred from the Raman spectra. Raman spectra of leogangite from different origins differ in that some spectra are more complex, where bands are sharp and the degenerate bands of (SO4)2- and (AsO4)3- are split and more intense. Lower wavenumbers of  H2O bending vibration in the spectrum may indicate the presence of weaker hydrogen bonds compared with those in a different leogangite samples. The formation of leogangite offers a mechanism for the removal of arsenic from the environment.

The molecular structure of the multianion mineral hidalgoite PbAl3(AsO4)(SO4)(OH)6 : implications for arsenic removal from soils

The objective of this research is to determine the molecular structure of the mineral hidalgoite PbAl3(AsO4)(SO4)(OH)6 using vibrational spectroscopy. The mineral is found in old mine sites. Observed bands are assigned to the stretching and bending vibrations of (SO4)2- and (AsO4)3- units, stretching and bending vibrations of hydrogen bonded (OH)- ions and Al3+-(O,OH) units. The approximate range of O-H...O hydrogen bond lengths is inferred from the Raman and infrared spectra. Values of 2.6989 Å, 2.7682 Å, 2.8659 Å were obtained. The formation of hidalgoite may offer a mechanism for the removal of arsenic from the environment.

Driving speed is altered by monocular Neutral Density filters : the Enright phenomenon

Introduction: An observer, looking sideways from a moving vehicle, while wearing a neutral density filter over one eye, can have a distorted perception of speed, known as the Enright phenomenon. The purpose of this study was to determine how the Enright phenomenon influences driving behaviour. Methods: A geometric model of the Enright phenomenon was developed. Ten young, visually normal, participants (mean age = 25.4 years) were tested on a straight section of a closed driving circuit and instructed to look out of the right side of the vehicle and drive at either 40 Km/h or 60 Km/h under the following binocular viewing conditions: with a 0.9 ND filter over the left eye (leading eye); 0.9 ND filter over the right eye (trailing eye); 0.9 ND filters over both eyes, and with no filters over either eye. The order of filter conditions was randomised and the speed driven recorded for each condition. Results: Speed judgments did not differ significantly between the two baseline conditions (no filters and both eyes filtered) for either speed tested. For the baseline conditions, when subjects were asked to drive at 60 Km/h they matched this speed well (61 ± 10.2 Km/h) but drove significantly faster than requested (51.6 ± 9.4 Km/h) when asked to drive at 40 Km/h. Subjects significantly exceeded baseline speeds by 8.7± 5.0 Km/h, when the trailing eye was filtered and travelled slower than baseline speeds by 3.7± 4.6 Km/h when the leading eye was filtered. Conclusions: This is the first quantitative study demonstrating how the Enright effect can influence perceptions of driving speed, and demonstrates that monocular filtering of an eye can significantly impact driving speeds, albeit to a lesser extent than predicted by geometric models of the phenomenon.

Raman spectroscopy of the multi-anion mineral schlossmacherite (H3O,Ca)Al3(AsO4,PO4,SO4)2(OH)6

The mineral schlossmacherite (H3O,Ca)Al3(AsO4,PO4,SO4)2(OH)6 , a multi-cation-multi-anion mineral of the beudantite mineral subgroup has been characterised by Raman spectroscopy. The mineral and related minerals functions as a heavy metal collector and is often amorphous or poorly crystalline, such that XRD identification is difficult. The Raman spectra are dominated by an intense band at 864 cm-1, assigned to the symmetric stretching mode of the AsO43- anion. Raman bands at 809 and 819 cm-1 are assigned to the antisymmetric stretching mode of AsO43- . The sulphate anion is characterised by bands at 1000 cm-1 (ν1), and at 1031, 1082 and 1139 cm-1 (ν3). Two sets of bands in the OH stretching region are observed: firstly between 2800 and 3000 cm-1 with bands observed at 2850, 2868, 2918 cm-1 and secondly between 3300 and 3600 with bands observed at 3363, 3382, 3410, 3449 and 3537 cm-1. These bands enabled the calculation of hydrogen bond distances and show a wide range of H-bond distances.

Symbolic number : the integration of magnitude and spatial representations in children aged 6 to 8 years

The process of learning symbolic Arabic digits in early childhood requires that magnitude and spatial information integrates with the concept of symbolic digits. Previous research has separately investigated the development of automatic access to magnitude and spatial information from symbolic digits. However, developmental trajectories of symbolic number knowledge cannot be fully understood when considering components in isolation. In view of this, we have synthesized the existing lines of research and tested the use of both magnitude and spatial information with the same sample of British children in Years 1, 2 and 3 (6-8 years of age). The physical judgment task of the numerical Stroop paradigm (NSP) demonstrated that automatic access to magnitude was present from Year 1 and the distance effect signaled that a refined processing of numerical information had developed. Additionally, a parity judgment task showed that the onset of the Spatial-Numerical Association of Response Codes (SNARC) effect occurs in Year 2. These findings uncover the developmental timeline of how magnitude and spatial representations integrate with symbolic number knowledge during early learning of Arabic digits and resolve inconsistencies between previous developmental and experimental research lines.

Book review: Ford, R.C., & Peeper, W.C. 2008. Managing Destination Marketing Organizations. Orlando: ForPer Publications

This volume represents the proceedings of the 13th ENTER conference, held at Lausanne, Switzerland during 2006. The conference brought together academics and practitioners across four tracks, which were eSolutions, refereed research papers, work-in-progress papers, and a Ph.D. workshop. This proceedings contains 40 refereed papers, which is less than the 51 papers presented in 2005. However, the editors advise that the scientific committee was stricter than in previous years, to the extent that the acceptance rate was 50%. A significant change in the current proceedings is the inclusion of extended abstracts of the 23 work-in-progress presentations. The papers cover a diverse range of topics across 16 research streams. This reviewer has adopted the approach of succinctly summarising the contribution of each of the 40-refereed papers, in the order in which they appear...

Raman spectroscopic study of the mineral arsenogorceixite BaAl3AsO3(OH)(AsO4,PO4)(OH,F)6

Arsenogorceixite BaAl3AsO3(OH)(AsO4,PO4)(OH,F)6 belongs to the crandallite mineral subgroup of the alunite supergroup. Arsenogorceixite forms a continuous series of solid solutions with related minerals including gorceixite, goyazite, arsenogoyazite, plumbogummite and philipsbornite. Two minerals from (a) Germany and (b) from Ashburton Downs, Australia were analysed by Raman spectroscopy. The spectra show some commonality but the intensities of the peaks vary. Sharp intense Raman bands for the German sample, are observed at 972 and 814 cm−1 attributed to the ν1 PO43− and AsO43− symmetric stretching modes. Raman bands at 1014, 1057, 1148 and 1160 cm−1 are attributed to the ν1 PO2 symmetric stretching mode and ν3 PO43− antisymmetric stretching vibrations. Raman bands at 764 and 776 cm−1 and 758 and 756 cm−1 are assigned to the ν3 AsO43− antisymmetric stretching vibrations. For the Australian mineral, the ν1 PO43− band is found at 973 cm−1. The intensity of the arsenate bands observed at 814, 838 and 870 cm−1 is greatly enhanced. Two low intensity Raman bands at 1307 and 1332 cm−1 are assigned to hydroxyl deformation modes. The intense Raman band at 441 cm−1 with a shoulder at 462 cm−1 is assigned to the ν2 PO43− bending mode. Raman bands at 318 and 340 cm−1 are attributed to the (AsO4)3−ν2 bending. The broad band centred at 3301 cm−1 is assigned to water stretching vibrations and the sharper peak at 3473 cm−1 is assigned to the OH stretching vibrations. The observation of strong water stretching vibrations brings into question the actual formula of arsenogorceixite. It is proposed the formula is better written as BaAl3AsO3(OH)(AsO4,PO4)(OH,F)6·xH2O. The observation of both phosphate and arsenate bands provides a clear example of solid solution formation.