Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Materials and technologies for energy conversion, saving and storage: A global network enabling capacity-building for sustainable energy in developing countries

Access to energy is a fundamental component of poverty abatement. People who live in homes without electricity are often dependent on dirty, time-consuming and disproportionately expensive solid fuel sources for heating and cooking. [1] In developing countries, the Human Development Index (HDI), which comprises measures of standard of living, longevity and educational attainment, increases rapidly with per capita electricity use. [2] For these reasons the United Nations has been making a concerted effort to promote global access to energy, first by naming 2012 the Year of Sustainable Energy for All, [3] and now by declaring 2014-2024 the Decade of Sustainable Energy for All. [4]

The impact of private and shared open space on liveability in subtropical apartment buildings

The study explores the relationship between open space design, factors impacting open space provision, and resident satisfaction with open space in multistorey apartment buildings in the context of the subtropical lifestyle and climate of Brisbane Australia. The purpose of the paper is to identify the specific physical and spatial design characteristics residents perceive to be important in open spaces associated with their private dwellings and with shared open spaces. Firsthand resident evaluations of everyday experiences of residing in inner urban high density environments are explored through a survey of 636 residents and interviews with 24 residents. Private balconies are highly valued, but residents’ satisfaction would be enhanced by spaciousness for diverse activities, privacy and climate responsive design. Communal spaces and facilities are used infrequently by many residents who prefer interactions with community outside of the building. This is related to preferences for a level of anonymity in a setting where privacy is difficult to achieve due to physical proximity of neighbours.

Private governance of public rights in Japan: Revisiting the Japanese governance debate

Dramatic growth in the Japanese economy in the postwar period – and its meltdown in the 1990s – has attracted sustained interest in the power dynamics underlying the management of Japan’s administrative state. For a long time, scholars and commentators have debated about who wields power in Japan. The question has been asked in different ways. In the 1970s and 1980s, the question was usually posed as: who orchestrated Japan’s economic miracle in the 1960s and 1970s? Today, the question is usually reframed to: who is accountable for the policy failures that plunged Japan into financial crisis and recession during the 1990s? Yet the core issue remains the same – who governs Japan? (Johnson 1995)...

Models for engaging public-private partnerships in civil infrastructure projects: A case of ‘having your cake and eating it too’?

Public-Private Partnerships (PPP) are established globally as an important mode of procurement and the features of PPP, not least of which the transfer of risk, appeal to governments and particularly in the current economic climate. There are many other advantages of PPP that are claimed as outweighing the costs of PPP and affording Value for Money (VfM) relative to traditionally financed projects or non-PPP. That said, it is the case that we lack comparative whole-life empirical studies of VfM in PPP and non-PPP. Whilst we await this kind of study, the pace and trajectory of PPP seem set to continue and so in the meantime, the virtues of seeking to improve PPP appear incontrovertible. The decision about which projects, or parts of projects, to offer to the market as a PPP and the decision concerning the allocation or sharing risks as part of engagement of the PPP consortium are among the most fundamental decisions that determine whether PPP deliver VfM. The focus in the paper is on latter decision concerning governments’ attitudes towards risk and more specifically, the effect of this decision on the nature of the emergent PPP consortium, or PPP model, including its economic behavior and outcomes. This paper presents an exploration into the extent to which the seemingly incompatible alternatives of risk allocation and risk sharing, represented by the orthodox/conventional PPP model and the heterodox/alliance PPP model respectively, can be reconciled along with suggestions for new research directions to inform this reconciliation. In so doing, an important step is taken towards charting a path by which governments can harness the relative strengths of both kinds of PPP model.

Public-private partnerships in information and communication technology for education

Public-private partnerships (PPPs) have generated a lot of interest from governments around the world for leveraging private sector involvement in developing and sustaining public infrastructure and services. Initially, PPPs were favoured by transport, energy, and other large infrastructure-intensive sectors. More recently, the concept has been expanded to include social sectors such as education.

Heavy haul sleeper design: A rational cost-saving method

Heavy haul railway lines are important and expensive items of infrastructure operating in an environment which is increasingly focussed on risk-based management and constrained profit margins. It is vital that costs are minimised but also that infrastructure satisfies failure criteria and standards of reliability which account for the random nature of wheel-rail forces and of the properties of the materials in the track. In Australia and the USA, concrete railway sleepers/ties are still designed using methods which the rest of the civil engineering world discarded decades ago in favour of the more rational, more economical and probabilistically based, limit states design (LSD) concept. This paper describes a LSD method for concrete sleepers which is based on (a) billions of measurements over many years of the real, random wheel-rail forces on heavy haul lines, and (b) the true capacity of sleepers. The essential principles on which the new method is based are similar to current, widely used LSD-based standards for concrete structures. The paper proposes and describes four limit states which a sleeper must satisfy, namely: strength; operations; serviceability; and fatigue. The method has been applied commercially to two new major heavy haul lines in Australia, where it has saved clients millions of dollars in capital expenditure.

Accountable to everyone, or to no one? Perspectives on the accountability of Australian private ancillary funds

This thesis explores perspectives on the accountability of Private Ancillary Funds (PAFs), a type of Australian endowed philanthropic foundation. Privately established for a public benefit purpose, with limited formal accountability requirements, there are differing and sometimes conflicting perspectives on the nature and scope of PAF accountability. Through in-depth interviews with managers and trustees of 10 PAFs, forms and relationships of PAF accountability are uncovered. Findings reveal accountability for PAFs does not necessarily include public disclosure or transparency. However, engagement with accountability for a PAF results in greater impact and satisfaction for those involved.

Sustainable native forest management. Case studies in managing private native forest in southeast Queensland.

The introduction describes productive forest in Queensland and summaries the principles of native forest management that achieve optimum productivity. Case study 1 deals with thinning an even-aged regrowth forest. It shows how thinning the stand actively manages the future composition and structure to improve productivity in the best stems and increase the commercial value of the next harvest. Case study 2 describes restoring productivity in a high-graded spotted gum - ironbark forest. It shows that defective and non-saleable trees should be removed so they do not repress the future stand; and that regeneration should be thinned, retaining the best trees in adequate growing space. Case study 3 discusses on-farm value adding for hardwood forests. It shows how long-term viability and maximum productivity and returns depend on the best management practices and knowing how to obtain the best returns from a range of forest products. Case study 4 examines integrated harvesting in a eucalypt forest. It shows how integrating the harvest enables the full range of timber products are harvested and sold for their maximum value while reducing the amount of waste.

Tree growth relationships and silvicultural tools to assist stand management in private native spotted gum dominant forests in Queensland and northern New South Wales.

Spotted gum dominant forests occur from Cooktown in northern Queensland (Qld) to Orbost in Victoria (Boland et al. 2006) and these forests are commercially very important with spotted gum the most commonly harvested hardwood timber in Qld and one of the most important in New South Wales (NSW). Spotted gum has a wide range of end uses from solid wood products through to power transmission poles and generally has excellent sawing and timber qualities (Hopewell 2004). The private native forest resource in southern Qld and northern NSW is a critical component of the hardwood timber industry (Anon 2005, Timber Qld 2006) and currently half or more of the native forest timber resource harvested in northern NSW and Qld is sourced from private land. However, in many cases productivity on private lands is well below what could be achieved with appropriate silvicultural management. This project provides silvicultural management tools to assist extension staff, land owners and managers in the south east Qld and north eastern NSW regions. The intent was that this would lead to improvement of the productivity of the private estate through implementation of appropriate management. The other intention of this project was to implement a number of silvicultural experiments and demonstration sites to provide data on growth rates of managed and unmanaged forests so that landholders can make informed decisions on the future management of their forests. To assist forest managers and improve the ability to predict forest productivity in the private resource, the project has developed: • A set of spotted gum specific silvicultural guidelines for timber production on private land that cover both silvicultural treatment and harvesting. The guidelines were developed for extension officers and property owners. • A simple decision support tool, referred to as the spotted gum productivity assessment tool (SPAT), that allows an estimation of: 1. Tree growth productivity on specific sites. Estimation is based on the analysis of site and growth data collected from a large number of yield and experimental plots on Crown land across a wide range of spotted gum forest types. Growth algorithms were developed using tree growth and site data and the algorithms were used to formulate basic economic predictors. 2. Pasture development under a range of tree stockings and the expected livestock carrying capacity at nominated tree stockings for a particular area. 3. Above-ground tree biomass and carbon stored in trees. •A series of experiments in spotted gum forests on private lands across the study area to quantify growth and to provide measures of the effect of silvicultural thinning and different agro-forestry regimes. The adoption and use of these tools by farm forestry extension officers and private land holders in both field operations and in training exercises will, over time, improve the commercial management of spotted gum forests for both timber and grazing. Future measurement of the experimental sites at ages five, 10 and 15 years will provide longer term data on the effects of various stocking rates and thinning regimes and facilitate modification and improvement of these silvicultural prescriptions.

New Year's greetings postcard with portrait of Sigmund and Toni Feist with two unidentified boys (perhaps students at Feist's private school in Mainz) Portraits; Groups

Printed: Prosit Neujahr!; Handwritten dedication

Qualitative study of patients' choice between public and private hospital emergency departments

Objective The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. Methods An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. Results Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. Conclusions Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.

Development of a productivity asessment toll for native spotted gum forest on private land based on estimates of forest growth on Crown land.

Reliable estimates of forest productivity are essential for improved predictions of timber yields for the private native spotted gum resource in southern Qld and northern NSW. The aim of this research was to estimate the potential productivity of native spotted gum forests on private land by making use of available inventory data collated from Qld and northern NSW for spotted gum forest on Crown land (i.e. state forests). We measured a range of site-related factors to determine their relative importance in predicting productivity of spotted gum forest. While measures such as stand height and height-diameter relationships are known to be useful predictors of productivity, we aimed to determine productivity for a site where this information was not available. Through estimation of stand growth rates we developed a spotted gum productivity assessment tool (SPAT) for use by landholders and extension officers. We aimed to develop a tool to allow private landholders to see the benefits of maintaining their timber resource. This paper summarises the information used to develop the SPAT with a particular focus on forest growth relationships.

New Year's greetings postcard with portrait of Sigmund and Toni Feist with two unidentified boys (perhaps students at Feist's private school in Mainz) Portraits; Groups

Printed: Prosit Neujahr!; Handwritten dedication

Econometric models of Finnish non-industrial private forest owners' timber supply and timber stock

This dissertation examines the short- and long-run impacts of timber prices and other factors affecting NIPF owners' timber harvesting and timber stocking decisions. The utility-based Faustmann model provides testable hypotheses of the exogenous variables retained in the timber supply analysis. The timber stock function, derived from a two-period biomass harvesting model, is estimated using a two-step GMM estimator based on balanced panel data from 1983 to 1991. Timber supply functions are estimated using a Tobit model adjusted for heteroscedasticity and nonnormality of errors based on panel data from 1994 to 1998. Results show that if specification analysis of the Tobit model is ignored, inconsistency and biasedness can have a marked effect on parameter estimates. The empirical results show that owner's age is the single most important factor determining timber stock; timber price is the single most important factor in harvesting decision. The results of the timber supply estimations can be interpreted using utility-based Faustmann model of a forest owner who values a growing timber in situ.