The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004

Objective: To survey the use, cost, beliefs and quality of life of users of complementary and alternative medicine (CAM). Design: A representative population survey conducted in 2004 with longitudinal comparison to similar 1993 and 2000 surveys. Participants: 3015 South Australian respondents over the age of 15 years (71.7% participation). Results: In 2004, CAMs were used by 52.2% of the population. Greatest use was in women aged 25-34 years, with higher income and education levels. CAM therapists had been visited by 26.5% of the population. In those with children, 29.9% administered CAMs to them and 17.5% of the children had visited CAM therapists. The total extrapolated cost in Australia of CAMs and CAM therapists in 2004 was AUD$1.8 billion, which was a decrease from AUD$2.3 billion in 2000. CAMs were used mostly to maintain general health. The users of CAM had lower quality-of-life scores than non-users. Among CAM users, 49.7% used conventional medicines on the same day and 57.2% did not report the use of CAMs to their doctor. About half of the respondents assumed that CAMs were independently tested by a government agency; of these, 74.8% believed they were tested for quality and safety, 21.8% for what they claimed, and 17.9% for efficacy. Conclusions: Australians continue to use high levels of CAMs and CAM therapists. The public is often unaware that CAMs are not tested by the Therapeutic Goods Administration for efficacy or safety.

Antecedents and consequences of service quality in consumer evaluation of self-service internet technologies

Advances in technology coupled with increasing labour costs have caused service firms to explore self-service delivery options. Although some studies have focused on self-service and use of technology in service delivery, few have explored the role of service quality in consumer evaluation of technology-based self-service options. By integrating and extending the self-service quality framework the service evaluation model and the Technology Acceptance Model the authors address this emerging issue by empirically testing a comprehensive model that captures the antecedents and consequences of perceived service quality to predict continued customer interaction in the technology-based self-service context of Internet banking. Important service evaluation constructs like perceived risk, perceived value and perceived satisfaction are modelled in this framework. The results show that perceived control has the strongest influence on service quality evaluations. Perceived speed of delivery, reliability and enjoyment also have a significant impact on service quality perceptions. The study also found that even though perceived service quality, perceived risk and satisfaction are important predictors of continued interaction, perceived customer value plays a pivotal role in influencing continued interaction.

An analysis of costs in institutions of higher education in England

Cost functions are estimated, using random effects and stochastic frontier methods, for English higher education institutions. The article advances on existing literature by employing finer disaggregation by subject, institution type and location, and by introducing consideration of quality effects. Estimates are provided of average incremental costs attached to each output type, and of returns to scale and scope. Implications for the policy of expansion of higher education are discussed.

Low-emission vehicle adoption in a UK local authority fleet:economic barriers and air quality benefits

Local air quality was one of the main stimulants for low carbon vehicle development during the 1990s. Issues of national fuel security and global air quality (climate change) have added pressure for their development, stimulating schemes to facilitate their deployment in the UK. In this case study, Coventry City Council aimed to adopt an in-house fleet of electric and hybrid-electric vehicles to replace business mileage paid for in employee's private vehicles. This study made comparisons between the proposed vehicle technologies, in terms of costs and air quality, over projected scenarios of typical use. The study found that under 2009 conditions, the electric and hybrid fleet could not compete on cost with the current business model because of untested assumptions, but certain emissions were significantly reduced >50%. Climate change gas emissions were most drastically reduced where electric vehicles were adopted because the electricity supply was generated by renewable energy sources. The study identified the key cost barriers and benefits to adoption of low-emission vehicles in current conditions in the Coventry fleet. Low-emission vehicles achieved significant air pollution-associated health cost and atmospheric emission reductions per vehicle, and widespread adoption in cities could deliver significant change. © The Author 2011. Published by Oxford University Press. All rights reserved.

A production/recycling model with quality consideration

An integrated production–recycling system is investigated. A constant demand can be satisfied by production and recycling. The used items might be bought back and then recycled. The not recycled products are disposed off. Two types of models are analyzed. The first model examines and minimizes the EOQ related cost. The second model generalizes the first one by introducing additionally linear waste disposal, recycling, production and buyback costs. This basic model was examined by the authors in a previous paper. The main results are that a pure strategy (either production or recycling) is optimal. This paper extends the model for the case of quality consideration: it is asked for the quality of the bought back products. In the former model we have assumed that all returned items are serviceable. One can put the following question: Who should control the quality of the returned items? If the suppliers examine the quality of the reusable products, then the buyback rate is strongly smaller than one, α<1. If the user does it, then not all returned items are recyclable, i.e. the use rate is smaller than one, δ<1. Which one of the control systems are more cost advantageous in this case?

A fittség (m)értéke. A fizikai inaktivitás nemzetgazdasági terhei Magyarországon (The value (degree) of fitness. The national economic costs of physical inactivity in Hungary)

Az elmúlt években Magyarországon is fokozatosan nőtt az érdeklődés az életminőség vizsgálata iránt. A 2004-2006 közötti időszakra készült első Nemzeti Fejlesztési Terv fő célkitűzése a lakosság életminőségének javítása volt, de célját nem érte el, mivel a WHO 2010 májusában közzétett statisztikája szerint a magyarországi életminőség-mutatók az európai rangsor végén találhatók. Elszomorító az Eurobarométer 2010. évi reprezentatív kutatásának eredménye: a népesség 77 százalékának életmódja mozgásszegény, fizikailag inaktív. Kutatásunk során azt a ténylegesen hiánypótló célt kívántuk elérni, hogy meghatározzuk és számszerűsítsük a mozgásszegény életmódból adódó nemzetgazdasági terheket, valamint megbecsüljük a fizikai inaktivitás csökkentésével elérhető megtakarítások számszerűsíthető mértékét. Az Országos Egészségbiztosítási Pénztár (OEP) és egy saját országos kérdőíves kutatás (n = 1158) adataira támaszkodtunk. A fizikai inaktivitás betegségeire vonatkozó megtakarítási lehetőségeket tételesen határoztuk meg, majd megállapítottuk az inaktivitásból származó gazdasági terheket, aminek alapján a döntéshozók elkészíthetik a fizikai inaktivitás csökkentésre alkalmas akcióterveiket. Ezzel nemcsak a lakosság "közérzete" javulhat számottevően, de komolyabb költségeket is meg lehet takarítani közép- és hosszú távon. / === / Interest in examining the quality of life has increased steadily in Hungary in recent years. Improving it was the main objective of the first National Development Plan, for the 2004-6 period, but it failed to do so, for Hungary's indices for quality of life were at the bottom of the European list according to figures published by the WHO in May 2010. The results of the representative research Furobarometer 2010 are saddening: 77 per cent of the population pursue a low-exercise, physically inactive lifestyle. The authors' researches sought to fill a gap by measuring and quantifying the national economic costs of a low-exercise lifestyle and to estimate quantitatively the savings to be made by reducing such physical inactivity. The paper relics on the data of the National Health Insurance Fund and on an authors' questionnaire (n = 1158). The potential savings on illness relating to physical activity are listed one by one. to arrive at the economic costs of such inactivity, based on which it is possible for decision-makers to prepare adequate action plans for reducing physical inactivity. This will improve the "morale" of the public and bring appreciable savings in the medium and long term.

Linking herbivory and pollination: Costs and selection implications in Centrosema virginianum Bentham (Fabaceae: Papilionoideae)

This research first evaluated levels and type of herbivory experienced by Centrosema virginianum plants in their native habitat and how florivory affected the pollinator activity. I found that populations of C. virginianum in two pine rockland habitat fragments experienced higher herbivory levels (15% and 22%) compared with plants in the protected study site (8.6%). I found that bees (Hymenoptera) pollinated butterfly pea. Furthermore, I found that florivores had a negative effect in the pollinators visitation rates and therefore in the seed set of the population. ^ I then conducted a study using a greenhouse population of C. virginianum. I applied artificial herbivory treatments: control, mild herbivory and severe herbivory. Flower size, pollen produced, ovules produced and seeds produced were negatively affected by herbivory. I did not find difference in nectar volume and quality by flowers among treatments. Surprisingly, severely damaged plants produced flowers with larger pollen than those from mildly damaged and undamaged plants. Results showed that plants tolerated mild and severe herbivory with 6% and 17% reduction of total fitness components, respectively. However, the investment of resources was not equisexual. ^ A comparison in the ability of siring seeds between large and small pollen was necessary to establish the biological consequence of size in pollen performance. I found that fruits produced an average of 18.7 ± 1.52 and 17.7 ± 1.50 from large and small pollen fertilization respectively. These findings supported a pollen number-size trade-off in plants under severe herbivory treatments. As far as I know, this result has not previously been reported. ^ Lastly, I tested how herbivory influenced seed abortion patterns in plants, examining how resources are allocated on different regions within fruits under artificial herbivory treatments. I found that self-fertilized fruits had greater seed abortion rates than cross-fertilized fruits. The proportion of seeds aborted was lower in the middle regions of the fruits in cross-fertilized fruits, producing more vigorous progeny. Self-fertilized fruits did not show patterns of seedling vigor. I also found that early abortion was higher closer to the peduncular end of the fruits. Position of seeds within fruits could be important in the seed dispersion mechanism characteristic of this species. ^

The Maintenance and Consequences of a Low Quality Diet in Poecilia Latipinna

The adaptive significance of herbivory in nature is not well understood. In order to document the conditions that select for an herbivorous feeding habit, we must first understand how such a diet is maintained, and the consequences of doing so. A few studies have begun to reveal mechanisms of maintaining herbivory (i.e. selective feeding, diet mixing, etc.) and the associated life history responses (i.e. growth, reproduction, etc.) in terrestrial and marine systems; however, studies of this kind are underrepresented in the freshwater literature. In this study, I use the sailfin molly (Poecilia latipinna) as a model organism to examine diet selectivity and the effects of an herbivorous diet on growth. To study food selectivity, sailfin mollies were fed either disturbed or intact periphyton mats from one of three localities within the Everglades (Water Conservation Area 3B, the Gap, or Chekika). Mats are structured with palatable algal species (i.e. greens and diatoms) comprising the inner components of the mat, and unpalatable species (i.e. cyanobacteria) comprising the outer edges. Fish gut contents were analyzed for each treatment and periphyton locality. Results suggest that when provided access to the inner components of the mats, fish preferentially eat more palatable algae. In a second experiment, effects of an herbivorous diet were examined using neonate sailfin mollies. Fish were fed either commercial food flakes, commercial algae flakes, or ground periphyton, and growth rate was measured weekly, from birth to 21 days. Fish fed the commercial diets grew at a faster rate and reached a larger final size than those fed periphyton. These results suggest that a periphyton diet is limited in nutritional elements compared to a pure algae diet and herbivorous organisms feeding upon it may experience negative effects on growth. By studying the costs and benefits of herbivory in a freshwater system, this paper contributes to a larger study of the question of why herbivory would evolve as an adaptation when seemingly inefficient compared to carnivorous and omnivorous diets.

Land Use and Water Quality Correlations in Miami-Dade, Florida

South Florida continues to become increasingly developed and urbanized. My exploratory study examines connections between land use and water quality. The main objectives of the project were to develop an understanding of how land use has affected water quality in Miami-Dade canals, and an economic optimization model to estimate the costs of best management practices necessary to improve water quality. Results indicate Miami-Dade County land use and water quality are correlated. Through statistical factor and cluster analysis, it is apparent that agricultural areas are associated with higher concentrations of nitrogen, while urban areas commonly have higher levels of phosphorous than agricultural areas. The economic optimization model shows that urban areas can improve water quality by lowering fertilizer inputs. Agricultural areas can also implement methods to improve water quality although it may be more expensive than urban areas. It is important to keep solutions in mind when looking towards future water quality improvements in South Florida.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

A cross-sectional study assessing the association between online ratings and structural and quality of care measures : results from two German physician rating websites

BACKGROUND: Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients' online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network "Quality and Efficiency" (QuE). METHODS: Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information. RESULTS: Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication. CONCLUSIONS: Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.

Obstruction and infiltration: a proposal of a quality indicator.

Background The quest for continuous improvement of the quality of provided care is the objective of nursing care. However, the insertion and permanence of a peripheral venous catheter has been associated to complications, thus making a systematic evaluation of the performance of professionals and the management of health services important. Objective: Analyse complications that caused removal of intravenous catheters. Methods A prospective study with 64 patients of a health service of Portugal, from July to September/2015. Included patients with age 18 years, with a peripheral venous catheter. Descriptive analysis using SPSS. Ethical requirements were met. Results Two hundred three (203) intravenous catheters, in 64 patients, most elderly (section 95.3 %), with mean age of 80 years were evaluated. The catheters remained inserted between one and 12 days (mean 2 days), 66 % of the devices were removed because of complications, such as: removal by the patient (17.7 %), obstruction (17.2 %), infiltration (14.8 %), phlebitis (9.4 %) and fluid exiting the insertion site (6.4 %). The prevalence of obstruction and infiltration per patient was respectively 36 % and 39 %. Conclusions Obstruction and infiltration were the complications of higher prevalence that led to the removal and reinsertion of a new peripheral venous catheter with the possibility of increased pain, infection and hospital costs. Faced with the risk of compromising patient safety and being able to contribute to the improvement of health care, we suggest the inclusion of obstruction and infiltration in the indicators of quality of care, in order to have systematic evaluation of results, (re)plan and implement preventive measures.

Optimization of aeroponic technology for future integration in quality potato seed production systems in tropical environments

Virus and soil borne pathogens negatively impact on the production of potatoes in tropical highland and sub-tropical environments, limiting supply of an increasingly popular and important vegetable in these regions. It is common for latent disease infected seed tubers or field grown cuttings to be used as potato planting material. We utilised an International Potato Centre technique, using aeroponic technology, to produce low cost mini-tubers in tropical areas. The system has been optimised for increased effectiveness in tropical areas. High numbers of seed tubers of cultivar Sebago (630) and Nicola per m2 (>900) were obtained in the first generation, and the system is capable of producing five crops of standard cultivars in every two years. Initial results indicate that quality seed could be produced by nurseries and farmers, therefore contributing to the minimisation of soil borne diseases in an integrated management plan. This technology reduces seed production costs, benefiting seed and potato growers. © ISHS.