Economic evaluation of a skin cancer prevention program in Australia : past achievements and future prospects

Objectives
Australia has the highest incidence of skin cancer in the world. Skin cancer prevention campaigns have been implemented in Australia for over two decades. The most notable is under the brand name, SunSmart. The aim of the current study is to assess the cost-effectiveness of SunSmart in the past and the potential cost-effectiveness of an ongoing national SunSmart program with optimal investment in the future.

Methods
An economic evaluation from a health sector perspective was conducted using the reduction in skin cancer incidence attributable to the SunSmart program modelled as the primary end-point. Historical SunSmart program expenditures were obtained from three representative states in three latitude zones, covering different levels of UVR exposure. Melanoma incidence rates from the three representative state cancer registers were used to model the health outcomes. Program effectiveness was assessed by the comparison between the well-resourced SunSmart state (Victoria) and the under-invested states (New South Wales and Queensland). Non-Melanoma Skin Cancer (NMSC) was modelled based on national survey results. 2003 was chosen as the reference year and future costs/outcomes over a 20 year time horizon were discounted at 3%.
The future level of investment in a national SunSmart was chosen to strengthen current practice by increasing current investment to a realistic and achievable level. This conservative increase in investment (expressed as ‘$ per capita’) reflected the investment level that has been achieved in Victoria over sustained periods. To model the potential cost-effectiveness of an upgraded national SunSmart program, a conservative approach was taken, whereby the same magnitude of effectiveness from 1988 to 2003 was applied to future skin cancer incidence.

Results
SunSmart in Victoria has saved 22,300 life-years, averted 27,900 disability-adjusted life-years(DALYs)(discounted) since its introduction in 1988 and achieved an incremental cost-effectiveness ratio (ICER) of $AUD 680 per life-year saved (LYS) and $AUD 540 per DALY averted. When the cost-offset from the estimated reduction in skin cancer treatment costs were taken into account, SunSmart achieved ‘dominance’. The net cost of SunSmart in the past was an estimated saving of $AUD 93 million. An upgraded national SunSmart for the next 20 years would save 91,000 life-years and avert 122,000 DALYs (discounted), involving an increased investment level from the current $AUD 0.07 per capita to the historical average of $AUD 0.28 per capita. The ICER for the upgraded SunSmart program was estimated at $AUD 940 per LYS and $AUD 700 per DALY averted. When the cost-offset is included, the program achieves dominance with a cost saving of $AUD 115 million – an estimated $AUD 2.32 return for every dollar invested between 2003 and 2022.

Conclusions
This study demonstrates that a sustained modest investment in skin cancer control is likely to be excellent value-for-money. While the available data base is certainly not prefect, key parameters would have to change dramatically for this conclusion to be challenged.

Factors influencing skin colour in cultured Australian snapper Pagrus auratus

Sea cage production of Australian snapper has been largely constrained during the past decade by abnormal skin pigmentation which has negatively impacted marketability. The research described in this study identified dietary, environmental and harvesting techniques to successfully alter skin colour to potentially improve the viability of snapper aquaculture in Australia.

Comparing experiments of the stressed skin diaphragm spanning several and few purlins

Concerning the specialty of the testing of stressed skin diaphragm assembly, the current loading method of cantilever beam test is improved by the diagonally loading method. In order to investigate the differences of the shear behavior between the stressed skins spanning several purlins and few purlins , which have the same forms and spaces of the connections and purlins, comparing experiments are carried out. Using the curve fitting method, the test results are quantified. The shear rigidity of two specimens is gained. It shows that the shear rigidity of the diaphragm spanning several purlins is quite higher than that spanning few purlins, but the carrying capacity of the former is a little lower than that of the latter.

Field test study on the shear behaviour of stressed skin diaphragm spanning several purlins

Although profiled steel sheets have the diaphragm effect in steel structure, since there is no specific code to follow in China, it is only used as the reservation of the structural stiffness.So it results in economic wastes.In order to investigate the contribution of stressed skin to the overall stiffness, field tests are carried out to measure the lateral stiffness of the frames with and without stressed skin diaphgram.Based on the superposition principle and using the curve fitting method, the test results are quantified.The shear rigidity of stressed skin diaphgram spanning several purlins is gained indirectly.It shows that the shear rigidity of the diaphragm between two frames is even close to the lateral stiffness of one frame.

The effect of skin passing on the material behavior of metal strip in pure bending and tension

The metal strip used in roll forming has often been preprocessed by (tension or roller) leveling or by skin-pass rolling, and as a consequence, may contain residual stresses. These stresses are not well observed by the tensile test, but could have a significant effect on the bending and springback behavior. With the advent of improved process design techniques for roll forming, including advanced finite element techniques, the need for precise material property data has become important. The major deformation mode of roll forming is that of bending combined with unloading and reverse bending, and hence property data derived from bend tests could be more relevant than that from tensile testing.

This work presents a numerical study on the effect of skin passing on the material behavior of stainless steel strip in pure bending and tension. A two dimensional (2-D) numerical model was developed using Abaqus Explicit to analyze the affect of skin passing on the residual stress profile across a section for various working conditions. The deformed meshes and their final stress fields were then imported as pre-defined fields into Abaqus Standard, and the post-skin passing material behavior in pure bending was determined. The results show that a residual stress profile is introduced into the steel strip during skin passing, and that its shape and stress level depend on the overall thickness reduction as well as the number of rolling passes used in the skin passing process. The material behavior in bending and the amount of springback changed significantly depending on the skin pass condition.

Measurement of light penetration through a simulated merino fleece

The degree of light penetration along the length of the fibre of a simulated Merino fleece was measured using a fibre optic probe to investigate the relationship between light exposure and photodamage to the wool fibre. The percentage of the total direct sunlight that reached the base of the 100-mm long, simulated, closed Merino fleece was ~1% and the section of the fibre from the root to 60 mm from the root was protected from exposure. The light intensity at the base of the fibre was increased to 2% when the density of the simulated fleece was halved. Wool was scoured and the yellowness and intensity of methylene blue staining was measured to estimate the extent of damage to wool staples.

Skin pedagogies and abject bodies

How does the beauty industry ‘narrate the skin’? What does it teach women from different cultural groups about the female body? How does skin function as a site where female subjection and abjection are produced and reproduced? In this paper we examine the skin industry pointing to its extreme commodification of the female body and to the inexcusable pressure this places on females of most age and cultural groups.We focus on two examples. Firstly, we show what the skin industry teaches girls and women about both their skin colour ‘problems’ and desirable practices of whitening and, secondarily, tanning. Secondly, we consider what the cosmetic surgery industry teaches us about female bodily ‘imperfections’ linked to certain ethnic and racial groups and the necessary ‘remedies’. Overall we show how the socio-cultural normalization of perfect skin is a product of a range of contemporary and enduring social and cultural forces overlain by complex pedagogies of power, expertise and affect.

Chromatic interaction between egg pigmentation and skin chromatophores in the nuptial coloration of female two-spotted gobies

In two-spotted gobies (Gobiusculus flavescens Fabricius 1779), females develop an orange belly as they approach sexual maturity. Bright belly coloration is preferred by males and has been suggested to act as a female ornament. This coloration is unusual in that it originates partly from pigmentation of the abdominal skin but also from strongly pigmented gonads directly visible through the skin. In addition, females have been observed to temporarily become more colourful during courtship and competition. To understand how gonad and skin pigmentation interact in this nuptial coloration, the potential for colour modification via regulation of skin chromatophores was investigated. Noradrenaline caused aggregation of chromatophore pigment and was used to experimentally reduce the contribution of skin chromatophores to the nuptial coloration. Chromatophore pigment aggregation caused bellies to become less colourful and abdominal skin biopsies to become less colourful and more transparent. There was a strong positive relationship between belly coloration and the coloration of the underlying gonads. This shows that belly coloration honestly reflects egg pigmentation, mainly because the transparency of the abdominal skin allows other fish to see the gonads directly. Interestingly, when noradrenaline caused pigment to aggregate and thereby increased the transparency of the skin, the relationship between belly and gonad coloration weakened. We conclude that female G. flavescens have a potential to use skin chromatophores to rapidly alter their nuptial coloration, thereby affecting the efficacy with which information about gonad coloration is conveyed.

Sleepwalking into the mirror : panic and the thin skin of a writer

This text interwoven with artworks by Elizabeth McQueen explores the act of writing and this writer’s search for a narrative form which, after Kafka, fuses dream and reality. Escaping from the back door of my PhD research, which has entered such liminal realities as sleepwalking and autism as a way of challenging familiar boundaries of western normative thought, this text explores a slightly different boundary transgression: a terrifying fusion of reality and writing when late one dark (but not stormy) night a character from my novel appeared at my back window.

Relationships between skin follicle characteristics and fibre properties of Suri and Huacaya alpacas and Peppin Merino sheep

We aimed to quantify the number, type and arrangement of skin follicles in Huacaya and Suri alpaca skin and correlate their follicle characteristics with fibre traits of harvested fibre and compared these relationships with those of Merino sheep. Fibre and skin samples were collected from the mid-side of 12 Huacaya alpacas, 24 Suri alpacas and 10 Merino sheep. The mean fibre diameter (MFD ± s.e.) of the Huacaya and Suri were: 35.5 ± 0.9 and 28.3 ± 1.0 μm, respectively. The follicle groups found for alpacas were very different from the normal trio of primary follicles found in sheep and goats. The follicle group of the alpacas consisted of a single primary follicle surrounded by a variable number of secondary follicles. The mean ± s.e. primary follicle density was 3.1 ± 0.3 and 2.7 ± 0.1 follicles/mm² for Huacaya and Suri, respectively. The mean ± s.e. secondary follicle density (SFD) was 13.7 ± 1.2 and 17.5 ± 0.6 follicles/mm² for Huacaya and Suri, respectively. The mean ± s.e. ratio of secondary to primary follicles (S/P ratio) was 5.1 ± 0.5 for the Huacaya and 7.3 ± 0.2 for the Suri alpacas. The sheep had higher S/P ratios and SFD, lower MFD and produced significantly heavier fleeces. The key correlations found between traits in alpacas include a negative correlation between SFD and MFD (r = –0.71, P = 0.001) and a negative correlation between S/P ratio and MFD (r = –0.44, P = 0.003) and a positive correlation between S/P ratio and total follicle density (r = 0.38, P = 0.010). The study revealed that important relationships exist between alpaca skin follicle characteristics and fibre characteristics. It was the number of secondary follicles in a group that imparts density and a corresponding reduced MFD.