Markov and Neural Network Models for Prediction of Structural Deterioration of Stormwater Pipe Assets

Storm-water pipe networks in Australia are designed to convey water from rainfall and surface runoff. They do not transport sewerage. Their structural deterioration is progressive with aging and will eventually cause pipe collapse with consequences of service interruption. Predicting structural condition of pipes provides vital information for asset management to prevent unexpected failures and to extend service life. This study focused on predicting the structural condition of storm-water pipes with two objectives. The first objective is the prediction of structural condition changes of the whole network of storm-water pipes by a Markov model at different times during their service life. This information can be used for planning annual budget and estimating the useful life of pipe assets. The second objective is the prediction of structural condition of any particular pipe by a neural network model. This knowledge is valuable in identifying pipes that are in poor condition for repair actions. A case study with closed circuit television inspection snapshot data was used to demonstrate the applicability of these two models

Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods

Cost-effectiveness analysis is now an integral part of health technology assessment and addresses the question of whether a new treatment or other health care program offers good value for money. In this paper we introduce the basic framework for decision making with cost-effectiveness data and then review recent developments in statistical methods for analysis of uncertainty when cost-effectiveness estimates are based on observed data from a clinical trial. Although much research has focused on methods for calculating confidence intervals for cost-effectiveness ratios using bootstrapping or Fieller’s method, these calculations can be problematic with a ratio-based statistic where numerator and=or denominator can be zero. We advocate plotting the joint density of cost and effect differences, together with cumulative density plots known as cost-effectiveness acceptability curves (CEACs) to summarize the overall value-for-money of interventions. We also outline the net-benefit formulation of the cost-effectiveness problem and show that it has particular advantages over the standard incremental cost-effectiveness ratio formulation

Palliative medicine practitioners' views on the concept of depression in the palliative care setting

Background: Despite its clinical importance in palliative care, depression remains an ambiguous concept. Objective: The purpose of this study was to explore how medical practitioners working in palliative care conceptualize depression in that setting. Design: Medical practitioners who attended a palliative medicine conference (N=185) were invited to respond to a questionnaire, which explored their views on the concept of depression in the palliative care context. Descriptive statistics were used to summarize responses, and comparison between groups was conducted using nonparametric statistics. Themes in free-text comments were identified. Results: Seventy-nine responses were obtained (response rate 43%). Depression was not a unified concept, but was generally considered to be an illness with psychological, spiritual, and existential causes. Respondents were more uncertain about depression being an illness in the palliative care setting compared with other settings, and were ambivalent about its causality. Treatment preferences leaned towards psychological interventions. Depression being different in the palliative care setting was a theme. It was considered to be more prevalent, different in quality, harder to define, and associated with greater barriers to diagnosis and treatment. Conceptual differences were associated with the respondents' area of work, work position, duration of practice, and previous mental health training. Conclusions: Depression in the palliative care setting is a variable concept for palliative medicine practitioners. The conceptual diversity and complexities of depression in this setting must be acknowledged and further explored in order to develop nuanced approaches in clinical practice and in research.Felicity Ng, Gregory B. Crawford and Anna Chur-Hanse

Critical perspectives on ‘consumer involvement’ in health research: epistemological dissonance and the know-do gap

Researchers in the area of health and social care (both in Australia and internationally) are encouraged to involve consumers throughout the research process, often on ethical, political and methodological grounds, or simply as ‘good practice’. This paper presents findings from a qualitative study in the UK of researchers’ experiences and views of consumer involvement in health research. Two main themes are presented in the paper. Firstly, we explore the ‘know-do gap’ which relates to the tensions between researchers’ perceptions of the potential benefits of, and their actual practices in relation to, consumer involvement. Secondly, we focus on one of the reasons for this ‘know-do gap’, namely epistemological dissonance. Findings are linked to issues around consumerism in research, lay/professional knowledges, the (re)production of professional and consumer identities and the maintenance of boundaries between consumers and researchers

Low dose effects of ethanol on suckling rats: Enzymes activity, histological alterations and growth parameters.

زمینه و هدف: غلظت های پایین اتانول می توانند از طریق جفت به جنین و از طریق شیر مادر به نوزاد تازه متولد شده منتقل شوند. این مطالعه با هدف بررسی اثرات دوزهای مختلف اتانول در طول دوره شیردهی بر تغییرات آنزیمی، بافتی و شاخص های رشد نوزادان شیرخوار در موش صحرایی انجام شد. روش بررسی: در این مطالعه تجربی، 21 سر موش صحرایی ماده بالغ نژاد ویستار به سه گروه شامل دو گروه تیمار و یک گروه شاهد تقسیم شدند. به گروه های تیمار از روز یک زایمان تا روز 24 شیردهی آب آشامیدنی به همراه اتانول با غلظت حجمی 2 و 4 درصد تجویز شد و گروه شاهد تنها به آب آشامیدنی دسترسی داشتند. از هر گروه، 9 سر نوزاد موش صحرایی 25 روزه انتخاب و فعالیت سرمی آنزیم های آلانین آمینوترانسفراز، گاماگلوتامیک ترانسفراز، آسپارتات آمینوترانسفراز، آلکالین فسفاتاز، لاکتات دهیدروژناز، کراتین فسفوکیناز، نیتروژن اوره خون و کراتینین اندازه گیری شدند. همچنین مطالعات آسیب شناسی بر روی بافت های مغز، کبد و کلیه انجام شد. داده ها به کمک آزمون های آماری آنالیزواریانس و تست دانت در نرم افزار SPSS تجزیه و تحلیل شدند. یافته ها: در گروه های تجربی میزان فعالیت سرمی آنزیم های آلانین آمینوترانسفراز، آسپارتات آمینوترانسفراز، نیتروژن اوره خون، کراتین فسفوکیناز و آلکالین فسفاتاز اختلاف معنی داری را نسبت به گروه شاهد نشان ندادند (05/0P). مطالعات هیستوپاتولوژیک آسیب های مختلفی را در بافت مغز، کبد و کلیه نوزادان در معرض اتانول 4 حجمی را نشان داد. نتیجه گیری: بر اساس نتایج این مطالعه، مصرف نوشیدنی های الکلی در دوران شیردهی می تواند ضایعات جبران ناپذیری بر روی نوزاد داشته باشد

Neoliberalism as a Political Rationality: Australian Public Policy Since the 1980s

Since the 1980s, a remarkable transformation has occurred in the rationale that informs public policy in Australia. This transformation reflects a fundamental change in the way national economies and populations are conceived by policy makers and has led to the emergence of new strategies of governance as a consequence. We argue that this change of direction in Australian public policy may be best thought of as a specific neoliberal political rationality. The first section of the paper outlines changes to conceptions of the economy and subjectivity which are associated with neoliberalism as a political rationality. The second part of the paper examines the articulation and implementation of neoliberalism in Australia over the last couple of decades

The systematic guideline review: method, rationale, and test on chronic heart failure

Background: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources-especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development-the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). Methods: A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Results: Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. Conclusion: The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines

Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study

Background Best practice guidelines to promote breastfeeding suggest that (i) mothers hold their babies in naked body contact immediately after birth, (ii) babies remain undisturbed for at least one hour and (iii) breastfeeding assistance be offered during this period. Few studies have closely observed the implementation of these guidelines in practice. We sought to evaluate these practices on suckling achievement within the first hour after birth. Methods Observations of seventy-eight mother-baby dyads recorded newborn feeding behaviours, the help received by mothers and birthing room practices each minute, for sixty minutes. Results Duration of naked body contact between mothers and their newborn babies varied widely from 1 to 60 minutes, as did commencement of suckling (range = 10 to 60 minutes). Naked maternal-infant body contact immediately after birth, uninterrupted for at least thirty minutes did not predict effective suckling within the first hour of birth. Newborns were four times more likely to sustain deep rhythmical suckling when their chin made contact with their mother’s breast as they approached the nipple (OR 3.8; CI 1.03 - 14) and if their mothers had given birth previously (OR 6.7; CI 1.35 - 33). Infants who had any naso-oropharyngeal suctioning administered at birth were six times less likely to suckle effectively (OR .176; CI .04 - .9). Conclusion Effective suckling within the first hour of life was associated with a collection of practices including infants positioned so their chin can instinctively nudge the underside of their mother’s breast as they approach to grasp the nipple and attach to suckle. The best type of assistance provided in the birthing room that enables newborns to sustain an effective latch was paying attention to newborn feeding behaviours and not administering naso-oropharyngeal suction routinely