Economic modelling of antenatal screening and ultrasound scanning programmes for identification of fetal abnormalities

Objective Within the framework of a health technology assessment and using an economic model, to determine the most clinically and cost effective policy of scanning and screening for fetal abnormalities in early pregnancy. Design A discrete event simulation model of 50,000 singleton pregnancies. Setting Maternity services in Scotland. Population Women during the first 24 weeks of their pregnancy. Methods The mathematical model was populated with data on uptake of screening, prevalence, detection and false positive rates for eight fetal abnormalities and with costs for ultrasound scanning and serum screening. Inclusion of abnormalities was based on the relative prevalence and clinical importance of conditions and the availability of data. Six strategies for the identification of abnormalities prenatally including combinations of first and second trimester ultrasound scanning and first and second trimester screening for chromosomal abnormalities were compared. Main outcome measures The number of abnormalities detected and missed, the number of iatrogenic losses resulting from invasive tests, the total cost of strategies and the cost per abnormality detected were compared between strategies. Results First trimester screening for chromosomal abnormalities costs more than second trimester screening but results in fewer iatrogenic losses. Strategies which include a second trimester ultrasound scan result in more abnormalities being detected and have lower costs per anomaly detected. Conclusions The preferred strategy includes both first and second trimester ultrasound scans and a first trimester screening test for chromosomal abnormalities. It has been recommended that this policy is offered to all women in Scotland.

Instrumental and interpretive methods in evaluating urban programmes

The turn within urban policy to address increasingly complex social, economic and environmental problems has exposed some of the fragility of traditional measurement models and their reliance on the rational paradigm. This article looks at the experiences of the European Union (EU) Programme for Peace and Reconciliation in Northern Ireland and its particular attempt to construct new District Partnerships to deliver area-based regeneration programmes. It highlights the need to combine instrumental and interpretative evaluation methods in an attempt to explain the wider contribution of governance to conflict resolution and participatory practice in local development. It concludes by highlighting the value of conceptual approaches that deal with the politics of evaluation and the distributional effects of policy interventions designed to create new relationships within and between multiple stakeholders.

Second-Order Training of Adaptive Critics for Online Process Control

A new algorithm for training of nonlinear optimal neuro-controllers (in the form of the model-free, action-dependent, adaptive critic paradigm). Overcomes problems with existing stochastic backpropagation training: need for data storage, parameter shadowing and poor convergence, offering significant benefits for online applications.

Citizenship training in school from the perspective of future primary education teachers

The aim of this paper is to recognize the images that prospective elementary school teachers have about citizenship and citizenship education in school. The qualitative methodology with an ethnographic approach is used for that deep interview of ethnographic kind and analysis of institutional documents, for example, curricula, course syllabus and graduated profi le. The revision of documents helps to a better understanding of discourses. The analysis of the corpus obtained after the application of the paradigm of codifi cation proposed in the established theory. As the principal fi ndings we way point out that the concept of citizens that is common among prospective elementary school teachers is reduced to the school environment because they consider that the promotion of citizenship helps to the incorporation of children to society, thus reproducing a propaedeutic view of education.