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.

DAQ339A Pest and disease identification and management in herbs

The major objective is to produce an educational tool for growers and research/extension personnel to allow accurate identification of a range of pests and diseases encountered in herbs. To a lessor extent develop both a mechanism to manage beneficial insects in field crops pre-harvest and to identify some common seed borne diseases in herbs.

Cancer survivors at work : Work-related problems and factors associated with their employment, work ability and social support from the work community

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are willing to return to work after their treatment. It is generally believed, however, that people with cancer are either unemployed, stay at home, or retire more often than people without cancer. This study investigated the problems that cancer survivors experience on the labour market, as well as the disease-related, sociodemographic and psychosocial factors at work that are associated with the employment and work ability of cancer survivors. The impact of cancer on employment was studied combining the data of Finnish Cancer Registry and census data of the years 1985, 1990, 1995 or 1997 of Statistics Finland. There were two data sets containing 46 312 and 12 542 people with cancer. The results showed that cancer survivors were slightly less often employed than their referents. Two to three years after the diagnosis the employment rate of the cancer survivors was 9% lower than that of their referents (64% vs. 73%), whereas the employment rate was the same before the diagnosis (78%). The employment rate varied greatly according to the cancer type and education. The probability of being employed was greater in the lower than in the higher educational groups. People with cancer were less often employed than people without cancer mainly because of their higher retirement rate (34% vs. 27%). As well as employment, retirement varied by cancer type. The risk of retirement was twofold for people having cancer of the nervous system or people with leukaemia compared to their referents, whereas people with skin cancer, for example, did not have an increased risk of retirement. The aim of the questionnaire study was to investigate whether the work ability of cancer survivors differs from that of people without cancer and whether cancer had impaired their work ability. There were 591 cancer survivors and 757 referents in the data. Even though current work ability of cancer survivors did not differ between the survivors and their referents, 26% of cancer survivors reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organization, or a good social climate at work, reported impairment less frequently. The aim of the other questionnaire study containing 640 people with the history of cancer was to examine extent of social support that cancer survivors needed, and had received from their work community. The cancer survivors had received most support from their co-workers, and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). More support was especially needed by men who had lymphoma, had received chemotherapy or had a low education level. The results of this study show that the majority of the survivors are able to return to work. There is, however, a group of cancer survivors who leave work life early, have impaired work ability due to their illness, and suffer from lack of support from their work place and the occupational health services. Treatment-related, as well as sociodemographic factors play an important role in survivors' work-related problems, and presumably their possibilities to continue working.

Wisdom in the military context

On the basis of the Berlin wisdom paradigm, we define wisdom in the military context as expert knowledge and judgment concerning in extremis military operations. We measured wisdom in the military context by asking participants to give advice to an inexperienced officer facing an in extremis operation; subsequently, we coded their responses. Data were provided by 74 senior noncommissioned officers (NCOs) in the U.S. defense forces. In support of convergent validity, wisdom in the military context was positively related to general objective wisdom and general self-assessed wisdom. Relationships of wisdom in the military context and general objective wisdom with Big Five personality characteristics were nonsignificant, whereas general self-assessed wisdom was positively related to extraversion, agreeableness, and openness to experience, and it was negatively related to neuroticism. The findings provide initial support for the validity of the new wisdom in the military context measure. We discuss several implications for future research and practice regarding wisdom in the military context.

Estimating Resource Requirements to Staff a Response to a Medium to Large Outbreak of Foot and Mouth Disease in Australia

A recent report to the Australian Government identified concerns relating to Australia's capacity to respond to a medium to large outbreak of FMD. To assess the resources required, the AusSpread disease simulation model was used to develop a plausible outbreak scenario that included 62 infected premises in five different states at the time of detection, 28 days after the disease entered the first property in Victoria. Movements of infected animals and/or contaminated product/equipment led to smaller outbreaks in NSW, Queensland, South Australia and Tasmania. With unlimited staff resources, the outbreak was eradicated in 63 days with 54 infected premises and a 98% chance of eradication within 3 months. This unconstrained response was estimated to involve 2724 personnel. Unlimited personnel was considered unrealistic, and therefore, the course of the outbreak was modelled using three levels of staffing and the probability of achieving eradication within 3 or 6 months of introduction determined. Under the baseline staffing level, there was only a 16% probability that the outbreak would be eradicated within 3 months, and a 60% probability of eradication in 6 months. Deployment of an additional 60 personnel in the first 3 weeks of the response increased the likelihood of eradication in 3 months to 68%, and 100% in 6 months. Deployment of further personnel incrementally increased the likelihood of timely eradication and decreased the duration and size of the outbreak. Targeted use of vaccination in high-risk areas coupled with the baseline personnel resources increased the probability of eradication in 3 months to 74% and to 100% in 6 months. This required 25 vaccination teams commencing 12 days into the control program increasing to 50 vaccination teams 3 weeks later. Deploying an equal number of additional personnel to surveillance and infected premises operations was equally effective in reducing the outbreak size and duration.

Australia's newest quarantine for biological control

The paper describes the QC3 quarantine facility and supporting infrastructure which were purpose built for weed biological control at the Ecosciences Precinct. The quarantine is one of two new weed quarantine facilities in Australia and will service northern Australia. An account of the sharing philosophy between CSIRO and the Queensland Government and the necessity of working very closely with architects, project managers, builders and quarantine personnel is also given. This philosophy contributed to certification of the facility without any undue delays.

Seligman Solomon Society records 1912-1922

Contains minutes of Meetings (May 1918; May 1921), bulletins, official reports, 25th Anniversary Journal, photographs, and correspondence (May 1917-May 1922), particularly concerning the organization's social and philanthropic activities. Much of the correspondence is with Jewish personnel serving in the armed forces during and after World War I (1918-1919).

Milton Weill papers, 1918-1950.

Contains correspondence, memoranda, speeches, etc. to various departments on the National Jewish Welfare Board, the Anti-Defamation League, and the Jewish War Veterans of the U.S. relating to Jewish personnel in the U.S. Armed Forces during World War II and concerned with public relations, anti-Semitism and discrimination, the chaplaincy, etc.; includes also published articles and radio addresses for the same period and extensive correspondence with Rabbi Milton Steinberg from 1946 to 1950, as well as material by and about Rabbi Steinberg. The collection also contains personal family correspondence while Weill was serving overseas during World War I, memorabilia and a scrapbook relating to these military experiences, and undated typescript copies of dramatic sketches.

Lt. Colonel Rachel (Rae) Diane Landy papers undated, 1913-2000

Rachel Diane Landy Papers consist of correspondence, reminiscences, legal documents, journal, newspaper and magazine articles and color Xerox copies of photographs as well as original photographs. This collection is of value to researchers studying the history of Hadassah and the living conditions and state of medical care in Palestine during the second decade of the 20th century. It is also of interest to researchers studying women in America during the first half of the 20th century who were able to pursue a challenging and productive career and become a leader and innovator in their chosen field. In addition it will be of interest to those researching the graduates of the Cleveland public and professional schools at the end of the 19th and beginning of the 20th centuries, and the Cleveland Jewish community and the George Crile U.S. Army Hospital in Cleveland during the 1940's.

Intranet Alman käytettävyydestä

Usability testing is a productive and reliable method for evaluating the usability of software. Planning and implementing the test and analyzing its results is typically considered time-consuming, whereas applying usability methods in general is considered difficult. Because of this, usability testing is often priorized lower than more concrete issues in software engineering projects. Intranet Alma is a web service, users of which consist of students and personnel of the University of Helsinki. Alma was published in 2004 at the opening ceremony of the university. It has 45 000 users, and it replaces several former university network services. In this thesis, the usability of intranet Alma is evaluated with usability testing. The testing method applied has been lightened to make its taking into use as easy as possible. In the test, six students each tried to solve nine test tasks with Alma. As a result concrete usability problems were described in the final test report. Goal-orientation was given less importance in the applied usability testing. In addition, the system was tested only with test users from the largest user group. Usability test found general usability problems that occurred no matter the task or the user. However, further evaluation needs to be done: in addition to the general usability problems, there are task-dependent problems, solving of which requires thorough gathering of users goals. In the basic structure and central functionality of Alma, for example in navigation, there are serious and often repeating usability problems. It would be of interest to verify the designed user interface solutions to these problems before taking them into use. In the long run, the goals of the users, that the software is planned to support, are worth gathering, and the software development should be based on these goals.

Legacies of War--[Ten percent terror]

Ten Percent Terror brings together leading creatives from the fields of contemporary theatre, contemporary dance, music theatre, circus and digital arts in the first collaboration of its kind. Commissioned by Brisbane Powerhouse, with support from the Anzac Centenary Arts and Culture Fund and in partnership with Dancenorth and Company 2, this is an inter-disciplinary work that combines theatrical narrative with eloquent physicality, through circus and dance, to express certain truths of the soldiers' experience. This production will be a circus-narrative that uses the form and language of circus to express the key themes of risk, panic and brotherhood. Ten Percent Terror is intended to be a work of scale, yet also intimacy: of stillness and panic, inertia and chaos. Project partners, Dancenorth and Company 2, share the vision to use contemporary artistic disciplines to connect younger and modern audiences to the ANZAC legacy, perhaps offering a connection for those audiences that they may not find through more traditional art forms. The development process has included a community research project in Townsville, conducted by Shane Pike, which explored contemporary Australians’ stories through interviews with serving military personnel and the local community, as well as collecting photographic documentation and other artefacts from around Townsville. This was followed by an archival research project in Brisbane, where Pike reviewed letters, photographs and personal accounts of soldiers from WW1. The results of these projects will be used by the creative team to inform the development of Ten Percent Terror. Given Townsville’s reputation as Australia’s ‘garrison’ city, the project partners plan to deliver the world premiere performance of Ten Percent Terror in Townsville in late 2015. It is intended that Ten Percent Terror will receive its Brisbane premiere in November 2015 at Brisbane Powerhouse, as part of a four-performance season. This expert panel included discussion of the project and its place in analysing key aspects of Australia's wartime history.

Development of a robust framework for an outdoor mobile manipulation UAV

There is a growing interest to autonomously collect or manipulate objects in remote or unknown environments, such as mountains, gullies, bush-land, or rough terrain. There are several limitations of conventional methods using manned or remotely controlled aircraft. The capability of small Unmanned Aerial Vehicles (UAV) used in parallel with robotic manipulators could overcome some of these limitations. By enabling the autonomous exploration of both naturally hazardous environments, or areas which are biologically, chemically, or radioactively contaminated, it is possible to collect samples and data from such environments without directly exposing personnel to such risks. This paper covers the design, integration, and initial testing of a framework for outdoor mobile manipulation UAV. The framework is designed to allow further integration and testing of complex control theories, with the capability to operate outdoors in unknown environments. The results obtained act as a reference for the effectiveness of the integrated sensors and low-level control methods used for the preliminary testing, as well as identifying the key technologies needed for the development of an outdoor capable system.

Development and evaluation of a spatial decision support system for malaria elimination in Bhutan

Background: Bhutan has reduced its malaria incidence significantly in the last 5 years, and is aiming for malaria elimination by 2016. To assist with the management of the Bhutanese malaria elimination programme a spatial decision support system (SDSS) was developed. The current study aims to describe SDSS development and evaluate SDSS utility and acceptability through informant interviews. Methods: The SDSS was developed based on the open-source Quantum geographical information system (QGIS) and piloted to support the distribution of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in the two sub-districts of Samdrup Jongkhar District. It was subsequently used to support reactive case detection (RACD) in the two sub-districts of Samdrup Jongkhar and two additional sub-districts in Sarpang District. Interviews were conducted to ascertain perceptions on utility and acceptability of 11 informants using the SDSS, including programme and district managers, and field workers. Results: A total of 1502 households with a population of 7165 were enumerated in the four sub-districts, and a total of 3491 LLINs were distributed with one LLIN per 1.7 persons. A total of 279 households representing 728 residents were involved with RACD. Informants considered that the SDSS was an improvement on previous methods for organizing LLIN distribution, IRS and RACD, and could be easily integrated into routine malaria and other vector-borne disease surveillance systems. Informants identified some challenges at the programme and field level, including the need for more skilled personnel to manage the SDSS, and more training to improve the effectiveness of SDSS implementation and use of hardware. Conclusions: The SDSS was well accepted and informants expected its use to be extended to other malaria reporting districts and other vector-borne diseases. Challenges associated with efficient SDSS use included adequate skills and knowledge, access to training and support, and availability of hardware including computers and global positioning system receivers.

Hospital-related fears and coping strategies in 4-6-year-old children

There is only little information available on the 4-6-year-old child s hospital-related fears, and on the coping with such fears, as expressed by the children themselves. However, previous data collected from parents and hospital personnel indicate that hospitalization is an anxiety-producing experience for young children. The purpose of this study was to describe the experience of hospital-related fears and the experience of coping with hospital-related fears of 4-6-year-old children. The aim of this study was to form a descriptive model of the subjective experience of hospital-related fears and coping strategies of 4-6-year old children. The data were collected by interviewing 4-6-year-old children from a hospital and kindergarten settings in Finland from 2004 to 2006. Ninety children were interviewed in order to describe the hospital-related fear and the experience of fear, and 89 to describe their coping with the fear and the experience of coping. The children were chosen through purposive sampling. The data were gathered by semi-structured interview, supported by pictures. The data about hospital-related fears and on strategies for coping with hospital-related fears were reviewed by qualitative and quantitative methods. The experience of hospital-related fears and coping with these fears were analyzed using Colaizzi s Method of Phenomenological Analysis. The results revealed that more than 90 % of the children said they were afraid of at least one thing in hospital. Most of the fears could be categorized as nursing interventions, fears of being a patient, and fears caused by the developmental stage of the child. Children interviewed in the hospital expressed substantially more fears than children interviewed in kindergarten. Children s meanings of hospital-related fears were placed into four main clusters: 1) insecurity, 2) injury, 3) helplessness, 4) and rejection. The results also showed that children have plenty of coping strategies, to deal with their fears, especially such strategies in which the children themselves play an active role. Most often mentioned coping strategies were 1) the presence of parents and other family members, 2) the help of the personnel, 3) positive images and humour, 4) play, and 5) the child s own safety toy. The children interviewed in the hospital mentioned statistically significantly more often play, positive imagination and humour as their coping strategy than children interviewed in kindergarten. The meaning of coping with hospital fears consisted of six clusters: pleasure, security, care, understanding the meaning of the situation participating, and protecting oneself. Being admitted to a hospital is an event which may increase the fears of a 4-6-year-old child. Children who have personal experience of being admitted to a hospital describe more fears than healthy children in kindergarten. For young children, hospital-related fear can be such a distressing experience that it reflects on their feelings of security and their behaviour. Children can sometimes find it difficult to admit their fear. Children need the help of adults to express their hospital-related fears, the objects of the fears, and to cope with the fears. Personnel should be aware of children s fears and support them in the use of coping strategies. In addition to the experiences of security and care, pre-school-aged children need active coping strategies that they can use themselves, regardless of the presence of the parents or nurses. Most of all, children need the possibility to play and experience pleasure. Children can also be taught coping strategies which give them an active, positive role.

Sugarcane-Based Biofuels and Bioproducts

Sugarcane has garnered much interest for its potential as a viable renewable energy crop. While the use of sugar juice for ethanol production has been in practice for years, a new focus on using the fibrous co-product known as bagasse for producing renewable fuels and bio-based chemicals is growing in interest. The success of these efforts, and the development of new varieties of energy canes, could greatly increase the use of sugarcane and sugarcane biomass for fuels while enhancing industry sustainability and competitiveness. Sugarcane-Based Biofuels and Bioproducts examines the development of a suite of established and developing biofuels and other renewable products derived from sugarcane and sugarcane-based co-products, such as bagasse. Chapters provide broad-ranging coverage of sugarcane biology, biotechnological advances, and breakthroughs in production and processing techniques. This text brings together essential information regarding the development and utilization of new fuels and bioproducts derived from sugarcane. Authored by experts in the field, Sugarcane-Based Biofuels and Bioproducts is an invaluable resource for researchers studying biofuels, sugarcane, and plant biotechnology as well as sugar and biofuels industry personnel.