Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

Dream dolls : misogyny and political mythology in fin de siecle Australian culture

Examines Australian nationalism from the 1890s onwards through the interaction between cultural stereotypes of the feminine and issues of identity, citizenship and political constructions of "democracy". The employment of an idealised masculine aesthetic as catalyst to creating an imagined state was compared in Australia and Wilhelmine Germany.

Are workers with a disability less productive or less understood? An empirical investigation from an entrepreneurial business planning perspective

This study investigated selected work-performance data of a large call centre using the entrepreneurial business planning paradigm as a theoretical framework and tested the hypothesis that levels of productivity would be different for each group between workers with a disability and workers without a disability. On five measures of productivity, no significant differences were discernible but on a sixth measure, length of employment, it was found that disability workers remained in employment significantly longer. These results strongly refute the ‘intuitive wisdom’ that workers with a disability are less productive. The results support a growing body of corporate experience and descriptive research indicating that workers with a disability perform as well as or better than their non-disability colleagues. Yet workers with a disability remain disproportionately under-employed. The key to translating the growing evidence of this research into higher levels of employment of workers with disabilities will depend upon employers adopting an entrepreneurial approach to the planning of human resource management.

Reflecting on contemporary accounting : teaching and learning social and critical perspectives

This paper provides a case description and analysis of an effort to enact accounting education change. The study reports on an attempt to renew the social and ethical worth of accounting education and practice in the post-Enron context of increased interest in how accounting may contribute to social responsibility and sustainability. The paper considers the organisation, aims, and content of a newly-developed unit on social and critical perspectives on accounting, and key elements of the pedagogy utilised. These include team teaching, the employment of research literature rather than a prescribed textbook, an expanded conception of accounting and accounting “knowledge”, the adoption of educational goals that encompass preparing students for economic and social life and for democratic participation, and a view that sees ethics, the environment, and society as central to accounting. It is concluded that accounting educational change must encompass the content and practice of classroom activity, but it also requires change to the self-consciousness of all actors involved. Explicit inclusion of the social, critical, environmental and ethical dimensions of accounting in our teaching and learning programs provides an avenue for academics to individually and collectively make a meaningful contribution.

The Aristotelian spoudaios as ethical exemplar in Finnis’s natural law theory

One provocative but frequently overlooked feature of John Finnis’s natural law theory is its appeal to the normative role of the Aristotelian spoudaios (the mature person of practical reasonableness). Finnis’s account of the basic requirements of practical reasonableness and defense of the methodological device of “focal meaning” both have recourse to Aristotle’s claim that, in ethics and politics, things should be judged in terms of how they appear to the mature practically reasonable person. The current paper examines the normative role played by the spoudaios within Finnis’s natural law theory and provides a defense of that role against the objection that it lacks justificatory force because it is dependent upon circular reasoning. Section one contextualizes Finnis’s use of the spoudaios by considering its Aristotelian origins and also sketches some reasons for its demise in subsequent moral theory. This serves as the basis for an assessment in section two of whether Finnis’s employment of the spoudaios as an ethical exemplar conflates explanation and justification, and therefore culminates in decisionism. The conclusion of the paper is that Finnis’s recourse to the spoudaios is not viciously circular, because it is grounded in the reflexive and dialogical mode of justification proper to ethical enquiry.

Student difficulties in learning density: a distributed cognition perspective

Density has been reported as one of the most difficult concepts for secondary school students (e.g. Smith et al. 1997). Discussion about the difficulties of learning this concept has been largely focused on the complexity of the concept itself or student misconceptions. Few, if any, have investigated how the concept of density was constituted in classroom interactions, and what consequences these interactions have for individual students’ conceptual understanding. This paper reports a detailed analysis of two lessons on density in a 7th Grade Australian science classroom, employing the theory of Distributed Cognition (Hollan et al. 1999; Hutchins 1995). The analysis demonstrated that student understanding of density was shaped strongly by the public classroom discussion on the density of two metal blocks. It also revealed the ambiguities associated with the teacher demonstration and the student practical work. These ambiguities contributed to student difficulties with the concept of density identified in this classroom. The results of this study suggest that deliberate effort is needed to establish shared understanding not only about the purpose of the activities, but also about the meaning of scientific language and the utility of tools. It also suggests the importance of appropriate employment of instructional resources in order to facilitate student scientific understanding.

Diabetes mellitus in the australian indigenous community

This report aims to investigate the higher prevalence of type 2 diabetes (T2D) among Indigenous Australians, with recommendations to Australians Health Professionals in order to increase awareness of Indigenous health peculiarities related to diabetes mellitus (DM). Diabetes has become one of the most common public health problems of the 21st century. The proportion of Aborigines Australians developing T2D is 5 to 10 times greater than non-Aborigines. Although DM in Aboriginal community is multifactorial, this report shows three perceived causes: (i) obesity and the "Thrifty Gene Hypothesis", (ii) geographical position and (iii) smoking. It concluded that the combination of these causes have increased the incidence of DM among Indigenous Australians. Therefore, the following are recommended: improvement of genetic research, improvement of medical facilities, and increased employment of Indigenous Health Professionals and improvement of anti-smoking policies.

Superannuation retirement balances: A surprising outcome

Aim: Although the guaranteed superannuation system is believed by many to provide a safe and adequate source of funds in retirement, some will be unpleasantly surprised. The aim of this paper is to demonstrate the significant effect of the economic cycle on the final accumulated balance in superannuation retirement accounts. Method: A Monte Carlo simulation is used to illustrate the variance in outcomes that can be expected for a hypothetical individual. Results: The expected accumulated superannuation balances for two hypothetical individuals are estimated. The spread of outcomes is used to illustrate the problem of using only the mean of the distribution as a predictor of wealth in the retirement years. Conclusions: Many retirees rely on superannuation to fund their retirement. However regular contributions to superannuation does not ensure a predictable outcome, and active management of contributions is required if retirement goals are to be met.

Exploring first year teachers’ identity transformation through theatre-based research

Why are beginning teachers leaving the profession in large numbers? Are they leaving because of their dissatisfaction with teaching? Are they leaving because of the conditions of their work that shape their identity? Teacher identity work emphasises it is important beginning teachers understand their professional identity as something shifting, fluid and emerging – not fixed. These and other water metaphors – such as ‘washout’, ‘sink or swim’, and ‘thrown in the deep end’ – are often used to describe beginning teachers’ experiences. Such words and metaphors assist to portray the fluid and unpredictable nature of identity transformation. However, these survival terms also influence beginning teachers to believe that their transition to teaching will be difficult. Recently there has been an increased concern over beginning teacher attrition linked to the difficulties they encounter in their early years of teaching. Yet the conditions of beginning teachers’ work in Victorian schools in Australia – including the contractual nature of employment of first year (1yr) teachers – encourage these 1yr practitioners to view their work as semi-permanent. As a result these 1yr teachers do not see themselves as teaching for extended periods of time, as was once the case. Throughout 2011 twelve 1yr teachers shared their experiences of identity transformation in semi-structured interviews with the researcher. Their interview data was analysed through a theatre-based research method, examining how first experiences shape teachers’ future practice and identity. This presentation includes excerpts from the theatre-based research performance ‘The First Time’, and expands on the methodological approaches taken to analyse the data in a way that reflects the fluid and unpredictable nature of teachers’ identity formation and transformation. This qualitative study allows categories of description to emerge from the data rather than pre-determining categories of investigation. As such the processes of scripting, rehearsing, and performing, were utilised to analyse and re-present the data. In an aim to uncover questions that have been buried by answers, the research is oriented as a phenomenographic inquiry. This mode of inquiry seeks to describe, analyse, and understand the qualitatively different experiences 1yr teachers undergo in their identity formation and transformation. The results of this research reveal that beginning teachers’ identity transformation through their first experiences have both individual features specific to each teacher’s roles and aspirations, and extra-individual factors such as interactions, affiliations, and status, which shape their identity. Categories of description that have emerged from the analysis include survival, liminal, and hegemonic discourses, artifacts as symbols of belonging, and the impact of the contractual nature of teaching. Implications of this research focus on the importance for beginning teachers to develop an understanding of the transformative nature of identity in relation to the practice of teaching, to counter the negative preconceptions beginning teachers are told to expect as rites of passage upon entering the profession. The research outcomes have implications for teacher educators and in-service teachers negotiating the waters of an ever-changing profession.

From ranking fuzzy numbers to solving fuzzy linear programming: a comprehensive review

Solving fuzzy linear programming (FLP) requires the employment of a consistent ranking of fuzzy numbers. Ineffective fuzzy number ranking would lead to a flawed and erroneous solving approach. This paper presents a comprehensive and extensive review on fuzzy number ranking methods. Ranking techniques are categorised into six classes based on their characteristics. They include centroid methods, distance methods, area methods, lexicographical methods, methods based on decision maker's viewpoint, and methods based on left and right spreads. A survey on solving approaches to FLP is also reported. We then point out errors in several existing methods that are relevant to the ranking of fuzzy numbers and thence suggest an effective method to solve FLP. Consequently, FLP problems are converted into non-fuzzy single (or multiple) objective linear programming based on a consistent centroid-based ranking of fuzzy numbers. Solutions of FLP are then obtained by solving corresponding crisp single (or multiple) objective programming problems by conventional methods.

EEG signal classification for BCI applications by wavelets and interval type-2 fuzzy logic systems

The nonlinear, noisy and outlier characteristics of electroencephalography (EEG) signals inspire the employment of fuzzy logic due to its power to handle uncertainty. This paper introduces an approach to classify motor imagery EEG signals using an interval type-2 fuzzy logic system (IT2FLS) in a combination with wavelet transformation. Wavelet coefficients are ranked based on the statistics of the receiver operating characteristic curve criterion. The most informative coefficients serve as inputs to the IT2FLS for the classification task. Two benchmark datasets, named Ia and Ib, downloaded from the brain-computer interface (BCI) competition II, are employed for the experiments. Classification performance is evaluated using accuracy, sensitivity, specificity and F-measure. Widely-used classifiers, including feedforward neural network, support vector machine, k-nearest neighbours, AdaBoost and adaptive neuro-fuzzy inference system, are also implemented for comparisons. The wavelet-IT2FLS method considerably dominates the comparable classifiers on both datasets, and outperforms the best performance on the Ia and Ib datasets reported in the BCI competition II by 1.40% and 2.27% respectively. The proposed approach yields great accuracy and requires low computational cost, which can be applied to a real-time BCI system for motor imagery data analysis.

"Well, There It Is"

While PASCAL meet all the requirements of a collaborative funding source, the Palmetto state still starved it of funds.

Transformação genética em cevada por bombardeamento de partículas

A presente Tese de Doutorado objetivou: (1) definir um método eficiente de transformação genética, por bombardeamento de partículas, para a obtenção de plantas transgênicas de cultivares brasileiras de cevada e (2) identificar gene(s) codificante(s) de quitinase(s) potencialmente capaz(es) de conferir resistência ao fungo patogênico de cevada Bipolaris sorokiniana. Culturas de calos obtidos a partir de escutelos imaturos das cultivares Brasileiras de cevada MN-599 e MN-698 (Cia. de Bebidas das Américas, AMBEV) foram bombardeadas com partículas de tungstênio e avaliadas quanto à expressão do gene repórter gusA através de ensaios histoquímicos de GUS e quanto ao efeito dos bombardeamentos na indução estruturas embriogênicas e regeneração de plantas. As condições de biobalística analisadas incluíram a região promotora regulando a expressão de gusA, tipo e pressão de gás hélio de dois aparelhos de bombardeamento, distância de migração das partículas, número de tiros e a realização de pré e pós-tratamento osmótico dos tecidos-alvo. No presente trabalho foram obtidos um número bastante alto de pontos azuis por calo, a indução de calos embriogênicos e embriões somáticos em uma freqüência de até 58,3% e a regeneração de 60 plantas, sendo 43 de calos bombardeados. As melhores condições observadas foram o promotor e primeiro íntron do gene Adh de milho (plasmídeo pNGI), o aparelho de bombardeamento “ Particle Inflow Gun” (PIG) utilizando-se a distância de migração de partículas de 14,8 cm, dois tiros disparados por placa e a realização de tratamento osmótico dos explantes com 0,2 M de manitol e 0,2 M de sorbitol 4-5 horas antes e 17-19 horas depois dos bombardeamentos. Das 43 plantas obtidas de calos bombardeadas, 3 apresentaram atividade de GUS na base das suas folhas. A utilização de primers sintéticos definidos a partir de genes de quitinases descritos na literatura em PCRs resultou na amplificação de dois fragmentos de aproximadamente 700 e 500 pb a partir de DNA total das cvs. MN-599 e MN-698 de cevada e um fragmento, com aproximadamente 500 pb, a partir do DNA total do isolado A4c de Trichoderma sp. Estes fragmentos foram purificados dos géis de agarose e diretamente seqüenciados de forma manual e automática. Os fragmentos de 700 e 500 pb amplificados do genoma da cultivar MN-599 foram identificados como genes de quitinases de cevada e o fragmento de 500 pb do isolado A4c de Trichoderma sp. não apresentou homologia com seqüências conhecidas de quitinases depositadas no EMBL/GenBank. A utilização de novos pares de primers, representando seqüências conservadas de quitinases do fungo Metarhizium anisopliae, resultou na amplificação de 3 fragmentos a partir do DNA total do isolado A4b de Trichoderma sp., que estão sendo purificados para realização de seqüenciamento.

QFD aplicado em uma metodologia para avaliação da satisfação de clientes em uma cadeia logística

Este trabalho apresenta uma metodologia para avaliação da satisfação de clientes em uma cadeia logística, que visa buscar a melhoria dos serviços logísticos. A metodologia utiliza técnicas estatísticas, técnicas de pesquisa de mercado e técnica de análise de decisão. A técnica de análise de decisão utilizada nesta metodologia é o Desdobramento da Função Qualidade (QFD) aplicada para planejar melhorias no serviço logístico, priorizando as características do serviço demandadas pelos clientes e os indicadores de desempenho para o mesmo. A aplicação desta metodologia em uma empresa do ramo alimentício resultou na confirmação da metodologia proposta como instrumento de apoio na elaboração de planos de melhorias para sistemas logísticos.

Expressão de uma quitinase de Metarhizium anisopliae em Nicotiana tabacum : obtenção de plantas transgênicas resistentes a doenças fúngicas

A resistência a doenças em plantas transgênicas tem sido obtida por meio da expressão de genes isolados de bactérias, fungos micoparasitas e plantas. Neste trabalho, relatamos a utilização de um gene do fungo entomopatogênico Metarhizium anisopliae como modo de gerar resistência a doenças fúngicas em plantas. O gene chit1 codifica a quitinase CHIT42 (EC 3.2.1.14), pertencente a uma classe de glicosil-hidrolases capazes de converter quitina em oligômeros de N-acetil-glicosamina (NAcGlc). Quando presentes em tecidos vegetais, supõese que as quitinases ataquem especificamente a parede celular de fungos invasores, provocando danos às hifas e causando a morte por lise das células fúngicas. Deste modo, dois diferentes grupos de plantas transgênicas de Nicotiana tabacum foram produzidos: no primeiro deles, denominado chitplus, os indivíduos possuem o gene chit1 sob o controle do promotor CaMV 35S. O segundo grupo, demoninado chitless, consiste de plantas transformadas com um T-DNA não contendo o gene do fungo. Trinta e quatro plantas transgênicas resistentes à canamicina (17 de cada grupo) foram regeneradas a partir de discos de folhas infectados por Agrobacterium tumefaciens. A produção da quitinase em extratos protéicos de folhas foi analisada por zimogramas em SDS-PAGE contendo glicol-quitina e corados por calcoflúor branco, na forma de um screening dos transgênicos primários. As plantas transgênicas foram testadas, ainda, por meio de ensaios colorimétricos empregando oligômeros sintéticos de NAcGlc como substratos específicos, além de immunoblot e Western blot com soro anti-quitinase. A quantidade de enzima recombinante nas plantas chitplus variou desde nenhuma atividade detectável a elevados níveis de expressão da enzima. A hibridização de Southern blot demonstrou que o número de cópias do gene chit1 integradas no genoma vegetal foi estimado entre uma e quatro. A primeira geração de plantas transgênicas geradas por autofecundação de parentais portadores de duas cópias do transgene foi testada com relação à estabilidade da herança do transgene e em 43 de um total de 67 descendentes, originados de quatro cruzamentos independentes, o padrão de segregação não diferiu das proporções Mendelianas esperadas. Ensaios de resistência, desafiando as plantas transgênicas com o basidiomiceto Rhizoctonia solani foram realizados e uma evidente diminuição da área foliar contendo lesões fúngicas foi observada entre as linhagens transgênicas, embora variações na atividade quitinolítica tenham influenciado o nível de resistência. Nossos resultados sugerem uma relação direta entre a atividade específica de quitinase e ao aumento nos níveis de resistência às lesões causadas pela infecção por R. solani.