The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

Letting go of Neo-Liberalism (with some help from Michel Foucault)

Neo-liberalism has become one of the boom concepts of our time. From its original reference point as a descriptor of the economics of the “Chicago School” such as Milton Friedman, or authors such as Friedrich von Hayek, neo-liberalism has become an all-purpose descriptor and explanatory device for phenomena as diverse as Bollywood weddings, standardized testing in schools, violence in Australian cinema, and the digitization of content in public libraries. Moreover, it has become an entirely pejorative term: no-one refers to their own views as “neo-liberal”, but it rather refers to the erroneous views held by others, whether they acknowledge this or not. Neo-liberalism as it has come to be used, then, bears many of the hallmarks of a dominant ideology theory in the classical Marxist sense, even if it is often not explored in these terms. This presentation will take the opportunity provided by the English language publication of Michel Foucault’s 1978-79 lectures, under the title of The Birth of Biopolitics, to consider how he used the term neo-liberalism, and how this equates with its current uses in critical social and cultural theory. It will be argued that Foucault did not understand neo-liberalism as a dominant ideology in these lectures, but rather as marking a point of inflection in the historical evolution of liberal political philosophies of government. It will also be argued that his interpretation of neo-liberalism was more nuanced and more comparative than the more recent uses of Foucault in the literature on neo-liberalism. It will also look at how Foucault develops comparative historical models of liberal capitalism in The Birth of Biopolitics, arguing that this dimension of his work has been lost in more recent interpretations, which tend to retro-fit Foucault to contemporary critiques of either U.S. neo-conservatism or the “Third Way” of Tony Blair’s New Labour in the UK.

Assessment of heat-related health impacts in Brisbane, Australia : comparison of different heatwave definitions

Background: There is no global definition of a heatwave because local acclimatisation and adaptation influence the impact of extreme heat. Even at a local level there can be multiple heatwave definitions, based on varying temperature levels or time periods. We investigated the relationship between heatwaves and health outcomes using ten different heatwave definitions in Brisbane, Australia. ---------- Methodology/Principal Findings: We used daily data on climate, air pollution, and emergency hospital admissions in Brisbane between January 1996 and December 2005; and mortality between January 1996 and November 2004. Case-crossover analyses were used to assess the relationship between each of the ten heatwave definitions and health outcomes. During heatwaves there was a statistically significant increase in emergency hospital admissions for all ten definitions, with odds ratios ranging from 1.03 to 1.18. A statistically significant increase in the odds ratios of mortality was also found for eight definitions. The size of the heat-related impact varied between definitions.---------- Conclusions/Significance Even a small change in the heatwave definition had an appreciable effect on the estimated health impact. It is important to identify an appropriate definition of heatwave locally and to understand its health effects in order to develop appropriate public health intervention strategies to prevent and mitigate the impact of heatwaves.

Skills for creative industries graduate success

Purpose: Although there is increasing evidence that the creative industries are essential to national economic growth as well as social and cultural well-being, creative graduates often find it difficult to become established professionally. This study investigates the value of career management competence and intrinsic career motivations (as elements of ‘protean career orientation’) in predicting positive graduate outcomes. ----- ----- Design/methodology: Self-report surveys were administered to 208 creative industries graduates from two Australian universities at two points in time: at course completion, and one year later. ----- ----- Findings: Individual career management competence and intrinsic work motivations, measured at course completion, were significant predictors of early career success, using both subjective and objective measures, measured one year later. ----- ----- Practical implications: This study suggests that an emphasis on student development beyond the traditional ‘key’ employability skills may well be worthwhile. The article also suggests a broad learning and teaching approach by which universities can encourage the development of student career identity, and thus engender student intrinsic career motivations and career self management skills and behaviours. ----- ----- Originality/value: This is one of the first studies to demonstrate empirically a link between a particular set of skills and graduate outcomes. In addition, it provides insights into the role of student career motivations in positive transitions to the world of work in the creative industries.

Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China : a time-stratified case-crossover study

Background: A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension. ---------- Methods: Daily data on emergency hospital visits (EHVs) for hypertension were collected from the Peking University Third Hospital. Daily data on gaseous air pollutants (sulfur dioxide (SO2) and nitrogen dioxide (NO2)) and particulate matter less than 10 μm in aerodynamic diameter (PM10) were collected from the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was conducted to evaluate the relationship between urban gaseous air pollution and EHVs for hypertension. Temperature and relative humidity were controlled for. ---------- Results: In the single air pollutant models, a 10 μg/m3 increase in SO2 and NO2 were significantly associated with EHVs for hypertension. The odds ratios (ORs) were 1.037 (95% confidence interval (CI): 1.004-1.071) for SO2 at lag 0 day, and 1.101 (95% CI: 1.038-1.168) for NO2 at lag 3 day. After controlling for PM10, the ORs associated with SO2 and NO2 were 1.025 (95% CI: 0.987-1.065) and 1.114 (95% CI: 1.037-1.195), respectively.---------- Conclusion: Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing, China.

Cost-effectiveness of a central venous catheter care bundle

Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. ---------- Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.---------- Conclusions: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.

The record producer as nexus : creative inspiration, technology and the recording industry

What is a record producer? There is a degree of mystery and uncertainty about just what goes on behind the studio door. Some producers are seen as Svengali-like figures manipulating artists into mass consumer product. Producers are sometimes seen as mere technicians whose job is simply to set up a few microphones and press the record button. Close examination of the recording process will show how far this is from a complete picture. Artists are special—they come with an inspiration, and a talent, but also with a variety of complications, and in many ways a recording studio can seem the least likely place for creative expression and for an affective performance to happen. The task of the record producer is to engage with these artists and their songs and turn these potentials into form through the technology of the recording studio. The purpose of the exercise is to disseminate this fixed form to an imagined audience—generally in the hope that this audience will prove to be real. Finding an audience is the role of the record company. A record producer must also engage with the commercial expectations of the interests that underwrite a recording. This dissertation considers three fields of interest in the recording process: the performer and the song; the technology of the recording context; and the commercial ambitions of the record company—and positions the record producer as a nexus at the interface of all three. The author reports his structured recollection of five recordings, with three different artists, that all achieved substantial commercial success. The processes are considered from the author’s perspective as the record producer, and from inception of the project to completion of the recorded work. What were the processes of engagement? Do the actions reported conform to the template of nexus? This dissertation proposes that in all recordings the function of producer/nexus is present and necessary—it exists in the interaction of the artistry and the technology. The art of record production is to engage with these artists and the songs they bring and turn these potentials into form.

Facilitating needs based cancer care for people with a chronic disease : evaluation of an intervention using a multi-centre interrupted time series design

Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. ---------- Methods/design: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention.---------- Discussion: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care.

QUT Digital Repository: Integrating the University’s IR with other digital collections

Queensland University of Technology’s Institutional Repository, QUT ePrints (http://eprints.qut.edu.au/), was established in 2003. With the help of an institutional mandate (endorsed in 2004) the repository now holds over 11,000 open access publications. The repository’s success is celebrated within the University and acknowledged nationally and internationally. QUT ePrints was built on GNU EPrints open source repository software (currently running v.3.1.3) and was originally configured to accommodate open access versions of the traditional range of research publications (journal articles, conference papers, books, book chapters and working papers). However, in 2009, the repository’s scope, content and systems were broadened and the ‘QUT Digital repository’ is now a service encompassing a range of digital collections, services and systems. For a work to be accepted in to the institutional repository, at least one of the authors/creators must have a current affiliation with QUT. However, the success of QUT ePrints in terms of its capacity to increase the visibility and accessibility of our researchers' scholarly works resulted in requests to accept digital collections of works which were out of scope. To address this need, a number of parallel digital collections have been developed. These collections include, OZcase, a collection of legal research materials and ‘The Sugar Industry Collection’; a digitsed collection of books and articles on sugar cane production and processing. Additionally, the Library has responded to requests from academics for a service to support the publication of new, and existing, peer reviewed open access journals. A project is currently underway to help a group of senior QUT academics publish a new international peer reviewed journal. The QUT Digital Repository website will be a portal for access to a range of resources to support copyright management. It is likely that it will provide an access point for the institution’s data repository. The data repository, provisionally named the ‘QUT Data Commons’, is currently a work-in-progress. The metadata for some QUT datasets will also be harvested by and discoverable via ‘Research Data Australia’, the dataset discovery service managed by the Australian National Data Service (ANDS). QUT Digital repository will integrate a range of technologies and services related to scholarly communication. This paper will discuss the development of the QUT Digital Repository, its strategic functions, the stakeholders involved and lessons learned.

"Re-imagining animation : the changing face of the moving image by Paul Wells and Johnny Hardstaff" (Book Review)

Advances in digital technology have caused a radical shift in moving image culture. This has occurred in both modes of production and sites of exhibition, resulting in a blurring of boundaries that previously defined a range of creative disciplines. Re-Imagining Animation: The Changing Face of the Moving Image, by Paul Wells and Johnny Hardstaff, argues that as a result of these blurred disciplinary boundaries, the term “animation” has become a “catch all” for describing any form of manipulated moving image practice. Understanding animation predicates the need to (re)define the medium within contemporary moving image culture. Via a series of case studies, the book engages with a range of moving image works, interrogating “how the many and varied approaches to making film, graphics, visual artefacts, multimedia and other intimations of motion pictures can now be delineated and understood” (p. 7). The structure and clarity of content make this book ideally suited to any serious study of contemporary animation which accepts animation as a truly interdisciplinary medium.

The Early Prevention of Obesity in CHildren (EPOCH) collaboration : an individual patient data prospective meta-analysis

Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori. Methods/Design: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics. Discussion: Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013. Trial registration number: ACTRN12610000789066

Aesthetic tensions : evaluating outcomes for practice-led research and industry

This paper explores principles of contemporary aesthetics to suggest a basis for determining qualitative outcomes of artistic works in two contexts: the arts industry and the academy setting of practice-led research. Commonly articulated measures of quality—creativity and innovation—are questioned as mere rhetoric if not framed in specific ways in the two discrete settings. The paper also interrogates generally held assumptions that a longer time to develop work and greater periods of self-reflexivity will produce higher calibre artistic outcomes. The unease produced by apparent differences in qualitative outcomes between art works created in an industry setting and those created through practice-led research is analysed through three interconnected framing devices: intention, contextual parameters and criteria for evaluation, in conjunction with the relationships between the art work, the artist and the audience/viewer/listener. Common and differentiated criteria in the two contexts are explored, leading to the conclusion that innovation is more likely to be revealed in the end product in an industry context whereas in practice-led research it may be in the methodological processes of creating the work. While identifying and acknowledging that the two contexts encourage and produce distinctive qualitative artistic outcomes, both of value to the arts and the academy, the paper recommends ways in which closer formal liaison between industry artists and practice-led artists and supervisors might occur in order to ensure ongoing mutual influence and relevance.

Toward a cultural economic geography of creative industries and urban development : introduction to the special issue on creative industries and urban development

The connections between the development of creative industries and the growth of cities was noted by several sources over the 2000s, but explanations relating to the nature of the link have thus far provide to be insufficient. The two dominant ‘scripts’ were those of ‘creative clusters’ and ‘creative/cities/creative class’ theories, but both have proved to be insufficient, not least because they privilege amenities-led, supply-drive accounts of urban development that fail to adequately situate cities in wider global circuits of culture and economic production. It is proposed that the emergent field of cultural economic geography provides some insights into redressing these lacunae, particularly in the possibilities for an original synthesis of cultural and economic geography, cultural studies and new strands of economic theory.

Developing reflective practitioners online: The business of blogs in work integrated learning

Reflective practice is widely considered across discussions around educational psychology, professional identity, employability of graduates, and generic or graduate capabilities. Critical reflection is essential for providing a bridge between the university and the workplace, and for ultimately preparing work ready graduates (Patrick et al, 2008). Work integrated learning, particularly through internships and work placements for students, is viewed as a valuable approach for students developing skills in reflective practice. Reflective journals are one of the tools often used to encourage and develop student reflection. Shifting the reflective journal to an online interface as a reflective blog presents opportunities for more meaningful, frequent and richer interaction between the key players in a work integrated learning experience. This paper examines the adoption, implementation and refinement of the use of reflective blogs in a work integrated learning unit for business students majoring in advertising, marketing and public relations disciplines. The reflective blog is discussed as a learning and assessment tool, including the approaches taken to integrate and scaffold the blog as part of the work integrated learning experience. Graduate capabilities were used as cornerstones for students to frame students’ thinking, experiences and reflection. These capabilities emphasise the value of coherent theoretical and practical knowledge, coupled with critical, creative and analytical thinking, problem solving skills, self reliance and resilience. Underlying these graduate capabilities is a focus on assessment for learning matched with assessment of learning. Using specific triggers and prompts as part of the reflective process, and incorporating ongoing feedback from academic supervisors, students moved from descriptive levels of reflection, to more meaningful and critical reflection. Students’ blogs are analysed to identify key themes, challenges and achievements in the work integrated learning experience. Suggestions for further development and improvement, together with a model of best practice, are proposed.

Creativity as emergence : policy issues for creative cities

The creative industries concept was born in the UK, nurtured in Australia (among other countries), but is now being implemented most vigorously in China. The UK and Australia seem to be pulling back from the concept: • Critical response to CI policy in the UK; and post-GFC cutbacks limit scope for government action. • Australia relies on the resources boom; even though recent WIPO report puts Australian ‘copyright industries’ at over 10 percent of GDP (second only to the USA at 11%). Not surprisingly the USA remains happy with the term ‘copyright industries.’ This faltering policy environment in advanced countries may work to their own longer-term economic detriment. The creative industries’ transformative impact on the global economy may come instead from China.