Lavage treatment of distal intestinal obstruction syndrome in children with cystic fibrosis

The efficacy, adverse reactions, and long-term effects of intestinal lavage treatment with a balanced electrolyte solution (Golytely) was evaluated in patients with cystic fibrosis and distal intestinal obstruction syndrome. Twenty-two patients with cystic fibrosis (mean age 21.8 years, range 14 to 34 years, 15 boys or men) who sough medical attention because of abdominal pain and a mass in the right iliac fossa received Golytely, 5.6 ± 1.9 L (mean ± 1 SD), either orally (n = 14) or via nasogastric tube (n = 8) during 5.6 ± 2.4 hours. No serious side effects occurred. Serum electrolyte values remained within normal limits. Body weight did not change significantly. Minor adverse reactions included bloating (n = 12), nausea (n = 8), vomiting (n = 1), and chills (n = 3). All but one patient reported impressive relief of symptoms and remained pain free for an average of 3 months (range 1 to 19 months). Symptoms of abdominal pain and radiologic signs of fecal impaction assessed before and after lavage both decreased significantly (P < .0001). During follow-up (mean 15.2 months, range 4 to 26 months), 11 patients required a total of 38 (range one to nine) additional doses of Golytely. Seven patients drank the solution at home (21 treatments); only two patients chose a nasogastric tube. In ten patients with symptoms of recurrent distal intestinal obstruction syndrome prior to institution of therapy, duration of hospitalization was significantly reduced by this treatment (5.1 ± 7.6 v 2.3 ± 6.3 hospital days per annum, P < .02). It is concluded that intestinal lavage is a well-accepted, safe, and effective therapy for distal intestinal obstruction syndrome in patients with cystic fibrosis.

Inconsistencies in and the inadequacies of the family counselling and FDR confidentiality and admissibility provisions: The need for reform

In this article the author discusses issues arising from counselling and family dispute resolution (FDR) in relation to confidentiality and admissibility, such as whether an admission of abuse to a child, or a threat to harm the other parent, can be disclosed by the counsellor or family dispute resolution practitioner (FDRP) and used in court proceedings. It is found that the admissibility provisions in the Family Law Act 1975 (Cth) are far more narrowly defined than the confidentiality requirements and have been interpreted strictly by the courts. There are competing policy considerations: the strict “traditionalist” approach, that people can have absolute faith in the integrity of counsellors and mediators and in the confidential nature of the process, must be balanced against a more “protectionist” stance, being the individual rights of victims to have all relevant information placed before the court and to be protected from violence and abuse. It is suggested that legislative reform is required to ensure that courts balance these considerations appropriately and don’t compromise the safety of victims of abuse and family violence.

Uskonto ilman uskontoa : Radikaalin postmodernin uskonnonfilosofian haaste

Religion without religion. The challenge of radical postmodern philosophy of religion. The aim of this study is to examine the central ideas of Mark C. Taylor, Don Cupitt, and Grace Jantzen on the subject of the philosophy of religion. The method is a qualitative, systematic analysis of the works of the aforementioned philosophers. The purpose is to present, analyze, identify, find connections, and to gain an understanding of the original texts. This thesis shows that radical postmodern religion is “religion without religion”. God is “dead” and the concept of God is seen as “writing”, an ideal, a relationship of meanings or a language. In ethics, there are no objective values or principles. People must create their own morality. Reality is each person´s concept of reality. Language is universal in that language and reality cannot be considered separately. The human subject is contingent and formed in the linguistic and social context. According to postmodern feminism, the ideas that men present as facts are often degrading to women, distort reality and support the power of men. For this reason, we should create a new kind of philosophy of religion and a new language that takes women into consideration. Finally, we will study some philosophers, who have used postmodern ideas in a more moderate manner. In this way, we will look for a balanced solution between modernism and postmodernism. This study shows that the postmodern idea of religion is very different from classical Christianity. Ethics becomes subjective, anarchistic and nihilistic. Epistemology is relativistic and the human being becomes the measure of all things. Objective reality becomes blurry. Language is seen to be game-like, and it has no relation to reality. The moral responsibility of a subject becomes problematic. Science and rationality come into question without the permanent core provided by our consciousness. Women are not in an epistemologically privileged position. The truth claims by either men or women must each be evaluated one at a time. Many postmodern ideas can successfully be made of use if used in moderate manner.

Prolonged hyperinsulinemia affects metabolic signal transduction markers in a tissue specific manner

Insulin dysregulation is common in horses although the mechanisms of metabolic dysfunction are poorly understood. We hypothesized that insulin signaling in striated (cardiac and skeletal) muscle and lamellae may be mediated through different receptors as a result of receptor content, and that transcriptional regulation of downstream signal transduction and glucose transport may also differ between tissues sites during hyperinsulinemia. Archived samples from horses treated with a prolonged insulin infusion or a balanced electrolyte solution were used. All treated horses developed marked hyperinsulinemia and clinical laminitis. Protein expression was compared across tissues for the insulin receptor and insulin-like growth factor 1 receptor (IGF-1R) by immunoblotting. Gene expression of metabolic insulin-signaling markers (insulin receptor substrate 1, Akt2, and glycogen synthase kinase 3 beta [GSK-3β]) and glucose transport (basal glucose transporter 1 and insulin-sensitive glucose transporter 4) was evaluated using real-time reverse transcription polymerase chain reaction. Lamellar tissue contained significantly more IGF-1R protein than skeletal muscle, indicating the potential significance of IGF-1R signaling for this tissue. Gene expression of the selected markers of insulin signaling and glucose transport in skeletal muscle and lamellar tissues was unaffected by prolonged hyperinsulinemia. In contrast, the significant upregulation of Akt2, GSK-3β, GLUT1, and GLUT4 gene expression in cardiac tissue suggested that the prolonged hyperinsulinemia induced an increase in insulin sensitivity and a transcriptional activation of glucose transport. Responses to insulin are tissue-specific, and extrapolation of data across tissue sites is inappropriate.

Post-industrial Intervention : An Activity-Theoretical Expedition Tracing the Proximal Development of Forms of Conducting Interventions

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Issues in socially desirable responding and personality research

The four studies presented in this dissertation were designed to examine the influence of socially desirable responding (SDR) on personality research outcomes. The assessment of personality relies heavily on the use of self-report questionnaires. Their validity could be threatened by people being dishonest in their self-descriptions and ascribing more desirable traits to themselves than would be warranted by their behaviour. Scales designed to detect SDR have been around for half a century, but their status continues to be debated. Paulhus (1991) Balanced Inventory of Desirable Responding (BIDR) is perhaps the most prominent of the scales developed to distinguish between those individuals who have distorted their responses and those who have not. The first two studies included in this dissertation mostly deal with the properties of the BIDR. The other two studies are less focused on SDR scales and investigate, more generally, the potential effects of SDR on two phenomena that are of central interest to the general personality discourse personality stability over time and volunteering as participants in psychological research. The data of Studies I and II showed that Paulhus BIDR scales, designed to be indicators of SDR, are not pure measures both the communion management and self-deceptive enhancement scales are, at once, measures of response bias and measures of more substantive individual differences in behaviour. The data further suggested that the communion management and self-deceptive enhancement scales of the BIDR are somewhat accurate measures of communal and agentic bias, respectively. No evidence for a suppressor model of SDR, and only weak evidence for a moderator model, was found in those studies. Concerning research on personality stability, some data in Study I suggested that SDR may add reliable and common variance to a personality questionnaire administered at two different points in time, thus artificially inflating the test-retest correlation of that questionnaire. Furthermore, Study III demonstrated that the maturity-stability hypothesis may be in part, but not entirely, a product of SDR. Study IV suggested that some of the observed personality differences between research volunteers and nonvolunteers may be due to heightened SDR of volunteers. However, those personality differences were by no means exclusively attributable to differences in SDR. In sum, the work presented in this thesis reveals some ambiguity regarding the effects of SDR on personality research, as is true of much of the previous research on SDR. Clear-cut conclusions are difficult to reach, as the data were neither fully consistent with the view that SDR can be ignored, nor with the view that SDR needs to be controlled in some way. The struggle to understand the influence of SDR on personality research continues.

Energetics of the condensed ternary fuel-oxidizer systems

the heats of reaction of an oxygen-balanced ternary fuel-oxidizer system have been shown to be linearly related to the total oxidizing valences (P0) of the composition. Because calculation of P0 is simple, the method is found to help in evaluating the energetics of such systems. The accuracy of the method when applied to various ternary systems has been discussed.

The performance of irrigated mixtures of tall fescue, ryegrass and white clover in subtropical Australia. 2. The effects on yield and botanical composition of managing for quality.

The effects on yield, botanical composition and persistence, of using a variable defoliation schedule as a means of optimising the quality of the tall fescue component of simple and complex temperate pasture mixtures in a subtropical environment was studied in a small plot cutting experiment at Gatton Research Station in south-east Queensland. A management schedule of 2-, 3- and 4-weekly defoliations in summer, autumn and spring and winter, respectively, was imposed on 5 temperate pasture mixtures: 2 simple mixtures including tall fescue (Festuca arundinacea) and white clover (Trifolium repens); 2 mixtures including perennial ryegrass (Lolium perenne), tall fescue and white clover; and a complex mixture, which included perennial ryegrass, tall fescue, white, red (T. pratense) and Persian (T. resupinatum) clovers and chicory (Cichorium intybus). Yield from the variable cutting schedule was 9% less than with a standard 4-weekly defoliation. This loss resulted from reductions in both the clover component (13%) and cumulative grass yield (6%). There was no interaction between cutting schedule and sowing mixture, with simple and complex sowing mixtures reacting in a similar manner to both cutting schedules. The experiment also demonstrated that, in complex mixtures, the cutting schedules used failed to give balanced production from all sown components. This was especially true of the grass and white clover components of the complex mixture, as chicory and Persian clover components dominated the mixtures, particularly in the first year. Quality measurements (made only in the final summer) suggested that variable management had achieved a quality improvement with increases in yields of digestible crude protein (19%) and digestible dry matter (9%) of the total forage produced in early summer. The improvements in the yields of digestible crude protein and digestible dry matter of the tall fescue component in late summer were even greater (28 and 19%, respectively). While advantages at other times of the year were expected to be smaller, the data suggested that the small loss in total yield was likely to be offset by increases in digestibility of available forage for grazing stock, especially in the critical summer period.

The Development of the Concept of Music Education in Estonian Kindergartens, 1905-2008 : a Historical–Critical Overview

The dissertation focuses on the development of music education in Estonian kindergartens and the factors influencing it, analysed in the historical perspective relying on post-positivist paradigm. The study is based on the factors and subjects’ views on kindergarten music education from 1905 to 2008, recorded in written sources or ascertained by means of questionnaire and interview. The dissertation deals with music’s functions, music education in retrospective, factors influencing child’s musical aptitude and development and teacher’s role in it through the prism of history. The formation of Estonian kindergarten music education and the phenomenon of its development have been researched by stages: the first manifestations of music in kindergarten in 1905 - 1940; the formation of the concept of music education in 1941 - 1967 and the application of a unified system in 1968 - 1990. The work also outlines innovative trends in music education at the end of the last millennium and the beginning of this century, in 1991 - 2008. The study relies on a combined design and an analysis of historical archival material and empirical data. The empirical part of the study is based on the questionnaire (n=183) and interviews (n=18) carried out with kindergarten music teachers. The data has been analysed using both qualitative and quantitative methods. The subject of the research is the content and activity types of kindergarten music education and the role of music teacher in their implementation. The study confirmed that fundamental changes took place in Estonian kindergarten music education due to the change in political power in the 1940s. Following the example of the Soviet system of education, music in kindergarten became an independent music educational orientation and the position of a professionally trained music teacher was established (1947). It was also confirmed that in the newly independent Estonian Republic under the influence of innovative trends a new paradigm of music education arose from the traditional singing-centred education towards the more balanced use of music activity types (attaching importance to the child-centred approach, an increase in the number and variety of activity types). The most important conclusions made in the dissertation are that there has been improvement and development deriving from contemporary trends in the clear concept that has evolved in Estonian kindergarten music education over a century; professionally trained music teachers have had a crucial role in shaping it; and kindergarten music education is firmly positioned as a part of preschool education in Estonian system of education. Key words: early childhood music education, history of music education, kindergarten music education, early childhood music teachers

Do UNESCO Schools in Finland Prepare Their Students for the Future? : A Study of Their School-based Curriculums

The purpose of the research was to study how Finnish lower-stage schools participating in the international network of UNESCO schools, also called the Associated Schools Project (ASP), prepare their students for the future at the level of their school-based curriculums. In the research, the future trends were discussed, and the importance of their consideration in educational practice was explained from a global viewpoint: Based on the examination of today's problematic world state, and development trends characterized by globalization, the challenges and demands set for schooling and education in the future were discussed. Understanding the significance of an individual's action and responsibility was considered to be the central resource for building a more just and sustainable future. The study was grounded on a theoretical model developed by the researcher, which combined the models of Dalin & Rust (1996) and UNESCO (Delors et al. 1996) about future-oriented learning. The model consists of four basic elements of curriculum; "Nature", "Culture", "Myself", and "Others", and four dimension of learning; "Learning to know", "Learning to do", "Learning to live together" and "Learning to be". The model represents the holistic aspect of educational theory, and its aim is to maintain a balance between its different components. The research material composed of ten lower-stage UNESCO schools' school-based curriculums. They were analyzed using the theoretical model by the methology of content analysis. The research results were notably consistent between the different schools. They showed cultural learning and learning concerned with "myself" to be clearly more emphasized than learning referring to nature and other people. In addition, they reflected the central position of subjects, knowledge and skills, thus leaving the development of the pupils' personalities, and particularly learning concerned with living with other people, in a marginal role. The question about whether the schools prepare for the future interms of their curriculums, was discussed in the light of the results. The research offered a way and a model to approach the relationship between education and the future, and to evaluate schools' future-orientation. Based on the results, the schools are suggested to lay more stress on learning concerned with nature and other people, and focus more on developing the mental capasities of their pupils and competencies they need for living with other people. Above all, what the present societies require of schools is education which produces balanced and broadly aware human beings who have the mental strength to face the challenges of the future and abilities to direct it along the lines they desire. Keywords: future, curriculum, content analysis

Nitrogen use for high productivity and sustainability in cashew.

Interest in cashew production in Australia has been stimulated by domestic and export market opportunities and suitability of large areas of tropical Australia. Economic models indicate that cashew production is profitable at 2.8 t ha-1 nut-in-shell (NIS). Balanced plant nutrition is essential to achieve economic yields in Australia, with nitrogen (N) of particular importance because of its capacity to modify growth, affect nut yield and cause environmental degradation through soil acidification and off-site contamination. The study on a commercial cashew plantation at Dimbulah, Australia, investigated the effect of N rate and timing on cashew growth, nut production, N leaching and soil chemical properties over five growth cycles (1995-1999). Nitrogen was applied during the main periods of vegetative (December-April) and reproductive (June-October) growth. Commercial NIS yields (up to 4.4 t ha-1 from individual trees) that exceeded the economic threshold of 2.8 t ha-1 were achieved. The yield response was mainly determined by canopy size as mean nut weight, panicle density and nuts per panicle were largely unaffected by N treatments. Nitrogen application confined to the main period of vegetative growth (December-April) produced a seasonal growth pattern that corresponded most consistently with highest NIS yield. This N timing also reduced late season flowering and undesirable post-November nut drop. Higher yields were not produced at N rates greater than 17 g m-2 of canopy surface area (equating to 210 kg N ha-1 for mature size trees). High yields were attained when N concentrations in Mveg leaves in May-June were about 2%, but this assessment occurs at a time when it is not feasible to correct N deficiency. The Mflor leaf of the preceding November, used in conjunction with the Mveg leaf, was proposed as a diagnostic tool to guide N rate decisions. Leaching of nitrate-N and acidification of the soil profile was recorded to 0.9 m. This is an environmental and sustainability hazard, and demonstrates that improved methods of N management are required.

Utilisation of local ingredients in commercial pig feeds

The long-term competitiveness of the both the Vietnamese feed and pig production industries are constrained and under pressure whilst the industry is dependent on the use of imported feed ingredients in diets for animal production. These cost pressures are a result of import taxes, transport costs, currency fluctuations and feed supply limitations. By undertaking studies on available resources which are currently under-utilised and with potential as local feeds, we can prove their suitability for use as feedstuffs in pig diets and as replacements for imported feed ingredients. In undertaking this process we can lower feeding costs for pig production in Vietnam by the use of local feeds which are cheaper, generate new industries in Vietnam harvesting or processing these feeds and increase the incomes of Vietnamese workers who are involved in producing these by-products. Our project has shown that rubber seed, when processed correctly to lower the hydrogen cyanide content, is a safe and suitable protein meal feedstuff for use in pig diets with the potential to replace significant quantities of imported soybean and fishmeal in Vietnamese pig diets as long as diets are balanced for any amino acid shortfalls. Our peanut studies have shown that use of binders can help alleviate pig production problems with aflatoxin content in peanut meals. Further work is needed to characterise the fate of the bound aflatoxin to see if there is any meat residue risk. Cassava residue is a resultant by-product from starch extraction in both large and small cassava processing factories. Sub-samples from these two mill types were collected and evaluated for residue HCN. Analyses has shown that the processing and sun drying results in a product with relatively consistent low HCN content. Chemical analyses also reveal that significant residual starch also remains in this by-product. Digestibility studies and pig performance feeding studies have shown that cassava residue can be included in diets at 30% with no adverse effect, although the higher fibre content of this product means that strategically, cassava residue is more suitably used in finisher and sow diets. Research has examined the digestible energy content of a number of sunflower meal types available in Australia and identified major differences in their energy value based on processing, additionally, amino acid analysis has shown a significantly lower lysine content than previous reported. We also examined the digestible energy content of a number of Australian stylo forage legume harvest batches and identified the differences in their energy value based on age/harvest time of the forage legume. Analysis results of various stylo cuts showed that the early cut stylo has a higher starch content and lower fibre fraction content than observed in late and recut stylo which were allowed to grow longer. As a result the faecal digestible energy content was higher for the early cut stylo than for the subsequent cut stylo material which had been allowed to become woody. The results have shown that feeding of stylo meal does provide some nutritive value to the pig with increased energy and nitrogen supply, with a portion of the nitrogen presented which the pig is able to retain. Based on nutrient and fibre content stylo could have a useful role in sow feeding and satiety under non-stall housing situations. With increasing Vietnamese investment in rubber production seen with larger areas under plantations the amounts of rubber seed available for animal feeding will grow significantly over the next 15 years and the importance of the by-product ie rubber seed meal as a protein source in diets for Vietnamese pigs.

Early-onset depressive disorders,related mental health disorders and substance use-A prospective : longitudinal study of Finnish twins born 1983-1987

Early-onset psychiatric illnesses effects scatter to academic achievements as well as functioning in familial and social environments. From a public health point of view, depressive disorders are the most significant mental health disorders that begin in adolescence. Using prospective and longitudinal design, this study aimed to increase the understanding of early-onset depressive disorders, related mental health disorders and developing substance use in a large population-derived sample of adolescent Finnish twins. The participants of this study, FinnTwin12, an ongoing longitudinal population-based study, came from Finnish families with twins born in 1983-87 (exhaustive of five birth cohorts, identified from Finland s Central Population Register). With follow-up ongoing at age 20-24, this thesis assessed adolescent mental health in the first three waves, starting from baseline age 11-12 to follow-ups at age 14 and 17½. Some 5600 twins participated in questionnaire assessments of a wide range of health related behaviors. Mental health was further assessed among an intensively studied subsample of 1852 adolescents, who completed also professionally administered interviews at age 14, which provided data for full DSM-IV/III-R (Diagnostic and Statistical Manual for Mental Health disorders, 4th and 3rd editions) diagnoses. The participation rates of the study were 87-92%. The results of the study suggest, that the diagnostic criteria for major depressive disorder (MDD) may not capture youth with clinically significant early-onset depressive conditions outside clinical settings. Milder cases of depression, namely adolescents fulfilling the diagnostic criteria for minor depressive disorder, a qualitatively similar condition to MDD with fewer symptoms are also associated with marked suicidal thoughts, plans and attempts, recurrences and a high degree of comorbidity. Prospectively and longitudinally, early-onset depressive disorders were of substantial importance in the context of other mental health disorders and substance use behaviors: These data from a large population-derived sample established a substantial overlap between early-onset depressive disorders and attention deficit hyperactivity disorder in adolescent females, both of them significantly predictive for development of substance use among girls. Only in females baseline DSM-IV ADHD symptoms were strong predictors of alcohol abuse and dependence and illicit drug use at age 14 and frequent alcohol use and illicit drug use at age 17.½ when conduct disorder and previous substance use were controlled for. Early-onset depressive disorders were also prospectively and longitudinally associated to daily smoking behavior, smokeless tobacco use, frequent alcohol use and illicit drug use and eating disorders. Analysis of discordant twins suggested that these predictive associations were independent of familial confounds, such as family income, structure and parental models. In sum, early-onset depressive disorders predict subsequent involvement of substance use and psychiatric morbidity. A heightened risk for substance use is substantial also among those depressed below categorical diagnosis of MDD. Whether early recognition and interventions among these young people hold potential for substance use prevention further in their lives has potential public health significance and calls for more research. Data from this population-derived sample with balanced representation of boys and girls, suggested that boys and girls with ADHD behaviors may differ from each other in their vulnerability to substance use and depressive disorders: the data suggest more adverse substance use outcome for girls that was not attenuated by conduct disorder or previous substance use. Further, the prospective associations of early-onset depressive disorders and future elevated levels of addictive substance use is not explained by familial factors supporting future substance use, which could have important implications for substance use prevention.

Routine Measurement of Health-Related Quality of Life in Assessing Cost-Effectiveness in Secondary Health Care

Aims: The aims of this study were 1) to identify and describe health economic studies that have used quality-adjusted life years (QALYs) based on actual measurements of patients' health-related quality of life (HRQoL); 2) to test the feasibility of routine collection of health-related quality of life (HRQoL) data as an indicator of effectiveness of secondary health care; and 3) to establish and compare the cost-utility of three large-volume surgical procedures in a real-world setting in the Helsinki University Central Hospital, a large referral hospital providing secondary and tertiary health-care services for a population of approximately 1.4 million. Patients and methods: So as to identify studies that have used QALYs as an outcome measure, a systematic search of the literature was performed using the Medline, Embase, CINAHL, SCI and Cochrane Library electronic databases. Initial screening of the identified articles involved two reviewers independently reading the abstracts; the full-text articles were also evaluated independently by two reviewers, with a third reviewer used in cases where the two reviewers could not agree a consensus on which articles should be included. The feasibility of routinely evaluating the cost-effectiveness of secondary health care was tested by setting up a system for collecting HRQoL data on approximately 4 900 patients' HRQoL before and after operative treatments performed in the hospital. The HRQoL data used as an indicator of treatment effectiveness was combined with diagnostic and financial indicators routinely collected in the hospital. To compare the cost-effectiveness of three surgical interventions, 712 patients admitted for routine operative treatment completed the 15D HRQoL questionnaire before and also 3-12 months after the operation. QALYs were calculated using the obtained utility data and expected remaining life years of the patients. Direct hospital costs were obtained from the clinical patient administration database of the hospital and a cost-utility analysis was performed from the perspective of the provider of secondary health care services. Main results: The systematic review (Study I) showed that although QALYs gained are considered an important measure of the effectiveness of health care, the number of studies in which QALYs are based on actual measurements of patients' HRQoL is still fairly limited. Of the reviewed full-text articles, only 70 reported QALYs based on actual before after measurements using a valid HRQoL instrument. Collection of simple cost-effectiveness data in secondary health care is feasible and could easily be expanded and performed on a routine basis (Study II). It allows meaningful comparisons between various treatments and provides a means for allocating limited health care resources. The cost per QALY gained was 2 770 for cervical operations and 1 740 for lumbar operations. In cases where surgery was delayed the cost per QALY was doubled (Study III). The cost per QALY ranges between subgroups in cataract surgery (Study IV). The cost per QALY gained was 5 130 for patients having both eyes operated on and 8 210 for patients with only one eye operated on during the 6-month follow-up. In patients whose first eye had been operated on previous to the study period, the mean HRQoL deteriorated after surgery, thus precluding the establishment of the cost per QALY. In arthroplasty patients (Study V) the mean cost per QALY gained in a one-year period was 6 710 for primary hip replacement, 52 270 for revision hip replacement, and 14 000 for primary knee replacement. Conclusions: Although the importance of cost-utility analyses has during recent years been stressed, there are only a limited number of studies in which the evaluation is based on patients own assessment of the treatment effectiveness. Most of the cost-effectiveness and cost-utility analyses are based on modeling that employs expert opinion regarding the outcome of treatment, not on patient-derived assessments. Routine collection of effectiveness information from patients entering treatment in secondary health care turned out to be easy enough and did not, for instance, require additional personnel on the wards in which the study was executed. The mean patient response rate was more than 70 %, suggesting that patients were happy to participate and appreciated the fact that the hospital showed an interest in their well-being even after the actual treatment episode had ended. Spinal surgery leads to a statistically significant and clinically important improvement in HRQoL. The cost per QALY gained was reasonable, at less than half of that observed for instance for hip replacement surgery. However, prolonged waiting for an operation approximately doubled the cost per QALY gained from the surgical intervention. The mean utility gain following routine cataract surgery in a real world setting was relatively small and confined mostly to patients who had had both eyes operated on. The cost of cataract surgery per QALY gained was higher than previously reported and was associated with considerable degree of uncertainty. Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is two-fold compared to hip replacement. Cost-utility results from the three studied specialties showed that there is great variation in the cost-utility of surgical interventions performed in a real-world setting even when only common, widely accepted interventions are considered. However, the cost per QALY of all the studied interventions, except for revision hip arthroplasty, was well below 50 000, this figure being sometimes cited in the literature as a threshold level for the cost-effectiveness of an intervention. Based on the present study it may be concluded that routine evaluation of the cost-utility of secondary health care is feasible and produces information essential for a rational and balanced allocation of scarce health care resources.

Smart sorbers - value adding spent litter fertiliser. A pilot trial

Currently spent litter is not a balanced fertiliser. This project is a first step in improving the ability to reduce environmental contamination and to more fully realise the full fertilizer and soil amendment value of this material.