Evaluation of the cost-effectiveness of strategies claiming to reduce the risk of surgical site infections following primary total hip arthroplasty

Background Total hip arthroplasty (THA) is a commonly performed procedure and numbers are increasing with ageing populations. One of the most serious complications in THA are surgical site infections (SSIs), caused by pathogens entering the wound during the procedure. SSIs are associated with a substantial burden for health services, increased mortality and reduced functional outcomes in patients. Numerous approaches to preventing these infections exist but there is no gold standard in practice and the cost-effectiveness of alternate strategies is largely unknown. Objectives The aim of this project was to evaluate the cost-effectiveness of strategies claiming to reduce deep surgical site infections following total hip arthroplasty in Australia. The objectives were: 1. Identification of competing strategies or combinations of strategies that are clinically relevant to the control of SSI related to hip arthroplasty 2. Evidence synthesis and pooling of results to assess the volume and quality of evidence claiming to reduce the risk of SSI following total hip arthroplasty 3. Construction of an economic decision model incorporating cost and health outcomes for each of the identified strategies 4. Quantification of the effect of uncertainty in the model 5. Assessment of the value of perfect information among model parameters to inform future data collection Methods The literature relating to SSI in THA was reviewed, in particular to establish definitions of these concepts, understand mechanisms of aetiology and microbiology, risk factors, diagnosis and consequences as well as to give an overview of existing infection prevention measures. Published economic evaluations on this topic were also reviewed and limitations for Australian decision-makers identified. A Markov state-transition model was developed for the Australian context and subsequently validated by clinicians. The model was designed to capture key events related to deep SSI occurring within the first 12 months following primary THA. Relevant infection prevention measures were selected by reviewing clinical guideline recommendations combined with expert elicitation. Strategies selected for evaluation were the routine use of pre-operative antibiotic prophylaxis (AP) versus no use of antibiotic prophylaxis (No AP) or in combination with antibiotic-impregnated cement (AP & ABC) or laminar air operating rooms (AP & LOR). The best available evidence for clinical effect size and utility parameters was harvested from the medical literature using reproducible methods. Queensland hospital data were extracted to inform patients’ transitions between model health states and related costs captured in assigned treatment codes. Costs related to infection prevention were derived from reliable hospital records and expert opinion. Uncertainty of model input parameters was explored in probabilistic sensitivity analyses and scenario analyses and the value of perfect information was estimated. Results The cost-effectiveness analysis was performed from a health services perspective using a hypothetical cohort of 30,000 THA patients aged 65 years. The baseline rate of deep SSI was 0.96% within one year of a primary THA. The routine use of antibiotic prophylaxis (AP) was highly cost-effective and resulted in cost savings of over $1.6m whilst generating an extra 163 QALYs (without consideration of uncertainty). Deterministic and probabilistic analysis (considering uncertainty) identified antibiotic prophylaxis combined with antibiotic-impregnated cement (AP & ABC) to be the most cost-effective strategy. Using AP & ABC generated the highest net monetary benefit (NMB) and an incremental $3.1m NMB compared to only using antibiotic prophylaxis. There was a very low error probability that this strategy might not have the largest NMB (<5%). Not using antibiotic prophylaxis (No AP) or using both antibiotic prophylaxis combined with laminar air operating rooms (AP & LOR) resulted in worse health outcomes and higher costs. Sensitivity analyses showed that the model was sensitive to the initial cohort starting age and the additional costs of ABC but the best strategy did not change, even for extreme values. The cost-effectiveness improved for a higher proportion of cemented primary THAs and higher baseline rates of deep SSI. The value of perfect information indicated that no additional research is required to support the model conclusions. Conclusions Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalised patients, save lives and enhance resource allocation. By implementing a more beneficial infection control strategy, scarce health care resources can be used more efficiently to the benefit of all members of society. The results of this project provide Australian policy makers with key information about how to efficiently manage risks of infection in THA.

A method for systematically pooling data in very early stage construction price forecasting

Client owners usually need an estimate or forecast of their likely building costs in advance of detailed design in order to confirm the financial feasibility of their projects. Because of their timing in the project life cycle, these early stage forecasts are characterized by the minimal amount of information available concerning the new (target) project to the point that often only its size and type are known. One approach is to use the mean contract sum of a sample, or base group, of previous projects of a similar type and size to the project for which the estimate is needed. Bernoulli’s law of large numbers implies that this base group should be as large as possible. However, increasing the size of the base group inevitably involves including projects that are less and less similar to the target project. Deciding on the optimal number of base group projects is known as the homogeneity or pooling problem. A method of solving the homogeneity problem is described involving the use of closed form equations to compare three different sampling arrangements of previous projects for their simulated forecasting ability by a cross-validation method, where a series of targets are extracted, with replacement, from the groups and compared with the mean value of the projects in the base groups. The procedure is then demonstrated with 450 Hong Kong projects (with different project types: Residential, Commercial centre, Car parking, Social community centre, School, Office, Hotel, Industrial, University and Hospital) clustered into base groups according to their type and size.

Regulation of land access for resource development: A coal seam gas case study from Queensland

A number of regulatory statutes provide for agreements with landowners which are given extended effect, that is, are binding upon the landowner’s successors (‘statutory agreements’). Several Queensland statutes require a project proponent to enter into a statutory agreement with a landowner before a resource development activity can be carried out on private land or by accessing private land. Provisions of Queensland’s Petroleum and Gas (Production and Safety) Act 2004 make certain types of statutory agreements binding upon successors and assigns of the landowner, but do not clearly prescribe the nature and contents of an agreement, nor require that the agreement be recorded on the land title or petroleum register. If statutory agreements are to be used for such purposes, their purpose and content should be more clearly defined by statute and they should be recorded on a searchable register.

Children's Literature Digital Resource (CLDR)

Children’s Literature Digital Resources incorporates primary texts published from white settlement to 1945, including children’s and young adult fiction, poetry, short stories, and picture books. This collection is supported by selected secondary material. The objective is to provide a centralised access point for information about Australian children's literature and writers and a growing body of full-text primary resources. Four key aims are: * To establish an important digital facility for research, teaching, and information provision around Australian children’s literature; * To provide access to a wide range of high-quality full-text data, both primary and secondary resources; * To provide access to essential library and research information infrastructure and facilities for established and emerging researchers in the fields of Humanities and Education; To enable research while preserving important heritage material. The collection contains texts digitised for AustLit through cooperation with various Australian libraries. The collection includes children’s and young adult fiction, poetry, picture books, short stories, and critical articles relating to relevant primary texts. Authors of primary sources include Irene Cheyne, E. W. Cole, Richard Rowe, Lillian M. Pyke, and Dorothy Wall. Secondary sources include critical works by Clare Bradford, Heather Scutter, Kerry White, Sharyn Pearce, and Marcie Muir. These full-text materials are keyword searchable (both within individual texts and across the CLDR corpus) and can be downloaded for research purposes. As well as digitising primary and secondary material, the project locates and provides pathways to existing online resources or internet publications to enhance AustLit's Children's Literature subset. These resources include both primary and secondary texts.

A comparison of safety climate and safety outcomes between construction and resource functions in a large case study organisation

The research described in this paper forms part of an in-depth investigation of safety culture in one of Australia’s largest construction companies. The research builds on a previous qualitative study with organisational safety leaders and further investigates how safety culture is perceived and experienced by organisational members, as well as how this relates to their safety behaviour and related outcomes at work. Participants were 2273 employees of the case study organisation, with 689 from the Construction function and 1584 from the Resources function. The results of several analyses revealed some interesting organisational variance on key measures. Specifically, the Construction function scored significantly higher on all key measures: safety climate, safety motivation, safety compliance, and safety participation. The results are discussed in terms of relevance in an applied research context.

Curbing resource consumption using team-based feedback : paper printing in a longitudinal case study

This paper details a team-based feedback approach for reducing resource consumption. The approach uses paper printing within office environments as a case study. It communicates the print usage of each participant’s team rather than the participant’s individual print usage. Feedback is provided weekly via emails and contains normative information, along with eco-metrics and team-based comparative statistics. The approach was empirically evaluated to study the effectiveness of the feedback method. The experiment comprised of 16 people belonging to 4 teams with data on their print usage gathered over 58 weeks, using the first 30-35 weeks as a baseline. The study showed a significant reduction in individual printing with an average of 28%. The experiment confirms the underlying hypothesis that participants are persuaded to reduce their print usage in order to improve the overall printing behaviour of their teams. The research provides clear pathways for future research to qualitatively investigate our findings.

International entrepreneurship for SME business growth : a resource and dynamic capability view of the firm : an internet context

This research explores the relationship between international business Internet capabilities and international entrepreneurial characteristics. It has been suggested, that the accumulation of a firms Internet capability can assist international operations, especially when operating in fast changing dynamic environments. However, the international entrepreneurial characteristics which are seen as a precursor to leveraging such capabilities are still vague. Given this finding a conceptual framework is constructed and research issues are then developed in order to focus attention on the relationship between the Internet and a firm’s resource base, dynamic capabilities and international market performance.

A new database compilation of whole-rock chemical and geochronological data of igneous rocks in Queensland : a new resource for HDR geothermal resource exploration

The Geothermal industry in Australia and Queensland is in its infancy and for hot dry rock (HDR) geothermal energy, it is very much in the target identification and resource definition stages. As a key effort to assist the geothermal industry and exploration for HDR in Queensland, we are developing a comprehensive and new integrated geochemical and geochronological database on igneous rocks. To date, around 18,000 igneous rocks have been analysed across Queensland for chemical and/or age information. However, these data currently reside in a number of disparate datasets (e.g., Ozchron, Champion et al., 2007, Geological Survey of Queensland, journal publications, and unpublished university theses). The goal of this project is to collate and integrate these data on Queensland igneous rocks to improve our understanding of high heat producing granites in Queensland, in terms of their distribution (particularly in the subsurface), dimensions, ages, and controlling factors in their genesis.

Archival analysis of enterprise resource planning systems : the current state and future directions

Research on Enterprise Resource Planning (ERP) Systems is becoming a well-established research theme in Information Systems (IS) research. Enterprise Resource Planning Systems, given its unique differentiations with other IS applications, have provided an interesting backdrop to test and re-test some of the key and fundamental concepts in IS. While some researchers have tested well-established concepts of technology acceptance, system usage and system success in the context of ERP Systems, others have researched how new paradigms like cloud computing and social media integrate with ERP Systems. Moreover, ERP Systems provided the context for cross disciplinary research such as knowledge management, project management and business process management research. Almost after two-decades since its inception in IS research, this paper provides a critique of 198 papers published on ERP Systems since 2006-2012. We observe patterns on ES research, provide comparisons to past studies and provide future research directions.

Waste and resource management practices, legislation and policy encouraging and influencing ‘regeneration reuse’ of property assets

Carbon taxation governance is becoming increasingly popular, further evolving the polluter pays concept already well established in the built environment as a mechanism to controlling and licensing waste generation. This paper presents an explanation of property asset ‘regeneration reuse’ principles following deconstruction, which reduce waste generation associated with the process of demolition, construction and operation. An analysis is made of strategies in Australia and the United Kingdom, comparing jurisdiction targets pertaining to construction and demolition waste that encourage ‘regeneration reuse’. From examination of applicable Australian and United Kingdom legislation, strategic, fiscal and policy that influence on the 'regeneration reuse' of property assets, an evaluation to the variety of issues relevant to waste and resource management practices is reached. The paper concludes that a systematic evaluation framework to selecting building components and structures suitable for reuse after deconstruction must be considered in legislation.

Logan Basin Water Resource Plan : environmental assessment of the southern Moreton Bay islands. Technical Advisory Panel Report: Stage 1.

This report is a technical assessment of the hydrological environment of the southern Moreton Bay islands and follows the terms of reference supplied by the then Queensland Department of Natural Resources and Water. The terms of reference describe stage 1 as a condition assessment and stage 2 as an assessment of the implications of water planning scenarios on future condition. This report is the first stage of a two-stage investigation whose primary purpose is to identify and assess groundwater dependent ecosystems (GDEs) and the groundwater flow regimes necessary to support them. Within this context, the groundwaters themselves are also considered and comment made on their condition. Information provided in this report will inform an amendment to the Logan Basin Water Resource Plan to incorporate the southern Moreton Bay islands. The study area is the water resource plan amendment area, which includes North and South Stradbroke islands and the smaller islands between these and the mainland, including the inhabited smaller rocky islands—namely, Macleay, Russell, Karragarra, Lamb and Coochiemudlo islands. This assessment is largely a desktop study based on existing information, but incorporates some field observations, input from experts in specific areas and community representatives, and the professional experience and knowledge of the authors. This report reviews existing research and information on the southern Moreton Bay area with an emphasis on North Stradbroke Island, as it represents the largest and most regionally significant groundwater resource in southern Moreton Bay. The report provides an assessment of key waterrelated environmental features, their condition and their degree of dependence on groundwater. This report also assesses the condition and status of ecosystems within this region. In addition, the report identifies information gaps, uncertainties and potential impacts; reviews groundwater models that have been developed for North Stradbroke Island; and makes recommendations on monitoring and research needs.

Designing Innovative Business Models : A Design Catalyst Learning Resource

The term Design Led Innovation is emerging as a fundamental business process, which is rapidly being adopted by large as well as small to medium sized firms. The value that design brings to an organisation is a different way of thinking, of framing situations and possibilities, doing things and tackling problems: essentially a cultural transformation of the way the firm undertakes its business. Being Design Led is increasingly being seen by business as a driver of company growth, allowing firms to provide a strong point of difference to its stakeholders. Achieving this Design Led process, requires strong leadership to enable the organisation to develop a clear vision for top line growth. Specifically, based on deep customer insights and expanded through customer and stakeholder engagements, the outcomes of which are then adopted by all aspects of the business. To achieve this goal, several tools and processes are available, which need to be linked to new organisational capabilities within a business transformation context. The Design Led Innovation Team focuses on embedding tools and processes within an organisation and matching this with design leadership qualities to enable companies to create breakthrough innovation and achieve sustained growth, through ultimately transforming their business model. As all information for these case studies was derived from publicly accessed data, this resource is not intended to be used as reference material, but rather is a learning tool for designers to begin to consider and explore businesses at a strategic level. It is not the results that are key, but rather the process and philosophies that were used to create these case studies and disseminate this way of thinking amongst the design community. It is this process of unpacking a business guided by the framework of Osterwalder’s Business Model Canvas* which provides an important tool for designers to gain a greater perspective of a company’s true innovation potential.

Hepatitis C and policy implementation : ethics as a dialogic process for resource allocation

Hepatitis C, which was first identified in 1988, has become an important issue for public health as epidemiological and clinical evidence has emerged. These disciplines have highlighted the extent of infection and its medical consequences. Now, governments at both the state and federal levels are sifting through this evidence and are attempting to create structures to deal with the problem of hepatitis C. These structures have generally taken the form of expert committees and working parties organised from established medical, scientific and public health bodies...

Integrating agency and resource dependence theory : firm profitability, industry regulation, and board task performance

Boards of directors are key governancemechanisms in organizations and fulfill twomain tasks:monitoringmanagers and firm performance, and providing advice and access to resources. In spite of a wealth of researchmuch remains unknown about how boards attend to the two tasks. This study investigates whether organizational (firm profitability) and environmental factors (industry regulation) affect board task performance. The data combine CEOs' responses to a questionnaire, and archival data from a sample of large Italian firms. Findings show that past firm performance is negatively associatedwith board monitoring and advice tasks; greater industry regulation enhances perceived board task performance; board monitoring and advice tasks tend to reinforce each other, despite their theoretical and practical distinction.

A genetic analysis of serotonergic biosynthetic and metabolic enzymes in migraine using a DNA pooling approach

Migraine is a common debilitating primary headache disorder with significant mental, physical and social health implications. The brain neurotransmitter 5-hydroxytryptamine (5-HT; serotonin) is involved in nociceptive pathways and has been implicated in the pathophysiology of migraine. With few genetic studies investigating biosynthetic and metabolic enzymes governing the rate of 5-HT activity and their relationship to migraine, it was the objective of this study to assess genetic variants within the human tryptophan hydroxylase (TPH), amino acid decarboxylase (AADC) and monoamine oxidase A (MAOA) genes in migraine susceptibility. This objective was undertaken using a high-throughput DNA pooling experimental design, which proved to be a very accurate, sensitive and specific method of estimating allele frequencies for single nucleotide polymorphism, insertion deletion and variable number tandem repeat loci. Application of DNA pooling to a wide array of genetic loci provides greater scope in the assessment of population-based genetic association study designs. Despite the application of this high-throughput genotyping method, negative results from the two-stage DNA pooling design used to screen loci within the TPH, AADC and MAOA genes did not support their role in migraine susceptibility.