Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders

Background Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced. Aims To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each. Method Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared in terms of cost, burden averted and efficiency of current and optimal treatment. We then calculated the burden unavertable given current knowledge. The unit of health gain was a reduction in the years lived with disability (YLDs). Results Summing across all disorders, current treatment averted 13% of the burden, at an average cost of AUS$30 000 per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of AUS$18 000 per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at AUS$16 000 per YLD gained. Sixty per cent of the burden of mental disorders was deemed to be unavertable. Conclusions The efficiency of treatment varied more than tenfold across disorders. Although coverage of some of the more efficient treatments should be extended, other factors justify continued use of less-efficient treatments for some disorders. Declaration of interest None. Funding detailed in Acknowledgements.

Laparoscopically-assisted resection rectopexy for rectal prolapse: Ten years' experience

PURPOSE: This study has been undertaken to audit a single-center experience with laparoscopically-assisted resection rectopexy for full-thickness rectal prolapse. The clinical Outcomes and long-term results were evaluated. METHODS: The data were prospectively collected for the duration of the operation, time to passage of flatus postoperatively, hospital stay, morbidity, and mortality. For follow-up, patients received a questionnaire or were contacted. The data were divided into quartiles over the study period, and the differences in operating time and length of hospital stay were tested using the Kruskal-Wallis test. RESULTS: Between March 1992 and October 2003, a total of 117 patients underwent laparoscopic resection rectopexy for rectal prolapse. The median operating time during the first quartile (representing the early experience) was 180 minutes compared with 110 minutes for the fourth quartile (Kruskal-Wallis test for operating time = 35.523, 3 df, P < 0.0001). Overall morbidity was 9 percent (ten patients), with one death (< 1 percent). One patient had a ureteric injury requiring conversion. One minor anastomotic leak Occurred, necessitating laparoscopic evacuation of a pelvic abscess. Altogether, 77 patients were available for follow-up. The median follow-up was 62 months. Eighty percent of the patients reported alleviation of their symptoms after the operation. Sixty-nine percent of the constipated patients experienced an improvement in bowel frequency. No patient had new or worsening symptoms of constipation after Surgery. Two (2.5 percent) patients had full-thickness rectal prolapse recurrence. Mucosal prolapse recurred in 14 (18 percent) patients. Anastomotic dilation was performed for stricture in five (4 percent) patients. CONCLUSIONS: Laparoscopically-assisted resection rectopexy for rectal prolapse provides a favorable functional outcome and low recurrence rate. Shorter operating time is achieved with experience. The minimally invasive technique benefits should be considered when offering rectal prolapse patients a transabdominal approach for repair, and emphasis should now be on advanced training in the laparoscopic approach.

Ten Australian elementary teachers' discourse and reported pedagogical practices during cooperative learning

This article describes the types of discourse 10 Australian grade 4-6 teachers used after they had been trained to embed cooperative learning in their curriculum and to use communication skills to promote students' thinking and to scaffold their learning. One audiotaped classroom social science lesson involving cooperative learning was analyzed for each teacher. We provide vignettes from 2 teachers as they worked with groups and from 2 student groups. The data from the audiotapes showed that the teachers used a range of mediated-learning behaviors in their interactions with the children that included challenging their perspectives, asking more cognitive and metacognitive questions, and scaffolding their learning. In turn, in their interactions with each other, the children modelled many of the types of discourse they heard their teachers use. Follow-up interviews with the teachers revealed that they believed it was important to set expectations for children's group behaviors, teach the social skills students needed to deal with disagreement in groups, and establish group structures so children understood what was required both from each other and the task. The teachers reported that mixed ability and gender groups worked best and that groups should be no larger than 5 students. All teachers' programs were based on a child-centered philosophy that recognized the importance of constructivist approaches to learning and the key role interaction plays in promoting social reasoning and learning.

The reliability of ten-meter sprint time using different starting techniques

Acceleration is an important factor for success in team-sport athletes. The purpose of this investigation was to compare the reliability of 10-m sprint times when using different starting techniques. Junior male rugby players (n=15) were tested for speed over 10 m on 2 different testing sessions. Three trials of 3 different starting techniques (standing, foot, and thumb starts) were assessed. Despite large differences in the time taken to perform 10-m sprints from different starts, there was minimal difference in the typical error (similar to 0.02 seconds, or

Becoming media literate? Media Education in Slovenia after Ten Years

The system of education in Slovenia includes pre-school education; primary education; secondary education (vocational education, technical education, general education [grammar schools]); higher education (university [undergraduate and postgraduate education] and professional type). In this course students develop the ability to analyze and evaluate media messages and to identify for themselves issues of concern, as well as... to discuss, understand, explain and with production through cooperation with student's media their own communication (ZaIa, age 34, media education professor at University of Maribor).

Multiple system atrophy: laminar distribution of the pathological changes in frontal and temporal neocortex--a study in ten patients

OBJECTIVE: To determine the distribution of the pathological changes in the neocortex in multiple-system atrophy (MSA). METHOD: The vertical distribution of the abnormal neurons (neurons with enlarged or atrophic perikarya), surviving neurons, glial cytoplasmic inclusions (GCI) and neuronal cytoplasmic inclusions (NI) were studied in alpha-synuclein-stained material of frontal and temporal cortex in ten cases of MSA. RESULTS: Abnormal neurons exhibited two common patterns of distribution, viz., density was either maximal in the upper cortex or a bimodal distribution was present with a density peak in the upper and lower cortex. The NI were either located in the lower cortex or were more uniformly distributed down the cortical profile. The distribution of the GCI varied considerably between gyri and cases. The density of the glial cell nuclei was maximal in the lower cortex in the majority of gyri. In a number of gyri, there was a positive correlation between the vertical densities of the abnormal neurons, the total number of surviving neurons, and the glial cell nuclei. The vertical densities of the GCI were not correlated with those of the surviving neurons or glial cells but the GCI and NI were positively correlated in a small number of gyri. CONCLUSION: The data suggest that there is significant degeneration of the frontal and temporal lobes in MSA, the lower laminae being affected more significantly than the upper laminae. Cortical degeneration in MSA is likely to be secondary to pathological changes occurring within subcortical areas.

Response:Ideas are ten a penny - It's team implementation not idea generation that counts

Cet article présente une synthèse des recherches et théories qui éclairent notre compréhension de la créativité et de la mise en oeuvre de l’innovation dans les groupes de travail. Il semble que la créativité apparaisse essentiellement au cours des premières étapes du processus, avant la mise en oeuvre. On étudie l’influence des caractéristiques de la tâche, des capacités et de l’éventail des connaissances du groupe, des demandes externes, des mécanismes d’intégration et de cohérence de groupe. La perception d’une menace, l’incertitude ou de fortes exigences entravent la créativité, mais favorisent l’innovation. La diversité des connaissances et des capacités est un bon prédicteur de l’innovation, mais l’intégration du groupe et les compétences sont indispensables pour récolter les fruits de la diversité. On examine aussi les implications théoriques et pratiques de ces considérations. In this article I synthesise research and theory that advance our understanding of creativity and innovation implementation in groups at work. It is suggested that creativity occurs primarily at the early stages of innovation processes with innovation implementation later. The influences of task characteristics, group knowledge diversity and skill, external demands, integrating group processes and intragroup safety are explored. Creativity, it is proposed, is hindered whereas perceived threat, uncertainty or other high levels of demands aid the implementation of innovation. Diversity of knowledge and skills is a powerful predictor of innovation, but integrating group processes and competencies are needed to enable the fruits of this diversity to be harvested. The implications for theory and practice are also explored.