Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was $1,210 more per person per year than status quo care, and dialyses avoided gave net savings of $1.0 million at 3 years and $3.4 million at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided. (C) 2005 by the National Kidney Foundation, Inc.

Highly demanding resistive vibration exercise program is tolerated during 56 days of strict bed-rest

Several studies have tried to find countermeasures against musculoskeletal de-conditioning during bed-rest, but none of them yielded decisive results. We hypothesised that resistive vibration exercise (RVE) might be a suitable training modality. We have therefore carried out a bed-rest study to evaluate its feasibility and efficacy during 56 days of bed-rest. Twenty healthy male volunteers aged 24 to 43 years were recruited and, after medical check-ups, randomised to a non-exercising control (Ctrl) group or a group that performed RVE 11 times per week. Strict bed-rest was controlled by video surveillance. The diet was controlled. RVE was performed in supine position, with a static force component of about twice the body weight and a smaller dynamic force component. RVE comprised four different units (squats, heel raises, toe raises, kicks), each of which lasted 60 - 100 seconds. Pre and post exercise levels of lactate were measured once weekly. Body weight was measured daily on a bed scale. Pain questionnaires were obtained in regular intervals during and after the bed-rest. Vibration frequency was set to 19 Hz at the beginning and progressed to 25.9 Hz (SD 1.9) at the end of the study, suggesting that the dynamic force component increased by 90%. The maximum sustainable exercise time for squat exercise increased from 86 s (SD 21) on day 11 of the BR to 176 s (SD 73) on day 53 (p = 0.006). On the same days, post-exercise lactate levels increased from 6.9 mmol/l (SD2.3) to 9.2 mmol/l (SD 3.5, p = 0.01). On average, body weight was unchanged in both groups during bed-rest, but single individuals in both groups depicted significant weight changes ranging from -10% to + d10% (p < 0.001). Lower limb pain was more frequent during bed-rest in the RVE subjects than in Ctrl (p = 0.035). During early recovery, subjects of both groups suffered from muscle pain to a comparable extent, but foot pain was more common in Ctrl than in RVE (p = 0.013 for plantar pain, p = 0.074 for dorsal foot pain). Our results indicate that RVE is feasible twice daily during bed-rest in young healthy males, provided that one afternoon and one entire day per week are free. Exercise progression, mainly by progression of vibration frequency, yielded increases in maximum sustainable exercise time and blood lactate. In conclusion, RVE as performed in this study, appears to be safe.

Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: An evaluation of the friends program

This study evaluated the long-term effectiveness of the FRIENDS Program in reducing anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison to a control condition. Longitudinal data for Lock and Barrett's (2003) universal prevention trial is presented, along with data from 12-month follow-up to 24- and 36-month follow-up. Results of this study indicate that intervention reductions in anxiety reported in Lock and Barrett were maintained for students in Grade 6, with the intervention group reporting significantly lower ratings of anxiety at long-term follow-up. A significant Time times Intervention Group times Gender Effect on Anxiety was found, with girls in the intervention group reporting significantly lower anxiety at 12-month and 24-month follow-up but not at 36-month follow-up in comparison to the control condition. Results demonstrated a prevention effect with significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition. Results are discussed within the context of prevention research.

Predicting population dynamics of weed biological control agents: science or gazing into crystal balls?

Various factors can influence the population dynamics of phytophages post introduction, of which climate is fundamental. Here we present an approach, using a mechanistic modelling package (CLIMEX), that at least enables one to make predictions of likely dynamics based on climate alone. As biological control programs will have minimal funding for basic work (particularly on population dynamics), we show how predictions can be made using a species geographical distribution, relative abundance across its range, seasonal phenology and laboratory rearing data. Many of these data sets are more likely to be available than long-term population data, and some can be incorporated into the exploratory phase of a biocontrol program. Although models are likely to be more robust the more information is available, useful models can be developed using information on species distribution alone. The fitted model estimates a species average response to climate, and can be used to predict likely geographical distribution if introduced, where the agent is likely to be more abundant (i.e. good locations) and more importantly for interpretation of release success, the likely variation in abundance over time due to intra- and inter-year climate variability. The latter will be useful in predicting both the seasonal and long-term impacts of the potential biocontrol agent on the target weed. We believe this tool may not only aid in the agent selection process, but also in the design of release strategies, and for interpretation of post-introduction dynamics and impacts. More importantly we are making testable predictions. If biological control is to become more of a science making and testing such hypothesis will be a key component.

Stepping Stones Triple P: A pilot study to evaluate acceptability of the program by parents of a child diagnosed with an Autism Spectrum Disorder

The experience of parents of children with Autism Spectrum Disorder (ASD) in standard parenting programs has not been researched, although anecdotal evidence suggests that they do not find them acceptable. Forty-two parents of children with ASD were asked to view a DVD explaining individual parenting strategies from Stepping Stones, a new branch of the Triple P program targeted specifically at parents of children with disabilities. Parents were asked to rate each strategy for acceptability, usability and behavioural intention, i.e., their intention to use the strategy. Additionally, parental attributions and parental perceived control were explored as possible barriers to positive evaluations of Stepping Stones parenting strategies. A focus group of parents was used to gather more detailed parent response to the program. Parent responses to the program were generally positive and attribution of the child's behaviour to uncontrollable factors was found to predict higher ratings of usability. The results were interpreted within the context of Weiner's attributional theory and the theory of reasoned action. The limitations of this study and suggestions for future research are discussed. (c) 2005 Elsevier Ltd. All rights reserved.

Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes

OBJECTIVE - The purpose of this study was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program. RESEARCH DESIGN AND METHODS - We studied 57 overweight (BMI >= 27 kg/m(2)) sedentary men and women aged 40-80 years with established (> 6 months) type 2 diabetes. initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control (HbA(1c) [A1C]) was assessed at 0, 2, and 14 months. RESULTS - Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A I C remained lower than baseline values at 14 months in the center group (- 0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in AIC during the maintenance period were positively associated with exercise adherence in the center group only. CONCLUSIONS - Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.

Formal change impact analyses for emulated control software

Processor emulators are a software tool for allowing legacy computer programs to be executed on a modern processor. In the past emulators have been used in trivial applications such as maintenance of video games. Now, however, processor emulation is being applied to safety-critical control systems, including military avionics. These applications demand utmost guarantees of correctness, but no verification techniques exist for proving that an emulated system preserves the original system’s functional and timing properties. Here we show how this can be done by combining concepts previously used for reasoning about real-time program compilation, coupled with an understanding of the new and old software architectures. In particular, we show how both the old and new systems can be given a common semantics, thus allowing their behaviours to be compared directly.

Urinary arsenic, porphyrins and malondialdehyde in a population 16 years after arsenic mitigation program in Xinjian, China

Arsenic contamination of groundwater (0.05 to 0.84 mg/L) in Kuitun, Xinjiang was first found in 1970’s. Alternative clean surface water was introduced in 1985. We aimed to assess the exposure and heath outcome since the mitigation. In 2000, we collected a total of 360 urine samples from villagers from the endemic area and a nearby control area for arsenic (As), porphyrins and malondialdehyde (MDA) measurements. The averaged urinary As level of villagers from the endemic site (117±8.3 μg/g creatinine; 4.2 to 943.8 μg/g creat) was higher than that of the control site (73.6±3.2 μg/g creat). No significant differences were found in urinary porphyrins or MDA between the endemic and control sites. However, when the urinary arsenic was higher than 150 μg/g creat, these two biomarkers were higher in the exposed group than the control. Within the exposed group, villagers with arsenic-related skin symptoms had higher arsenic, uroporphyrin and MDA compared to those who had not shown symptoms. Sine the water mitigation, villagers whose urinary arsenic levels were 270 μg/g creat dropped from 20% to 10% of the population. Population with arsenic-related skin symptoms remained unchanged at 31%. We noted that 7.8% of those who had skin lesions were born after the implementation of intervention and that some villagers still prefer to drink the groundwater. Further, in the dry season, lack of surface water and electrical power breakdowns are to blame for failure to ensure continuous supply of clean water. It is concluded that despite the prompt action and successful water mitigation program to curb arsenic poisonings, it is essential to continue to monitor the health outcome of this population.

Determining the specification of a control system from that of its environment

Well understood methods exist for developing programs from given specifications. A formal method identifies proof obligations at each development step: if all such proof obligations are discharged, a precisely defined class of errors can be excluded from the final program. For a class of closed systems such methods offer a gold standard against which less formal approaches can be measured. For open systems -those which interact with the physical world- the task of obtaining the program specification can be as challenging as the task of deriving the program. And, when a system of this class must tolerate certain kinds of unreliability in the physical world, it is still more challenging to reach confidence that the specification obtained is adequate. We argue that widening the notion of software development to include specifying the behaviour of the relevant parts of the physical world gives a way to derive the specification of a control system and also to record precisely the assumptions being made about the world outside the computer.

Simulation of robot manipulator control strategies

The high capital cost of robots prohibit their economic application. One method of making their application more economic is to increase their operating speed. This can be done in a number of ways e.g. redesign of robot geometry, improving actuators and improving control system design. In this thesis the control system design is considered. It is identified in the literature review that two aspects in relation to robot control system design have not been addressed in any great detail by previous researchers. These are: how significant are the coupling terms in the dynamic equations of the robot and what is the effect of the coupling terms on the performance of a number of typical independent axis control schemes?. The work in this thesis addresses these two questions in detail. A program was designed to automatically calculate the path and trajectory and to calculate the significance of the coupling terms in an example application of a robot manipulator tracking a part on a moving conveyor. The inertial and velocity coupling terms have been shown to be of significance when the manipulator was considered to be directly driven. A simulation of the robot manipulator following the planned trajectory has been established in order to assess the performance of the independent axis control strategies. The inertial coupling was shown to reinforce the control torque at the corner points of the trajectory, where there was an abrupt demand in acceleration in each axis but of opposite sign. This reduced the tracking error however, this effect was not controllable. A second effect was due to the velocity coupling terms. At high trajectory speeds it was shown, by means of a root locus analysis, that the velocity coupling terms caused the system to become unstable.

Electronic Education in the Field of Electrical Engineering Disciplines. Combined Didactic Interactive Program System

At present in the educational process of electrical engineering disciplines electronic learning program, providing control over reproductive educational-cognitive activity (the decision of standard problems) and universal modeling program systems, for instance Electronics Workbench, giving a chance of organizing productive, in particular research activity are basically used. However universal modeling program systems can not provide auto control over educational-cognitive activity because of the absence of the feedback with students. The combined didactic interactive program system, providing the closed directed auto control over both the reproductive and productive heuristic educational-cognitive activity of the student is offered.

A WEB-System for Computer Experiments in the Field of Program Transformations

The paper presents basic notions and scientific achievements in the field of program transformations, describes usage of these achievements both in the professional activity (when developing optimizing and unparallelizing compilers) and in the higher education. It also analyzes main problems in this area. The concept of control of program transformation information is introduced in the form of specialized knowledge bank on computer program transformations to support the scientific research, education and professional activity in the field. The tasks that are solved by the knowledge bank are formulated. The paper is intended for experts in the artificial intelligence, optimizing compilation, postgraduates and senior students of corresponding specialties; it may be also interesting for university lecturers and instructors.

KM governance:the mechanisms for guiding and controlling KM program

Purpose: To establish and sustain their KM programs organizations need to establish mechanisms to ensure their governance. KM programs require business integration, senior management involvement and decision making authority. The present research investigates the KM governance mechanisms organizations use to guide and control their KM programs. The research seeks to contribute to a better understanding of the governance of KM and to support organizations in the development of their KM programs. Methodology: The study employs multiple case research methodology to analyze the KM governance arrangements of twelve international organizations and identify patterns in their governance configurations. Findings: The analysis identifies a range of structural, process and relational mechanisms that are critical for governing an organizational KM program. Different patterns among the KM governance mechanisms are identified which lead to the development of generic KM governance typologies. Research implications: The development of the KM governance framework allows future research to systematically investigate the KM governance phenomenon. As the present study is based on a configurational analysis future research should particularly target the performance implications of different KM governance configurations. Practical implications: The research provides insights into the diversity of KM governance mechanisms and their impact on a KM program. The KM governance framework can assist managers in reviewing their present and prospective KM programs and thereby support benchmarking or re-organization efforts. Originality: Building on prior research that has focused on individual KM governance aspects, the present study adopts a comprehensive perspective integrating structural, process and relational governance mechanisms.