Addressing obesity in the management of knee and hip osteoarthritis - weighing in from an economic perspective

BACKGROUND: Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA). So there is increasing interest from a public health perspective in addressing obesity in the management of OA. While evidence of the efficacy of intereventions designed to address obesity in OA populations continues to grow, little is known about their economic credentials. The aim of this study is to conduct a scoping review of: (i) the published economic evidence assessing the economic impact of obesity in OA populations; (ii) economic evaluations of interventions designed to explicitly address obesity in the prevention and management of OA in order to determine which represent value for money. Besides describing the current state of the literature, the study highlights research gaps and identifies future research priorities.

METHODS: In July 2014, a search of the peer reviewed literature, published in English, was undertaken for the period January 1975 - July 2014 using Medline Complete (Ebscohost), Embase, Econlit, Global Health, Health Economics Evaluation Database (HEED), all Cochrane Library databases as well as the grey literature using Google and reference lists of relevant studies. A combination of key search terms was used to identify papers assessing the economic impact of obesity in OA or economic evaluations conducted to assess the efficiency of obesity interventions for the prevention or management of OA.

RESULTS: 14 studes were identified; 13 were cost burden studies assessing the impact of obesity as a predictor for higher costs in Total Joint Arthroplasty (TJA) patients and one a cost-effectiveness study of an intervention designed to address obesity in the managment of mild to moderate OA patients.

CONCLUSION: The majority of the economic studies conducted are cost burden studies. While there is some evidence of the association between severe obesity and excess hospital costs for TJA patients, heterogeneity in studies precludes definitive statements about the strength of the association. With only one economic evaluation to inform policy and practice, there is a need for future research into the cost-effectiveness of obesity interventions designed both for prevention or management of OA along the disease spectrum and over the life course.

Multi-criteria evaluation of wave energy projects on the south-east Australian coast

In the last decade, multiple studies focusing on national-scale assessments of the ocean wave energy resource in Australia identified the Southern Margin to be one of the most energetic areas worldwide suitable for the extraction of wave energy for electricity production. While several companies have deployed single unit devices, the next phase of development will most likely be the deployment of parks with dozens of units, introducing the risk of conflicts within the marine space. This paper presents a geo-spatial multi-criteria evaluation approach to identify optimal locations to deploy a wave energy farm while minimizing potential conflicts with other coastal and offshore users. The methodology presented is based around five major criteria: ocean wave climatology, nature of the seabed, distance to key infrastructure, environmental factors and potential conflict with other users such as shipping and fisheries. A case study is presented for an area off the south-east Australian coast using a total of 18 physical, environmental and socio-economic parameters. The spatial restrictions associated with environmental factors, wave climate, as well as conflict of use, resulted in an overall exclusion of 20% of the study area. Highly suitable areas identified ranged between 11 and 34% of the study area based on scenarios with varying criteria weighting. By spatially comparing different scenarios we identified persistence of a highly suitable area of 700 km2 off the coast of Portland across all model domains investigated. We demonstrate the value of incorporation spatial information at the scale relevant to resource exploitation when examining multiple criteria for optimal site selection of Wave Energy Converters over broad geographic regions.

A COMPARATIVE STUDY AND EVALUATION OF COLLABORATIVE RECOMMENDATION SYSTEMS

Consumers currently enjoy a surplus of goods (books, videos, music, or other items) available to purchase. While this surplus often allows a consumer to find a product tailored to their preferences or needs, the volume of items available may require considerable time or effort on the part of the user to find the most relevant item. Recommendation systems have become a common part of many online business that supply users books, videos, music, or other items to consumers. These systems attempt to provide assistance to consumers in finding the items that fit their preferences. This report presents an overview of recommendation systems. We will also briefly explore the history of recommendation systems and the large boost that was given to research in this field due to the Netflix Challenge. The classical methods for collaborative recommendation systems are reviewed and implemented, and an examination is performed contrasting the complexity and performance among the various models. Finally, current challenges and approaches are discussed.

Computational Evaluation of Wind Loads on Low- and High- Rise Buildings

Buildings and other infrastructures located in the coastal regions of the US have a higher level of wind vulnerability. Reducing the increasing property losses and causalities associated with severe windstorms has been the central research focus of the wind engineering community. The present wind engineering toolbox consists of building codes and standards, laboratory experiments, and field measurements. The American Society of Civil Engineers (ASCE) 7 standard provides wind loads only for buildings with common shapes. For complex cases it refers to physical modeling. Although this option can be economically viable for large projects, it is not cost-effective for low-rise residential houses. To circumvent these limitations, a numerical approach based on the techniques of Computational Fluid Dynamics (CFD) has been developed. The recent advance in computing technology and significant developments in turbulence modeling is making numerical evaluation of wind effects a more affordable approach. The present study targeted those cases that are not addressed by the standards. These include wind loads on complex roofs for low-rise buildings, aerodynamics of tall buildings, and effects of complex surrounding buildings. Among all the turbulence models investigated, the large eddy simulation (LES) model performed the best in predicting wind loads. The application of a spatially evolving time-dependent wind velocity field with the relevant turbulence structures at the inlet boundaries was found to be essential. All the results were compared and validated with experimental data. The study also revealed CFD’s unique flow visualization and aerodynamic data generation capabilities along with a better understanding of the complex three-dimensional aerodynamics of wind-structure interactions. With the proper modeling that realistically represents the actual turbulent atmospheric boundary layer flow, CFD can offer an economical alternative to the existing wind engineering tools. CFD’s easy accessibility is expected to transform the practice of structural design for wind, resulting in more wind-resilient and sustainable systems by encouraging optimal aerodynamic and sustainable structural/building design. Thus, this method will help ensure public safety and reduce economic losses due to wind perils.

Young people's well-being and the economic crisis: How does parental unemployment and family wealth affect the downturn experience?

Background: Portugal is among the European countriesmost severely hit by the economic recession and the fifth with the highest unemployment rate. Given that adolescents' development is highly influenced by their living contexts, monitoring the repercussions of the economic recession is essential for the evaluation and improvement of their current and future public health. Objective: To investigate youth perceived repercussions of the economic recession, its association with life satisfaction, as well as to assess differences across parental employment status and family perceived wealth. Methods: Data were drawn from the Portuguese 2014 Health Behaviour in School-aged children survey, aWHO collaborative cross-national study, with a nationally representative sample of 2748 students (Mage = 14.7 years ± 1.2; 48% boys). Descriptive statistics and linear regression models were performed. Results: Levels of life satisfaction are lower when young people perceive that the economic recession generated negative lifestyle changes. Having unemployed parents was found to be significantly associated with perceiving such repercussions and family wealth to decrease the perception of repercussions of the recession. Conclusions: Findings enhance our understanding of how Portuguese youth are being affected by the socioeconomic conditions surrounding them. Such information contributes to improve future research and also allow some considerations about the policies aimed at protecting young people'swellbeing during a period of high unemployment and socioeconomic downturn.

Irish state infrastructural investment: an analysis of past patterns, and an outline of a future integrated systems of systems evaluation methodology

The literature clearly links the quality and capacity of a country’s infrastructure to its economic growth and competitiveness. This thesis analyses the historic national and spatial distribution of investment by the Irish state in its physical networks (water, wastewater and roads) across the 34 local authorities and examines how Ireland is perceived internationally relative to its economic counterparts. An appraisal of the current status and shortcomings of Ireland’s infrastructure is undertaken using key stakeholders from foreign direct investment companies and national policymakers to identify Ireland's infrastructural gaps, along with current challenges in how the country is delivering infrastructure. The output of these interviews identified many issues with how infrastructure decision-making is currently undertaken. This led to an evaluation of how other countries are informing decision-making, and thus this thesis presents a framework of how and why Ireland should embrace a Systems of Systems (SoS) methodology approach to infrastructure decision-making going forward. In undertaking this study a number of other infrastructure challenges were identified: significant political interference in infrastructure decision-making and delivery the need for a national agency to remove the existing ‘silo’ type of mentality to infrastructure delivery how tax incentives can interfere with the market; and their significance. The two key infrastructure gaps identified during the interview process were: the need for government intervention in the rollout of sufficient communication capacity and at a competitive cost outside of Dublin; and the urgent need to address water quality and capacity with approximately 25% of the population currently being served by water of unacceptable quality. Despite considerable investment in its national infrastructure, Ireland’s infrastructure performance continues to trail behind its economic partners in the Eurozone and OECD. Ireland is projected to have the highest growth rate in the euro zone region in 2015 and 2016, albeit that it required a bailout in 2010, and, at the time of writing, is beginning to invest in its infrastructure networks again. This thesis proposes the development and implementation of a SoS approach for infrastructure decision-making which would be based on: existing spatial and capacity data of each of the constituent infrastructure networks; and scenario computation and analysis of alternative drivers eg. Demographic change, economic variability and demand/capacity constraints. The output from such an analysis would provide valuable evidence upon which policy makers and decision makers alike could rely, which has been lacking in historic investment decisions.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

A pro-active and dynamic prediction assistance using BaranC framework

Monitoring user interaction activities provides the basis for creating a user model that can be used to predict user behaviour and enable user assistant services. The BaranC framework provides components that perform UI monitoring (and collect all associated context data), builds a user model, and supports services that make use of the user model. In this case study, a Next-App prediction service is built to demonstrate the use of the framework and to evaluate the usefulness of such a prediction service. Next-App analyses a user's data, learns patterns, makes a model for a user, and finally predicts based on the user model and current context, what application(s) the user is likely to want to use. The prediction is pro-active and dynamic; it is dynamic both in responding to the current context, and also in that it responds to changes in the user model, as might occur over time as a user's habits change. Initial evaluation of Next-App indicates a high-level of satisfaction with the service.

Adherence to a Mediterranean-style diet and effects on cognition in adults: a qualitative evaluation and systematic review of longitudinal and prospective trials

The Mediterranean-style diet (MedDiet) involves substantial intake of fruits, vegetables, and fish, and a lower consumption of dairy, red meat, and sugars. Over the past 15 years, much empirical evidence supports the suggestion that a MedDiet may be beneficial with respect to reducing the incidence of cardiovascular disease, cancer, metabolic syndrome, and dementia. A number of cross-sectional studies that have examined the impact of MedDiet on cognition have yielded largely positive results. The objective of this review is to evaluate longitudinal and prospective trials to gain an understanding of how a MedDiet may impact cognitive processes over time. The included studies were aimed at improving cognition or minimizing of cognitive decline. Studies reviewed included assessments of dietary status using either a food frequency questionnaire or a food diary assessment. Eighteen articles meeting our inclusion criteria were subjected to systematic review. These revealed that higher adherence to a MedDiet is associated with slower rates of cognitive decline, reduced conversion to Alzheimer's disease, and improvements in cognitive function. The specific cognitive domains that were found to benefit with improved Mediterranean Diet Score were memory (delayed recognition, long-term, and working memory), executive function, and visual constructs. The current review has also considered a number of methodological issues in making recommendations for future research. The utilization of a dietary pattern, such as the MedDiet, will be essential as part of the armamentarium to maintain quality of life and reduce the potential social and economic burden of dementia.

Arts in Basic Curriculum : 20-Year Anniversary Evaluation

The Arts in Basic Curriculum (ABC) Project has ensured students throughout South Carolina have a quality, comprehensive arts education for 20 years. Through funding, research, advocacy and training and technical assistance, the Project has been a model for a number of advancements in arts education. The statewide focus, the creation of arts education standards and curriculum, the success of its advocacy and its inroads on arts education assessment and integration mark the ABC Project as a significant leader in the field of arts education. At its 20th anniversary, the ABC Project engaged an independent evaluator to explore the Project’s impact at this stage of its history. This report captures the findings of this 20-year evaluation.

Impacto del Programa de Alimentación Escolar en el Trabajo Infantil: Una aproximación desde la toma de decisiones familiares

Esta investigación analiza el impacto del Programa de Alimentación Escolar en el trabajo infantil en Colombia a través de varias técnicas de evaluación de impacto que incluyen emparejamiento simple, emparejamiento genético y emparejamiento con reducción de sesgo. En particular, se encuentra que este programa disminuye la probabilidad de que los escolares trabajen alrededor de un 4%. Además, se explora que el trabajo infantil se reduce gracias a que el programa aumenta la seguridad alimentaria, lo que consecuentemente cambia las decisiones de los hogares y anula la carga laboral en los infantes. Son numerosos los avances en primera infancia llevados a cabo por el Estado, sin embargo, estos resultados sirven de base para construir un marco conceptual en el que se deben rescatar y promover las políticas públicas alimentarias en toda la edad escolar.

Las reformas emprendidas en Túnez de la mano del FMI y el BM ¿Precedente para la revolución de los Jazmines?”(1987-2010)

El estallido de la “Revolución de los Jazmines” cuestionó el éxito de un país que por más de dos décadas fue exaltado por el Banco Mundial (BM) y el Fondo Monetario Internacional (FMI) por los logros alcanzados gracias a un programa de restructuración económica. Las exigencias e inconformidades de los manifestantes, que iban más allá de la falta de garantías democráticas, permitieron ver que el país sufría de problemas estructurales relacionados a los altos niveles de desempleo, la precariedad de la situación laboral y la desigualdad. Esta monografía pretende evaluar el papel que tuvieron las reformas económicas y en general el modelo de desarrollo que siguió Túnez de la mano del FMI y el BM, en el surgimiento y consolidación de las condiciones que dieron lugar a la Revolución de los Jazmines a finales del año 2010.

Economic feasibility analysis of the implementation of a high value-added molecule extraction system in an olive oil mill

The production of olive oil generates several by-products that can be seen as an additional business opportunity. Among them are the olive pits, already used for heat and/or electricity generation in some mills. They contain compounds that are commercially very interesting and, if recovered, contribute to the sustainability of the olive mills. The work presented in this paper is a preliminary evaluation of the economic feasibility of implementing a system based on a batch prototype with 1 m3 for the extraction of high value-added bioactive molecules from olive pits that are separated during the production of virgin olive oil. For the analysis, a small representative olive mill in Portugal was considered and the traditional Discounted Cash Flow Method was applied. Based on the assumptions made, the simple payback for implementation a system for the extraction of value-added molecules from the olive pits is around 7 years.

Emergetic evaluation of cattle rearing in a montado farm

O Montado, em Portugal, é um complexo sistema silvopastoril de uso da terra, tipicamente Mediterrânico, com diversos estratos de vegetação, incluindo sobreiro e azinheira em várias densidades, onde é frequente a criação de gado. Esta actividade pecuária beneficia das pastagens no sob-coberto, de algumas espécies arbustivas e também das bolotas que caem do coberto arbóreo, contribuindo para evitar a invasão da pastagem por matos. No entanto, dependendo da sua gestão, este gado pode comprometer a regeneração do sistema. Nos últimos 20 anos, os subsídios no âmbito da Política Agrícola Comum da União Europeia têm promovido a criação de gado bovino em detrimento de outras espécies e raças mais leves, bem como a intensificação desta produção. Esta intensificação pode impossibilitar a regeneração natural das árvores ameaçando o equilíbrio do Montado. Por esta razão é necessária uma avaliação focada na criação de gado bovino e nos seus impactos sobre o sistema. O objectivo deste estudo foi obter uma melhor compreensão do funcionamento de uma exploração silvopastoril num sistema de Montado, através da aplicação do Método de Avaliação Emergética e do cálculo de índices emergéticos. Pretende-se assim compreender a melhor forma de o gerir, bem como conceber estratégias que maximizem o fluxo de emergia na exploração. Uma comparação deste método com a avaliação económica permitiu perceber em que aspectos esta pode ser complementada pelo método da avaliação emergética. O método da avaliação emergética permite a avaliação de sistemas multifuncionais complexos à escala de uma exploração individual, fornecendo informação extra em relação à avaliação económica como a renovabilidade dos inputs do sistema, ou a quantidade de fluxos livres da natureza que é valorada por preços de mercado. Este método permite a integração das emternalidades e das externalidades à contabilização económica, transformando uma avaliação tendencialmente separada do seu sistema mais vasto, numa avaliação de um sistema em conexão com aqueles mais vastos nos quais se integra; Abstract: The Montado, in Portugal, is a complex silvo-pastoral system of land use, typically Mediterranean, with different strata of vegetation, including cork and holm oaks in various densities, and where cattle rearing is common. This stockfarm benefits from the herbaceous layer under the trees, as well as from some species in the shrub layer, and also from the acorns faling down from the tree cover, while contributing to prevent the invasion of pastures by shrubs. Nevertheless, depending on its management, livestock can affect the system regeneration. Over the past 20 years, subsidies of the European Union's common agricultural policy have promoted the cattle rearing at expense of other lighter species and breeds, as well as its intensification. This intensification may impair the natural regeneration of trees threatening the balance of the Montado. Therefore an assessment focused on cattle and their impact on the system is required. The purpose of this study was to obtain a better understanding of the functioning of a silvo-pastoral farm in a Montado system, by applying the emergy evaluation method and through the calculation of emergy indices. It is intended to understand the best way to manage and design strategies that maximize the emergy flow on the farm. A comparison of this method with the economic evaluation allowed to realize in what aspects it can be complemented by the emergy evaluation method. The emergy evaluation method alows the assessment of complex multi-functional systems at the scale of an individual farm, providing extra information in relation to economic avaluation as the renewability of the inputs to a system and the amount of free flows of nature that is valued by market prices. This method allows the integration of the emternalities and the externalities to the economic accounting, transforming an evaluation tended separated from its wider system, in an evaluation of a system in connection with the larger ones on which it is incorporated.

Efficacy and economic returns from various insecticide combinations applied for tobacco budworm control in the Brazos River Valley.

A field efficacy evaluation revealed significant differences in efficacy among a few of the numerous insecticides or combinations of insecticides applied for Heliothis spp. control. An increasing proportion of made up this field population during the test period. Partial budgeting revealed that the net returns from applying any treatment were directly proportional to the resulting yield obtained from that treatment.