Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

Opportunities and challenges in engaging citizens in the co-production of infrastructure-based public services in Australia

Research and practice have observed a shift towards service-oriented approaches that depend on input from citizens as co-producers of services. Yet in the delivery of public infrastructure the focus is still on managing assets rather than services. Using a Policy Delphi approach, we found that although experts advocate service-centric approaches guidelines and policies lack a service-centric perspective. Findings revealed a range of impediments to effective stakeholder involvement. The paper contributes to co-production and new public governance literature and offers directions for public infrastructure decision-makers to support and reconnect disengaged government–citizen relations, and determine ways of understanding optimal service outcomes.

Strategies for teaching evidence-based practice to undergraduate health students: A systematic review protocol

Review question/objective The objective of this review is to find, critically appraise and synthesize the available quantitative evidence on the effectiveness of interventions that promote successful teaching of the evidence-based practice process in undergraduate health students, in preparation for them to become professional evidence-based practitioners. More specifically, the question that this review seeks to answer is: What is the effectiveness of teaching strategies for evidence-based practice for undergraduate health students? Inclusion criteria Types of participants This review will consider studies that include undergraduate health students from any undergraduate health discipline, including but not limited to medicine, nursing and allied health. Post graduate and post-registration students will not be included. Types of interventions This review will consider studies that evaluate strategies or interventions aimed at teaching any or all of the five steps of evidence-based practice, namely asking a structured clinical question; collecting the best evidence available; critically appraising the evidence to ensure validity, relevance and applicability; applying or integrating the results into clinical practice, and evaluating outcomes. The strategy may take place solely within a tertiary education environment or may be combined with a clinical setting. Types of outcomes This review will consider studies that include the following outcome measures: evidence-based practice behavior, knowledge, skills, attitudes, self-efficacy (or self-confidence), beliefs, values, intention to use evidence-based practice (future use) and confidence levels. Tools used to measure these outcomes will be assessed for reported validity, reliability and generalizability. Outcomes will be measured during the student’s education period up to graduation. If studies are conducted across different year levels this will be taken into account during analysis and reported accordingly.

Arts education and iPads in the early years

This chapter takes as a working premise that digital culture is embedded in the every-day life experiences of most children living in post-industrial societies, both in home and, increasingly, in educational contexts. We outline how our research project investigated strategies for developing learning in the arts for young children by using the iPad as a creative device, rather than one on which they consume content in the form of games, on demand television and streaming video. We ask critical questions around creative ecologies and creative production; these grow from our observations on how young children and their families engaged with iPads through activities such as combining painting with digital photography. Analysis of work samples produced by children during the project enables interrogation of the ways in which young children can participate in arts practices and learning when digital media production is available. The chapter is structured around three themes of practice for iPad-based arts and creative education in preschool settings.

Technoeconomic analysis of an integrated microalgae photobioreactor, biodiesel and biogas production facility

As fossil fuel prices increase and environmental concerns gain prominence, the development of alternative fuels from biomass has become more important. Biodiesel produced from microalgae is becoming an attractive alternative to share the role of petroleum. Currently it appears that the production of microalgal biodiesel is not economically viable in current environment because it costs more than conventional fuels. Therefore, a new concept is introduced in this article as an option to reduce the total production cost of microalgal biodiesel. The integration of biodiesel production system with methane production via anaerobic digestion is proved in improving the economics and sustainability of overall biodiesel stages. Anaerobic digestion of microalgae produces methane and further be converted to generate electricity. The generated electricity can surrogate the consumption of energy that require in microalgal cultivation, dewatering, extraction and transesterification process. From theoretical calculations, the electricity generated from methane is able to power all of the biodiesel production stages and will substantially reduce the cost of biodiesel production (33% reduction). The carbon emissions of biodiesel production systems are also reduced by approximately 75% when utilizing biogas electricity compared to when the electricity is otherwise purchased from the Victorian grid. The overall findings from this study indicate that the approach of digesting microalgal waste to produce biogas will make the production of biodiesel from algae more viable by reducing the overall cost of production per unit of biodiesel and hence enable biodiesel to be more competitive with existing fuels.

Microalgal biomass as a fermentation feedstock for bioethanol production

BACKGROUND The increasing cost of fossil fuels as well as the escalating social and industrial awareness of the environmental impacts associated with the use of fossil fuels has created the need for more sustainable fuel options. Bioethanol, produced from renewable biomass such as sugar and starch materials, is believed to be one of these options, and it is currently being harnessed extensively. However, the utilization of sugar and starch materials as feedstocks for bioethanol production creates a major competition with the food market in terms of land for cultivation, and this makes bioethanol from these sources economically less attractive. RESULT This study explores the suitability of microalgae (Chlorococum sp.) as a substrate for bioethanol production via yeast (Saccharomycesbayanus)under different fermentation conditions. Results show a maximum ethanol concentration of 3.83 g L -1 obtained from 10 g L-1 of lipid-extracted microalgae debris. CONCLUSION This productivity level (∼38% w/w), which is in keeping with that of current production systems endorses microalgae as a promising substrate for bioethanol production.

Dewatering of microalgal culture for biodiesel production : exploring polymer flocculation and tangential flow filtration

Background: Conventional biodiesel production relies on trans-esterification of lipids extracted from vegetable crops. However, the use of valuable vegetable food stocks as raw material for biodiesel production makes it an unfeasibly expensive process. Used cooking oil is a finite resource and requires extra downstream processing, which affects the amount of biodiesel that can be produced and the economics of the process. Lipids extracted from microalgae are considered an alternative raw material for biodiesel production. This is primarily due to the fast growth rate of these species in a simple aquaculture environment. However, the dilute nature of microalgae culture puts a huge economic burden on the dewatering process especially on an industrial scale. This current study explores the performance and economic viability of chemical flocculation and tangential flow filtration (TFF) for the dewatering of Tetraselmis suecicamicroalgae culture. Results: Results show that TFF concentrates the microalgae feedstock up to 148 times by consuming 2.06 kWh m-3 of energy while flocculation consumes 14.81 kWhm-3 to concentrate the microalgae up to 357 times. Economic evaluation demonstrates that even though TFF has higher initial capital investment than polymer flocculation, the payback period for TFF at the upper extreme ofmicroalgae revenue is ∼1.5 years while that of flocculation is ∼3 years. Conclusion: These results illustrate that improved dewatering levels can be achieved more economically by employing TFF. The performances of these two techniques are also compared with other dewatering techniques.

Rapid production of a plasmid DNA encoding a malaria vaccine candidate via amino-functionalized poly(GMA-co-EDMA) monolith

Malaria is a global health problem; an effective vaccine is urgently needed. Due to the relative poverty and lack of infrastructure in malaria endemic areas, DNA-based vaccines that are stable at ambient temperatures and easy to formulate have great potential. While attention has been focused mainly on antigen selection, vector design and efficacy assessment, the development of a rapid and commercially viable process to manufacture DNA is generally overlooked. We report here a continuous purification technique employing an optimized stationary adsorbent to allow high-vaccine recovery, low-processing time, and, hence, high-productivity. A 40.0 mL monolithic stationary phase was synthesized and functionalized with amino groups from 2-Chloro-N,N- diethylethylamine hydrochloride for anion-exchange isolation of a plasmid DNA (pDNA) that encodes a malaria vaccine candidate, VR1020-PyMSP4/5. Physical characterization of the monolithic polymer showed a macroporous material with a modal pore diameter of 750 nm. The final vaccine product isolated after 3 min elution was homogeneous supercoiled plasmid with gDNA, RNA and protein levels in keeping with clinical regulatory standards. Toxicological studies of the pVR1020-PyMSP4/5 showed a minimum endotoxin level of 0.28 EU/m.g pDNA. This cost-effective technique is cGMP compatible and highly scalable for the production of DNA-based vaccines in commercial quantities, when such vaccines prove to be effective against malaria. © 2008 American Institute of Chemical Engineers.