A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral -126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was f52.85 for those in urban areas and f59.93 per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was f47.13 for urban patients and f48.77 for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Exploring through cover - the integrated interpretation of high resolution aeromagnetic, airborne electromagnetic and ground gravity data from the Grant's Patch area, Eastern Goldfields Province, Archaean Yigarn Craton Part B; Gravity inversion as a

The cost and risk associated with mineral exploration in Australia increases significantly as companies move into deeper regolith-covered terrain. The ability to map the bedrock and the depth of weathering within an area has the potential to decrease this risk and increase the effectiveness of exploration programs. This paper is the second in a trilogy concerning the Grant's Patch area of the Eastern Goldfields. The recent development of the VPmg potential field inversion program in conjunction with the acquisition of high-resolution gravity data over an area with extensive drilling provided an opportunity to evaluate three-dimensional gravity inversion as a bedrock and regolith mapping tool. An apparent density model of the study area was constructed, with the ground represented as adjoining 200 m by 200 m vertical rectangular prisms. During inversion VPmg incrementally adjusted the density of each prism until the free-air gravity response of the model replicated the observed data. For the Grant's Patch study area, this image of the apparent density values proved easier to interpret than the Bouguer gravity image. A regolith layer was introduced into the model and realistic fresh-rock densities assigned to each basement prism according to its interpreted lithology. With the basement and regolith densities fixed, the VPmg inversion algorithm adjusted the depth to fresh basement until the misfit between the calculated and observed gravity response was minimised. The resulting geometry of the bedrock/regolith contact largely replicated the base of weathering indicated by drilling with predicted depth of weathering values from gravity inversion typically within 15% of those logged during RAB and RC drilling.

Repeated flood events and fossil forests at Curio Bay (Middle Jurassic), New Zealand

During the Middle Jurassic, the regional environment of Curio Bay, southeast South Island, New Zealand, was a fluvial plain marginal to volcanic uplands. Intermittent flashy, poorly-confined flood events buried successive conifer forests. With the termination of each flood, soils developed and vegetation was reestablished. In most cases, this developed into coniferous forest. In approximately 40 m of vertical section, 10 fossil forest horizons can be distinguished, highlighting a type of fluvial architecture which is poorly documented. Flood-basin material is minimal, but a short-Lived floodbasin lake is inferred to have developed within the interval of study. Paleocurrent indicators suggest enclosure of the basin on more than one side. Sedimentation style suggests a relatively dry (less than humid but not arid) climate with seasonal rainfall. (C) 2001 Elsevier Science B.V. All rights reserved.

neptune, a Kruppel-like transcription factor that participates in primitive erythropoiesis in Xenopus

The specification of the erythroid lineage from hematopoietic stem cells requires the expression and activity of lineage-specific transcription factors. One transcription factor family that has several members involved in hematopoiesis is the Kruppel-like factor (KLF) family [1]. For example, erythroid KLF (EKLF) regulates beta -globin expression during erythroid differentiation [2-6]. KLFs share a highly conserved zinc finger-based DNA binding domain (DBD) that mediates binding to CACCC-box and GC-rich sites, both of which are frequently found in the promoters of hematopoietic genes. Here, we identified a novel Xenopus KLF gene, neptune, which is highly expressed in the ventral blood island (VBI), cranial ganglia, and hatching and cement glands. neptune expression is induced in response to components of the BMP-4 signaling pathway in injected animal cap explants. Similar to its family member, EKLF, Neptune can bind CACCC-box and GC-rich DNA elements. We show that Neptune cooperates with the hematopoietic transcription factor XGATA-1 to enhance globin induction in animal cap explants. A fusion protein comprised of Neptune's DBD and the Drosophila engrailed repressor domain suppresses the induction of globin in ventral marginal zones and in animal caps. These studies demonstrate that Neptune is a positive regulator of primitive erythropoiesis in Xenopus.

Diversity and change in Australia's rangelands: a post-productivist transition with a difference?

Australia's rangelands are experiencing a post-productivist transition at a tempo comparable to Western Europe's, but in contexts that ensure marked divergence in impulses, actors, processes and outcomes. In Australia's most marginal lands, a flimsy mode of pastoral occupance is being displaced by renewed indigenous occupance, conservation and tourism, with significant changes in land ownership, property rights, investment sources and power relations, but also with structural problems arising from fugitive income streams. The sharp delineation between structurally coherent commodity-oriented regions and emerging amenity-oriented regions can provisionally be mapped at a national scale. A comparison of Australia with Western Europe indicates that three distinct but interconnected driving forces are propelling the rural transition, namely: agricultural overcapacity; the emergence of amenity-oriented uses; and changing societal values.

Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review

Objective: To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. Data sources and synthesis: (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. Results: For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over 80 years the relative benefit was about a third, and with quality-of-life adjustment only 14%, that in women aged 50-69 years. (ii) Of 10 000 Australian women participating in ongoing screening, about 400 are recalled for further testing, and, depending on age, about 70-112 undergo biopsy and about 19-80 cancers are detected. (iii) Cost-effectiveness estimates for extending the upper age limit for mammographic screening from 69 to 79 years range from $8119 to $27 751 per quality-adjusted life-year saved, which compares favourably with extending screening to women aged 40-49 years (estimated at between $24 000 and $65 000 per life-year saved). Conclusions: Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group.

MUC1 epithelial mucin (CD227) is expressed by activated dendritic cells

The MUC1 mucin (CD227) is a cell surface mucin originally thought to be restricted to epithelial tissues. We report that CD227 is expressed on human blood dendritic cells (DC) and monocyte-derived DC following in vitro activation. Freshly isolated murine splenic DC had very low levels of CD227; however, all DC expressed CD227 following in vitro culture. In the mouse spleen, CD227 was seen on clusters within the red pulp and surrounding the marginal zone in the white pulp. Additionally, we confirm CD227 expression by activated human T cells and show for the first time that the CD227 cytoplasmic domain is tyrosine-phosphorylated in activated T cells and DC and is associated with other phosphoproteins, indicating a role in signaling. The function of CD227 on DC and T cells requires further elucidation.

Evolution of additive and nonadditive genetic variance in development time along a cline in Drosophila serrata

Latitudinal clines provide natural systems that may allow the effect of natural selection on the genetic variance to be determined. Ten clinal populations of Drosophila serrata collected from the eastern coast of Australia were used to examine clinal patterns in the trait mean and genetic variance of the life-history trait egg-to-adult development time. Development time significantly lengthened from tropical areas to temperate areas. The additive genetic variance for development time in each population was not associated with latitude but was associated with the population mean development time. Additive genetic variance tended to be larger in populations with more extreme development times and appeared to be consistent with allele frequency change. In contrast, the nonadditive genetic variance was not associated with the population mean but was associated with latitude. Levels of nonadditive genetic variance were greatest in the region of the cline where the gradient in the change in mean was greatest, consistent with Barton's (1999) conjecture that the generation of linkage disequilibrium may become an important component of the genetic variance in systems with a spatially varying optimum.

Low input tillage/cropping systems for limited resource areas

Agriculture in limited resource areas is characterized by small farms which an generally too small to adequately support the needs of an average farm family. The farming operation can be described as a low input cropping system with the main energy source being manual labor, draught animals and in some areas hand tractors. These farming systems are the most important contributor to the national economy of many developing countries. The role of tillage is similar in dryland agricultural systems in both the high input (HICS) and low input cropping systems (LICS), however, wet cultivation or puddling is unique to lowland rice-based systems in low input cropping systems. Evidence suggest that tillage may result in marginal increases in crop yield in the short term, however, in the longer term it may be neutral or give rise to yield decreases associated with soil structural degradation. On marginal soils, tillage may be required to prepare suitable seedbeds or to release adequate Nitrogen through mineralization, but in the longer term, however, tillage reduces soil organic matter content, increases soil erodibility and the emission of greenhouse gases. Tillage in low input cropping systems involves a very large proportion of the population and any changes: in current practices such as increased mechanization will have a large social impact such as increased unemployment and increasing feminization of poverty, as mechanization may actually reduce jobs for women. Rapid mechanization is likely to result in failures, but slower change, accompanied by measures to provide alternative rural employment, might be beneficial. Agriculture in limited resource areas must produce the food and fiber needs of their community, and its future depends on the development of sustainable tillage/cropping systems that are suitable for the soil and climatic conditions. These should be based on sound biophysical principles and meet the needs of and he acceptable to the farming communities. Some of the principle requirements for a sustainable system includes the maintenance of soil health, an increase in the rain water use efficiency of the system, increased use of fertilizer and the prevention of erosion. The maintenance of crop residues on the surface is paramount for meeting these requirements, and the competing use of crop residues must be met from other sources. These requirements can be met within a zonal tillage system combined with suitable agroforestry, which will reduce the need for crop residues. It is, however, essential that farmers participate in the development of any new technologies to ensure adoption of the new system. (C) 2001 Elsevier Science B.V. All rights reserved.

Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice

Background Patients with known or suspected coronary disease are often investigated to facilitate risk assessment. We sought to examine the cost-effectiveness of strategies based on exercise echocardiography and exercise electrocardiography. Methods and results We studied 7656 patients undergoing exercise testing; of whom half underwent exercise echocardiography. Risk was defined with the Duke treadmill score for those undergoing exercise electrocardiography alone, and by the extent of ischaemia by exercise echocardiography. Cox proportional hazards models, risk adjusted for pretest likelihood of coronary artery disease, were used to estimate time to cardiac death or myocardial infarction. Costs (including diagnostic and revascularisation procedures, hospitalisations, and events) were calculated, inflation-corrected to year 2000 using Medicare trust fund rates and discounted at a rate of 5%. A decision model was employed to assess the marginal cost effectiveness (cost/life year saved) of exercise echo compared with exercise electrocardiography. Exercise echocardiography identified more patients as low-risk (51% vs 24%, p<0.001), and fewer as intermediate- (27% vs 51%, p<0.001) and high-risk (22% vs 4%); survival was greater in low- and intermediate- risk and less in high-risk patients. Although initial procedural costs and revascularisation costs (in intermediate- high risk patients) were greater, exercise echocardiography was associated with a greater incremental life expectancy (0.2 years) and a lower use of additional diagnostic procedures when compared with exercise electrocardiography (especially in lower risk patients). Using decision analysis, exercise echocardiography (Euro 2615/life year saved) was more cost effective than exercise electrocardiography. Conclusion Exercise echocardiography may enhance cost-effectiveness for the detection and management of at risk patients with known or suspected coronary disease. (C) 2003 Published by Elsevier Science Ltd on behalf of The European Society of Cardiology.

Genetic and environmental risk factors and their interactions for Parkinson's disease in a Chinese population

The interaction between genetic and environmental factors for PD was examined in a Chinese population. It was found that although the intron 2 MAOB (GT)(n) repeat polymorphism was not associated with PID in the population, a relationship might have been masked by the protective effect of tea drinking. In individuals who did not drink tea (<1 cup/day), the possession of short length less than or equal to 178 bp (GT), alleles conferred a borderline significant increased risk for PD (adjusted OR = 1.47; C.l. = 1.03-2. 1). As the extent of tea consumption increased, the association between the less than or equal to178 bp allele and PD disappeared. This result suggests that the MAOB gene may be associated with PD in Chinese if the putative protective effect of tea drinking is taken into account. The significance of this finding is unclear as the study may be limited because of its marginal significance and limited numbers. However, it does demonstrate the importance of considering putative positive and negative environmental risk factors in any examination of genetic risk factors for PD. (C) 2003 Elsevier Science Ltd. All rights reserved.

Idades e crescimento da cioba, Ocyururs chrysurus, da Costa Central do Brasil

A idade e o crescimento da cioba da costa central do Brasil foram estudados a partir de leituras de otólitos obtidos em amostragens mensais de desembarques comerciais, realizados nas cidades de Vitória e Vila Velha, entre os anos de 1998 e 1999. Através da análise do incremento marginal, foi verificada a formação anual de uma zona translúcida a partir do final do outono e durante o inverno. Foram observadas ciobas de 2 a 19 anos. Os comprimentos furcais (CF) médios retrocalculados variaram de 108 mm para idade 1 a 524 mm para idade 19. A equação de Von Bertalanffy ajustada aos CF médios retrocalculados foi CFt = 567,1 (1 - e -0.130 (t + 0.773)). A relação comprimento peso foi P = 2,68x10-5CF2.914, onde P = peso total em gramas. O crescimento é lento, com os incrementos anuais em peso aumentando gradativamente até atingir o máximo de 164 g entre as idades 7 e 8 anos. Os resultados deste trabalho indicam que a cioba tem longa expectativa de vida e baixas taxas de crescimento somático, características das espécies mais sensíveis à exploração pesqueira.

A narratividade do Hip Hop e suas interfaces com o contexto educacional

A presente tese de doutoramento em Educação aborda a cultura do Hip Hop e sua relação com o contexto educativo. Insere-se nas discussões da linha de pesquisa em Educação e Linguagens e problematiza o espaço escolar, enquanto espaço de reprodução da ideologia hegemônica, analisando o projeto “Escola de Rimas”, desenvolvido na Grande Vitória, como movimento de resistência e ressignificação cultural na escola. Parte da pergunta: Como as práticas discursivas do Hip Hop podem ressignificar o contexto escolar? A presente tese aborda a cultura do Hip Hop como campo discursivo singular de uma experiência narrativa (BENJAMIN, 1986; BONDÍA, 2001) e de uma subjetividade eticamente responsável (BAKHTIN, 1992a; 1992b; 2010), fundada no princípio da alteridade (PONZIO, 2009), e o analisa a partir de uma perspectiva crítica e dialógica (FREIRE, 1981; 1994; 1995; GIROUX, 1986; 1987; BRANDÃO, 1986; BAKHTIN, 1992a; 1992b; 2010). Desenvolve a pesquisa em um contexto limiar entre a escola e a cultura hip hop e dimensiona o debate das culturas marginais nos contextos educativos, voltando-se para os sujeitos e suas experiências narrativas, avaliando a interação de algumas de suas práticas discursivas com o processo de ensino-aprendizagem. Para isso, analisa o projeto cultural “Escola de Rimas”, criado pelos próprios ativistas do movimento hip hop da Grande Vitória e desenvolvido em uma escola da rede pública estadual de ensino do Espírito Santo, com o objetivo de discutir o seu papel em um processo de ressignificação educacional. Como hipótese de trabalho defende-se que o espaço escolar, como espaço de disputas, é ressignificado com a introdução de outras práticas discursivas e culturais, entre elas o hip hop, que aponta para a necessidade de ouvir responsiva e responsavelmente as narrativas dos educandos, contribuindo, assim, para a formação crítica desses sujeitos e enfrentando, ao mesmo tempo, práticas de exclusão historicamente instituídas.

Entre rios, praias e planetas : travessias do congo da Barra do Jucu

O Espírito Santo abriga grande diversidade de expressões populares tradicionais que se dividem em grupos, saberes e celebrações. Uma das práticas mais evidentes são as bandas de Congo que abrangem grande parte do Estado e ganham cada vez mais notoriedade. A Barra do Jucu é uma das comunidades mais antigas do Espírito Santo, uma vila de pescadores que séculos atrás compunha parte da grande fazenda Araçatiba fundada pelos Jesuítas e administrada no século XIX pelo coronel Sebastião Vieira Machado. A diversidade cultural dessa região habitada por africanos, indígenas e europeus, propiciou o surgimento de práticas populares como a Marujada, a Folia de Reis e as Bandas de Congo, que persistem até hoje nos municípios de Cariacica, Vila Velha, Guarapari e Viana, no passado, pertencentes à grande fazenda Araçatiba. A formação do Congo na Barra do Jucu é resultado de rodas informais realizadas por conguistas de comunidades ribeirinhas vizinhas, promovidas principalmente pelo senhor Ignácio Vieira Machado, descendente do coronel Sebastião e lideradas por Alcides Gomes da Silva, descendente de negros africanos e açorianos habitantes da fazenda Araçatiba. Durante muito tempo essa prática foi marginalizada, mas atualmente o Congo é considerado um ícone da cultura capixaba. Essa ressignificação está ligada a um processo de valorização e projeção midiática que se iniciou nos anos 1980 e se intensificou nas décadas seguintes. Boa parte dos movimentos e eventos que estimularam esse processo ocorreu na comunidade da Barra do Jucu. Por outro lado, políticos, empresários, indústria do entretenimento e outros setores sociais, aproveitam cada vez mais dessa ascensão do Congo utilizando os grupos tradicionais para fins lucrativos e promocionais. De prática marginal até se tornar ícone cultural, o Congo da Barra do Jucu passou por fazendas, rios, praias e planetas. E sobre essas travessias não só geográficas, mas sociais, culturais e políticas é que este trabalho pretende refletir, além das práticas tradicionais dos grupos e seus usos, buscando trazer à tona as relações entre conguistas, instituições públicas e privadas, mídia e público.