Learning in Practice: Cost-effectiveness of Continuing Professional Development in Health Care

Continuing professional development (CPD) for healthcare professionals is an important strategic instrument for improving health. The Department of Health identifies CPD as a way of maintaining standards of care; improving the health of the nation; and recruiting, motivating, and retaining high quality staff. To this end, direct NHS spending on continuing professional development in 1999-2000 was about £1bn ($1.6bn). If we regard CPD as any method to improve health professionals’ skills the total resources devoted to it are probably much greater, particularly with the recent increased participation in response to the need for recertification and revalidation. To ensure the maximum gain from participation in CPD, these resources must be used efficiently. To assess the efficiency of participating in CPD, economic criteria are needed. Resources for health care are scarce, and money spent on CPD could otherwise be used for direct patient care. These opportunity costs are explicitly considered in the economic methods of cost benefit analysis and cost effectiveness analysis. The literature contains various reviews of cost effectiveness analysis in both health care and education. Such articles explain why cost effectiveness analysis (or another method of economic evaluation) is essential and how such evaluation should be undertaken, and they clearly define the set of economic terms (such as cost benefit analysis, cost effectiveness analysis, rate of return, and opportunity cost) that need to be incorporated into this type of research. Casebeer et al highlighted the need for economic evaluation of CPD activities, but they emphasised the use of cost benefit analysis, which requires monetary values to be assigned to measures of effectiveness. Cost benefit analysis is generally used to ascertain whether an intervention should be undertaken. Cost effectiveness analysis is used to decide which interventions (out of a number of alternatives) should be undertaken. However, cost effectiveness analysis in education research is rare. This is partly because of limited training for researchers, antipathy toward (economic) analysis that might constrain policy, and the dearth of significant results in studies of educational effectiveness.9 The quality of such research is also often poor: Clune found that only 1% of 541 “cost-effectiveness” studies of elementary and secondary education between 1991 and 1996 could be considered reliable, with strong design and analysis. In contrast, economic evaluation of healthcare technologies is increasing, and the methods for making such analysis are rapidly evolving. (Even here, however, critical reviews identify a substantial number of weak cost benefit and cost effectiveness analyses.

Increasing the Confidence of In Silico Modelling in Toxicology

Consideration of all chemicals that we are exposed to on a daily basis is a daunting task, which has been traditionally assessed through animal testing procedures. However, the ethical and financial considerations associated with such testing has long been a topic of concern, with the desire to pursue alternative methods evident. Towards this, the vision of 21st century toxicology actively promoted the use of new approach methodologies (NAMs) that avoid the usage of animal testing, as well as fostering a more efficient means for toxicological assessment. Captured within these NAMs are in silico methods which include a range of in silico (or computational) approaches, one of the most popular being Quantitative Structure- Activity Relationships (QSARs). Although it is acknowledged that the majority of these in silico methods are by no means novel, it is the consideration of such within regulatory decisionmaking frameworks that is. Whilst these methods are being promoted for usage within regulatory settings, fundamental issues regarding assessment of confidence as well as knowledge sharing need to be addressed to further promote acceptance. Therefore, the aim of this thesis was to provide detailed analysis of methods for in silico model validation, and knowledge-sharing efforts that incorporate the state-of-the-art practices, which could potentially bolster their acceptance within regulatory settings. Recently developed uncertainty assessment criteria for the evaluation of QSARs were analysed with a particular focus on how they can be employed to demonstrate fitness-for-purpose. These uncertainty assessment criteria were subsequently developed further, with considerations of challenges in QSAR, such as mixture assessment and machine learning (ML) approaches. To facilitate this, a review was conducted of the key characteristics of QSAR methods applied to mixtures, using the knowledge gathered to identify areas for additional consideration within the criteria. ML approaches were studied, with six models developed to address ML-specific considerations within the criteria. The concept of model sharing has been promoted through the application of the FAIR (Findable, Accessible, Interoperable, Reusable) principles to in silico methods. Outcomes from each chapter and the overall thesis promote the advancement of regulatory acceptance of QSAR models and predictions, through development of improved reporting strategies and sharing methodologies. The thesis additionally benefits the field thorough considerations of the most challenging aspects of QSARs, and how these subfields, such as mixture assessment and ML approaches, can gain credibility

Oral health and pathology: a macrophage account.

Macrophages are present in healthy oral mucosa and their numbers increase dramatically during disease. They can exhibit a diverse range of phenotypes characterised as a functional spectrum from pro-inflammatory to anti-inflammatory (regulatory) subsets. This review illustrates the role of these subsets in the oral inflammatory disease lichen planus, and the immunosuppressive disease oral squamous cell carcinoma (SCC). We conclude that the role of macrophages in driving progression in oral disease identifies them as potential therapeutic targets for a range of oral pathologies

Dye-Loaded Quatsomes Exhibiting FRET as Nanoprobes for Bioimaging

Fluorescent organic nanoparticles (FONs) are emerging as an attractive alternative to the well-established fluorescent inorganic nanoparticles or small organic dyes. Their proper design allows one to obtain biocompatible probes with superior brightness and high photostability, although usually affected by low colloidal stability. Herein, we present a type of FONs with outstanding photophysical and physicochemical properties in-line with the stringent requirements for biomedical applications. These FONs are based on quatsome (QS) nanovesicles containing a pair of fluorescent carbocyanine molecules that give rise to Förster resonance energy transfer (FRET). Structural homogeneity, high brightness, photostability, and high FRET efficiency make these FONs a promising class of optical bioprobes. Loaded QSs have been used for in vitro bioimaging, demonstrating the nanovesicle membrane integrity after cell internalization, and the possibility to monitor the intracellular vesicle fate. Taken together, the proposed QSs loaded with a FRET pair constitute a promising platform for bioimaging and theranostics

Reducing Departure Delays for Adjacent Center Airports using Time-Based Flow Management Scheduler: Checkbox On or Off?

The Federal Aviation Administration (FAA) has enhanced the Time-Based Flow Management (TBFM) scheduling tool with a "Checkbox ON" vs. "OFF" function which allows Traffic Management Coordinators (TMCs) to make room in a crowded arrival stream for a departure. When scheduling a departure, having the checkbox ON can delay the Scheduled Times of Arrivals (STAs) of the airborne flights upstream of the TBFM freeze horizons and can compress these flights to their minimum required spacing, thereby creating a slot for a departure. Hence, having the checkbox ON can reduce the frequent ground delays of aircraft departing near high volume airports but can increase delays for airborne arrivals. A Human-in-the-Loop (HITL) simulation compared arrival and departure delays to Newark Airport (EWR) with the checkbox ON vs. OFF as the default position. Three other conditions in this HITL involved various National Airspace System (NAS)-wide approaches for timely delivery of aircraft to the TBFM region. These conditions were: Baseline, using current Mile-in-Trail (MIT) spacing restrictions; Integrated Demand Management (IDM), where all aircraft were given departure times (Expect Departure Clearance Times, or EDCTs), ultimately based on the EWR Airport Arrival Rate; and IDM plus Required Time of Arrival (RTA), a flight deck tool which allowed some aircraft to meet a controlled time of arrival to the TBFM area more precisely. Results showed that the checkbox tool was powerful: with the checkbox ON, departure delays decreased and airborne delays increased, as predicted. However, assuming that the cost ratio of a minute of airborne delay to a minute of departure delay is in the range of 1.2 to 3, as commonly indicated by the literature, checkbox ON and checkbox OFF conditions showed approximately equal total delay costs, i.e., the cost of delays in the air balanced the cost of the delay on the ground. The three scheduling conditions also had approximately equal total delay costs, although a simulation artifact may have reduced the delays in the Baseline condition. In the debrief following the simulation, the TMCs concluded that the checkbox should be used flexibly depending on the current delay situation, and suggested modifications to the checkbox tool which would help them use it in this way, along with enhanced training. The relatively similar total cost of both checkbox default options in this simulation indicates that this might be a fruitful approach, and replace the necessity to have the checkbox rigidly set to either ON or OFF

Accelerating Community College Graduation Rates: A Benefit–Cost Analysis

This article reports a benefit–cost evaluation of the Accelerated Study in Associate Programs (ASAP) of the City University of New York (CUNY). ASAP was designed to accelerate associate degree completion within 3 years of degree enrollment at CUNY’s community colleges. The program evaluation revealed that the completion rate for the examined cohort increased from 24.1% to 54.9%, and cost per graduate declined considerably (Levin & Garcia, 2012; Linderman & Kolenovic, 2012). The returns on investment to the taxpayer include the benefits from higher tax revenues and lower costs of spending on public health, criminal justice, and public assistance. For each dollar of investment in ASAP by taxpayers, the return was $3 to$4. For each additional graduate, the taxpayer gained an amount equal to a certificate of deposit with a value of $146,000 (net of the costs of the investment). Based on these estimated returns, a cohort of 1,000 students enrolled in ASAP would generate net fiscal benefits for the taxpayer of more than$46 million relative to enrolling in the conventional degree program. ASAP results demonstrate that an effective educational policy can generate returns to the taxpayer that vastly exceed the public investment required