Economic Evaluation of Positron Emission Tomography (PET) in Non Small Cell Lung Cancer (NSCLC), CHERE Working Paper 2007/6

Background: There are several perceived benefits from introducing positron emission tomography (PET) scanning into the staging of non small lung cancer (NSCLC). However, its greatest primary benefit is the role it can potential perform in reducing the number of unnecessary diagnostic examinations and futile surgeries. Objectives: To evaluate the economic impact and cost effectiveness of PET scanning in the management of potentially operable NSCLC patients using a cost-utility model. Methods: A literature review was conducted to find relevant studies and appropriate parameters to construct a decision model. Two strategies were compared. The first strategy was a conventional work up (CWU) consisting of an x-ray, a chest computer tomography (CT) scan and brochoscopy; the second strategy consisted of a CWU plus a whole body PET scan. These two strategies were applied to two sub-groups of NSCLC patients; those that had received a positive result on their CT scan and those that got a negative result on their CT scan. The cost-effectiveness of each strategy was dependent on a number of variables that were taken from a literature review. Costs were based on the Australian diagnostic related groups, a cost calculation for a chemotherapy course and values obtained from the literature. The life expectancy and utility scores were also taken from the literature and combined to create an incremental quality adjusted life year (QALY) value for PET for each of the patient groups. Results: The mean costs in CT negative and CT positive patients were lower in the CWU strategy, costing $A 20,427 and$A 23,578 per patient respectively compared to the PET strategy ($A 20,826 and$A 24,083 per patient respectively). The mean QALYs for both the CT positive and CT negative patients were higher in PET with 2.91 and 2.11 respectively compared to the CWU of 2.88 and 2.09. The incremental cost effectiveness ratio (ICER) for the CT negative strategy was $A 14,581 and$A 52,039 for the CT positive strategy. Conclusion: The PET strategy in CT negative and CT positive patients appears to be cost effective, however, there is much uncertainty surrounding this base result, particularly in CT positive patients.PET, non-small-cell lung cancer, economic evaluation

General Practitioners knowledge, views and practices regarding cervical cancer screening in Australia. CHERE Working Paper 2010/6

Objective General practitioners (GPs) are the main providers of cervical screening in Australia and are crucial to the successful implementation of the National Cervical Screening Program (NCSP). This study assesses the views of GPs about the value of the Pap smear tests, their knowledge of the current screening policy, awareness of new technologies and concerns of litigation. Design A postal survey was conducted of a random sample of GPs in New South Wales, Australia. Results GPs are generally supportive of NCSP guidelines, specifically 88.5% now agree with the recommended 2 year screening interval. However, half believe the age range should be enlarged to include both older and younger patients. There are notable differences in knowledge and views between male and female GPs. Female GPs tend to support extending the age range and are more familiar with new technologies, whilst male GPs are more concerned about the legal implications of over and under-screening patients. Conclusions While the NCSP is generally well supported by GPs, there are differences in the knowledge and views of male and female GPs. This information provides a contemporary baseline from which to optimise the effectiveness of GPs as providers of cervical screening, improve the rate of appropriate utilisation and successfully implement any future changes to the national screening guidelines.GPs, Cervical cancer screening, Australia

SLURRY ATOMISATION USING MIXED GAS PLASMAS

Unilever Research Port Sunlight Laboratories, Quarry Road East Bebington Wirral Merseysid

The Adiabatic Invariance of the Action Variable in Classical Dynamics

We consider one-dimensional classical time-dependent Hamiltonian systems with quasi-periodic orbits. It is well-known that such systems possess an adiabatic invariant which coincides with the action variable of the Hamiltonian formalism. We present a new proof of the adiabatic invariance of this quantity and illustrate our arguments by means of explicit calculations for the harmonic oscillator. The new proof makes essential use of the Hamiltonian formalism. The key step is the introduction of a slowly-varying quantity closely related to the action variable. This new quantity arises naturally within the Hamiltonian framework as follows: a canonical transformation is first performed to convert the system to action-angle coordinates; then the new quantity is constructed as an action integral (effectively a new action variable) using the new coordinates. The integration required for this construction provides, in a natural way, the averaging procedure introduced in other proofs, though here it is an average in phase space rather than over time.Comment: 8 page

A model for best practice HTA

The aims of this paper are: to review and describe different approaches to HTA used in Australia and in other countries and to identify the features of best practice in HTA, particularly those likely to be most relevant to HTA at a local (ie state/regional) level. There are a number of well-developed models of HTA at the national and local levels. Most information about the operation of these models, particularly about the type and number of evaluations conducted, the recommendations/decisions made and the reasons for these is available for national processes, but there is much less readily available documentation about local level HTA. Most HTA processes that operate nationally and internationally can be categorised in one of three ways: guidance (provides structured information about appropriate technologies), mandatory (provides mandatory information about technologies to be implemented) and funding and implementation (provides structured evidence-based advice about which technologies should be implemented, the level of funding required to implement them and the source of these funds). The main factors which distinguish a high quality HTA process are that i) it is efficient in terms of setting priorities, the scope of the technologies to be assessed, avoidance of duplication and overall cost of the process, ii) the overall impact on utilisation and health budget is calculated as part of the HTA and iii) procedural justice occurs and is seen to occur; iv) it includes a comprehensive assessment of the impact on issues such as workforce, credentialing of providers and the ethical dimension of the technology; v) it influences decision making by being communicated appropriately and using trusted methods; vi) it influences adoption and diffusion of technology by ensuring that there is no diffusion prior to HTA, the results are incorporated into guidelines or recommendations, funding is linked to the decision, and remuneration arrangements and other characteristics of the HS facilitate the appropriate adoption and diffusion and vii) it influences health outcomes/efficiency/equity by ensuring that the methods and/or results are available and able to be used at a local level. Firm recommendations for an ideal system for HTA at the local level are not possible as much of the necessary information and evidence is not available about the strengths and weaknesses of HTA practices and processes currently in use. However, it is likely that the operation of a successful model of HTA at a local level would require the development of a central organizational unit, a process for implementing the results of HTA and, crucially, the building of capacity to support both types of activities. Additional expertise and skills will be required for both providers of HTA evaluations and for the commissioners and users of HTA.health technology assessment, Australia, review

Waters of belonging : Al-miyahu Tajma'unah: Arabic Australians and the Georges River Parklands

This book, Rivers of Belonging, includes the stories of Arabic Australians about the parks and rivers of their homeland as well as those about the parks on the Georges River.This book arises from Parklands, Culture and Communities, a project which looks at how cultural diversity shapes people's understandings and use of the Georges River and green spaces in Sydney's south west. Culturally diverse uses and views have not often been recognised in Australia in park and green space management models, which tend to be based on Anglo-Celtic 'norms' about nature and recreation. This book focusses on the experiences of four local communities - Aboriginal, Vietnamese, Arabic and Anglo Australians - and their relationships with the river, parks and each other

Waters of Belonging

This book arises from Parklands, Culture and Communities, a project which looks at how cultural diversity shapes people's understandings and use of the Georges River and green spaces in Sydney's south west. Culturally diverse uses and views have not often been recognised in Australia in park and green space management models, which tend to be based on Anglo-Celtic 'norms' about nature and recreation. This book focusses on the experiences of four local communities - Aboriginal, Vietnamese, Arabic and Anglo Australians - and their relationships with the river, parks and each other

Evaluating the use of lake sedimentary DNA in palaeolimnology:A comparison with long‐term microscopy‐based monitoring of the phytoplankton community

Palaeolimnological records provide valuable information about how phytoplankton respond to long-term drivers of environmental change. Traditional palaeolimnological tools such as microfossils and pigments are restricted to taxa that leave sub-fossil remains, and a method that can be applied to the wider community is required. Sedimentary DNA (sedDNA), extracted from lake sediment cores, shows promise in palaeolimnology, but validation against data from long-term monitoring of lake water is necessary to enable its development as a reliable record of past phytoplankton communities. To address this need, 18S rRNA gene amplicon sequencing was carried out on lake sediments from a core collected from Esthwaite Water (English Lake District) spanning ~105 years. This sedDNA record was compared with concurrent long-term microscopy-based monitoring of phytoplankton in the surface water. Broadly comparable trends were observed between the datasets, with respect to the diversity and relative abundance and occurrence of chlorophytes, dinoflagellates, ochrophytes and bacillariophytes. Up to 20% of genera were successfully captured using both methods, and sedDNA revealed a previously undetected community of phytoplankton. These results suggest that sedDNA can be used as an effective record of past phytoplankton communities, at least over timescales of <100 years. However, a substantial proportion of genera identified by microscopy were not detected using sedDNA, highlighting the current limitations of the technique that require further development such as reference database coverage. The taphonomic processes which may affect its reliability, such as the extent and rate of deposition and DNA degradation, also require further research

Attachment insecurity and dispositional aggression:The mediating role of maladaptive anger regulation

Attachment insecurity has been associated with dysfunctional strategies for emotion regulation, leading to inflexible or maladaptive responding. Currently, application of the attachment framework to anger is underspecified. This study presents a preliminary investigation of attachment-related differences in the dispositional regulation of anger and aggressive outcomes. 270 participants completed measures of adult attachment (attachment anxiety and attachment avoidance), anger regulation processes (anger suppression, unregulated anger and anger control) and aggressive outcomes (physical aggression, verbal aggression and hostility). While those high in attachment anxiety have been found to under-regulate other negative emotions, our results postulate that these individuals may implement a suppression strategy when faced with the experience of anger. Mediation models indicate that anger suppression is implicated in the relationship between attachment dimensions and hostility, but not physical aggression. This supports the notion that suppression may be useful in reducing the external expression of anger, but cannot alleviate the associated internal cognitions. These findings suggest that levels of attachment anxiety and avoidance should be considered when identifying techniques to target specific anger regulatory difficulties that contribute to increased aggression. Further, consideration and exploration of the role of security priming is encouraged as a possible mechanism by which to reduce dispositional hostility in those with high levels of attachment insecurity