Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes

n early 2001 there was a dramatic decline in the availability of heroin in New South Wales (NSW), Australia, where previously heroin had been readily available at a low price and high purity.1 The decline was confirmed by Australia's strategic early warning system, which revealed a reduction in heroin supply across Australia and a considerable increase in price,2 particularly from January to April 2001. This "heroin shortage" provided a natural experiment in which to examine the effect of substantial changes in price and availability on injecting drug use and its associated harms in Australia's largest heroin market,2 a setting in which harm reduction strategies were widely used. Publicly funded needle and syringe programmes were introduced to Australia in 1987, and methadone maintenance programmes, which were established in the 1970s, were significantly expanded in 1985 and again in 1999.

Selecting optimal instantiations of data models - Theory and validation of an ex ante approach

The schema of an information system can significantly impact the ability of end users to efficiently and effectively retrieve the information they need. Obtaining quickly the appropriate data increases the likelihood that an organization will make good decisions and respond adeptly to challenges. This research presents and validates a methodology for evaluating, ex ante, the relative desirability of alternative instantiations of a model of data. In contrast to prior research, each instantiation is based on a different formal theory. This research theorizes that the instantiation that yields the lowest weighted average query complexity for a representative sample of information requests is the most desirable instantiation for end-user queries. The theory was validated by an experiment that compared end-user performance using an instantiation of a data structure based on the relational model of data with performance using the corresponding instantiation of the data structure based on the object-relational model of data. Complexity was measured using three different Halstead metrics: program length, difficulty, and effort. For a representative sample of queries, the average complexity using each instantiation was calculated. As theorized, end users querying the instantiation with the lower average complexity made fewer semantic errors, i.e., were more effective at composing queries. (c) 2005 Elsevier B.V. All rights reserved.

The importance of modelling heterogeneity in complex disease: application to NIMH Schizophrenia Genetics Initiative data

As for other complex diseases, linkage analyses of schizophrenia (SZ) have produced evidence for numerous chromosomal regions, with inconsistent results reported across studies. The presence of locus heterogeneity appears likely and may reduce the power of linkage analyses if homogeneity is assumed. In addition, when multiple heterogeneous datasets are pooled, intersample variation in the proportion of linked families ( a) may diminish the power of the pooled sample to detect susceptibility loci, in spite of the larger sample size obtained. We compare the significance of linkage. findings obtained using allele- sharing LOD scores ( LODexp) - which assume homogeneity - and heterogeneity LOD scores ( HLOD) in European American and African American NIMH SZ families. We also pool these two samples and evaluate the relative power of the LODexp and two different heterogeneity statistics. One of these ( HLOD- P) estimates the heterogeneity parameter a only in aggregate data, while the second ( HLOD- S) determines a separately for each sample. In separate and combined data, we show consistently improved performance of HLOD scores over LODexp. Notably, genome-wide significant evidence for linkage is obtained at chromosome 10p in the European American sample using a recessive HLOD score. When the two samples are combined, linkage at the 10p locus also achieves genome-wide significance under HLOD- S, but not HLOD- P. Using HLOD- S, improved evidence for linkage was also obtained for a previously reported region on chromosome 15q. In linkage analyses of complex disease, power may be maximised by routinely modelling locus heterogeneity within individual datasets, even when multiple datasets are combined to form larger samples.

Foetal malformations and seizure control: 52 months data of the Australian Pregnancy Registry

The Australian Pregnancy Registry, affiliated European Register of Antiepileptic drugs in Pregnancy (EURAP), recruits informed consenting women with epilepsy on treatment with antiepileptic drugs (AEDs), those untreated, and women on AEDs for other indications. Enrolment is considered prospective if it has occurred before presence or absence of major foetal malformations (FMs) are known, or retrospective, if they had occurred after the birth of infant or detection of major FM. Telephone Interviews are conducted to ascertain pregnancy outcome and collect data about seizures. To date 630 women have been enrolled, with 565 known pregnancy outcomes. Valproate (VPA) above 1100 mg/day was associated with a significantly higher incidence of FMs than other AEDs (P < 0.05). This was independent of other AED use or potentially confounding factors on multivariate analysis (OR = 7.3, P < 0.0001). Lamotrigine (LTG) monotherapy (n = 65), has so far been free of malformations. Although seizure control was not a primary outcome, we noted that more patients on LTG than on VPA required dose adjustments to control seizures. Data indicate an increased risk of FM in women taking VPA in doses > 1100 mg/day compared with other AEDs. The choice of AED for pregnant women with epilepsy requires assessment of balance of risks between teratogenicity and seizure control.

Approximate processing of massive continuous quantile queries over high-speed data streams

Quantile computation has many applications including data mining and financial data analysis. It has been shown that an is an element of-approximate summary can be maintained so that, given a quantile query d (phi, is an element of), the data item at rank [phi N] may be approximately obtained within the rank error precision is an element of N over all N data items in a data stream or in a sliding window. However, scalable online processing of massive continuous quantile queries with different phi and is an element of poses a new challenge because the summary is continuously updated with new arrivals of data items. In this paper, first we aim to dramatically reduce the number of distinct query results by grouping a set of different queries into a cluster so that they can be processed virtually as a single query while the precision requirements from users can be retained. Second, we aim to minimize the total query processing costs. Efficient algorithms are developed to minimize the total number of times for reprocessing clusters and to produce the minimum number of clusters, respectively. The techniques are extended to maintain near-optimal clustering when queries are registered and removed in an arbitrary fashion against whole data streams or sliding windows. In addition to theoretical analysis, our performance study indicates that the proposed techniques are indeed scalable with respect to the number of input queries as well as the number of items and the item arrival rate in a data stream.

Reference values for whole body and cerebral multi-frequency bio-impedance data in neonates less than 12 h postpartum

Multiple frequency bio-electrical impedance analysis (MFBIA) may be useful for monitoring fluid balance in newborn infants or to provide early prediction of the outcome following perinatal asphyxia. A reference range of data is needed for identification of babies with abnormal impedance values. This was a cross-sectional observational study in 84 term and near-term healthy neonates less than 12 h postpartum. Whole body and cerebral MFBIA measurements were performed at the bedside in the post-natal ward. Gestational age, post-natal age, gender, birthweight, head circumference and foot length measures were recorded. Reference values for impedance at the characteristic frequency (Z(C)) and resistance at zero frequency (R-0) are reported for whole body and cerebral impedance. Significant correlations (p < 0.05) were observed between whole body impedance and birthweight, footlength and head circumference. Females had a significantly higher whole body R0 than males. Cerebral impedance did not correlate significantly with any of the demographic measures and therewere no gender differences observed for cerebral impedance. The reference range for whole body multi-frequency bio-impedance values in term and near-term infants within the first 12 h postpartum can be calculated from the footlength (FL) using the following equations: Z(C) = (942.9 - 4.818* FL) +/- 124.6 Omega; R-0 = (1042 - 4.520(*)FL) +/- 135.5 Omega. For cerebral impedance the reference range is 29.5-48.7 Omega for Z(C) and 33.7-58.0 Omega for R-0.

Sensitivity of marine-reserve design to the spatial resolution of socioeconomic data

Socioeconomic considerations should have an important place in reserve design, Systematic reserve-selection tools allow simultaneous optimization for ecological objectives while minimizing costs but are seldom used to incorporate socioeconomic costs in the reserve-design process. The sensitivity of this process to biodiversity data resolution has been studied widely but the issue of socioeconomic data resolution has not previously been considered. We therefore designed marine reserves for biodiversity conservation with the constraint of minimizing commercial fishing revenue losses and investigated how economic data resolution affected the results. Incorporating coarse-resolution economic data from official statistics generated reserves that were only marginally less costly to the fishery than those designed with no attempt to minimize economic impacts. An intensive survey yielded fine-resolution data that, when incorporated in the design process, substantially reduced predicted fishery losses. Such an approach could help minimize fisher displacement because the least profitable grounds are selected for the reserve. Other work has shown that low-resolution biodiversity data can lead to underestimation of the conservation value of some sites, and a risk of overlooking the most valuable areas, and we have similarly shown that low-resolution economic data can cause underestimation of the profitability of some sites and a risk of inadvertently including these in the reserve. Detailed socioeconomic data are therefore an essential input for the design of cost-effective reserve networks.

Skin cancer clinics in Australia: workload profile and performance indicators from an analysis of billing data

Objective: To describe the workload profile in a network of Australian skin cancer clinics. Design and setting: Analysis of billing data for the first 6 months of 2005 in a primary-care skin cancer clinic network, consisting of seven clinics and staffed by 20 doctors, located in the Northern Territory, Queensland and New South Wales. Main outcome measures: Consultation to biopsy ratio (CBR); biopsy to treatment ratio (BTR); number of benign naevi excised per melanoma (number needed to treat [NNT]). Results: Of 69780 billed activities, 34 622 (49.6%) were consultations, 19 358 (27.7%) biopsies, 8055 (11.5%) surgical excisions, 2804 (4.0%) additional surgical repairs, 1613 (2.3%) non-surgical treatments of cancers and 3328 (4.8%) treatments of premalignant or non-malignant lesions. A total of 6438 cancers were treated (116 melanomas by excision, 4709 non-melanoma skin cancers [NMSCs] by excision, and 1613 NMSCs non-surgically); 5251 (65.2%) surgical wounds were repaired by direct suture, 2651 (32.9%) by a flap (of which 44.8% were simple flaps), 42 (0.5%) by wedge excision and 111 (1.4%) by grafts. The CBR was 1.79, the BTR was 3.1 and the NNT was 28.6. Conclusions: In this network of Australian skin cancer clinics, one in three biopsies identified a skin cancer (BTR, 3.1), and about 29 benign lesions were excised per melanoma (NNT, 28.6). The estimated NNT was similar to that reported previously in general practice. More data are needed on health outcomes, including effectiveness of treatment and surgical repair.

Stock structure of Spanish mackerel Scomberomorus commerson along the Australian east coast deduced from parasite data

The parasite fauna of Spanish mackerel Scomberomorus commerson from three regions off eastern Australia was examined for evidence of separate stocks. The abundance of five metacestodes was very similar in all areas suggesting that extensive mixing of the fish occurs along the coast, unlike the Situation across northern Australia where large differences have been found between regions. The similarity in abundances of two metacestodes from Townsville fish and south-east Queensland fish Suggests that these two regions have fish with very similar histories. The data lead to the conclusion that the seasonal fishery for Spanish mackerel off south-east Queensland is based on a random group of fish from the same origin as fish sampled off Townsville and is not a subpopulation that moves south each year. (c) 2006 The Fisheries Society of the British Isles.

Tradeoffs of different types of species occurrence data for use in systematic conservation planning

Data on the occurrence of species are widely used to inform the design of reserve networks. These data contain commission errors (when a species is mistakenly thought to be present) and omission errors (when a species is mistakenly thought to be absent), and the rates of the two types of error are inversely related. Point locality data can minimize commission errors, but those obtained from museum collections are generally sparse, suffer from substantial spatial bias and contain large omission errors. Geographic ranges generate large commission errors because they assume homogenous species distributions. Predicted distribution data make explicit inferences on species occurrence and their commission and omission errors depend on model structure, on the omission of variables that determine species distribution and on data resolution. Omission errors lead to identifying networks of areas for conservation action that are smaller than required and centred on known species occurrences, thus affecting the comprehensiveness, representativeness and efficiency of selected areas. Commission errors lead to selecting areas not relevant to conservation, thus affecting the representativeness and adequacy of reserve networks. Conservation plans should include an estimation of commission and omission errors in underlying species data and explicitly use this information to influence conservation planning outcomes.

Public reporting of hospital outcomes based on administrative data: risks and opportunities

In the wake of findings from the Bundaberg Hospital and Forster inquiries in Queensland, periodic public release of hospital performance reports has been recommended. A process for developing and releasing such reports is being established by Queensland Health, overseen by an independent expert panel. This recommendation presupposes that public reports based on routinely collected administrative data are accurate; that the public can access, correctly interpret and act upon report contents; that reports motivate hospital clinicians and managers to improve quality of care; and that there are no unintended adverse effects of public reporting. Available research suggests that primary data sources are often inaccurate and incomplete, that reports have low predictive value in detecting outlier hospitals, and that users experience difficulty in accessing and interpreting reports and tend to distrust their findings.

Presence-absence versus abundance data for monitoring threatened species

Effective detection of population trend is crucial for managing threatened species. Little theory exists, however, to assist managers in choosing the most cost-effective monitoring techniques for diagnosing trend. We present a framework for determining the optimal monitoring strategy by simulating a manager collecting data on a declining species, the Chestnut-rumped Hylacola (Hylacola pyrrhopygia parkeri), to determine whether the species should be listed under the IUCN (World Conservation Union) Red List. We compared the efficiencies of two strategies for detecting trend, abundance, and presence-absence surveys, underfinancial constraints. One might expect the abundance surveys to be superior under all circumstances because more information is collected at each site. Nevertheless, the presence-absence data can be collected at more sites because the surveyor is not obliged to spend a fixed amount of time at each site. The optimal strategy for monitoring was very dependent on the budget available. Under some circumstances, presence-absence surveys outperformed abundance surveys for diagnosing the IUCN Red List categories cost-effectively. Abundance surveys were best if the species was expected to be recorded more than 16 times/year; otherwise, presence-absence surveys were best. The relationship between the strategies we investigated is likely to be relevant for many comparisons of presence-absence or abundance data. Managers of any cryptic or low-density species who hope to maximize their success of estimating trend should find an application for our results.