The real costs of technology – what agencies and funders should be paying for computers

RealWorld Systems has just completed a study for Citizenship and Immigration Canada on technology needs of agencies serving immigrants and refugees in Ontario. Citizenship and Immigration Canada computerized the entire settlement sector in Ontario, spending about $12 million over three years to supply every funded agency with computers, networks, technical support and a state-of-the-art extranet. We were asked to make recommendations on how CIC should invest in the sector over the next few years. We spent considerable time attempting to identify ways to support the technology requirements of these agencies as efficiently as possible. All of our analyses led us to the conclusion that agencies and funders should assume a minimum amount of investment per workstation in order to manage their technology effectively. Further, we concluded that funders should provide technology funding directly to agencies as part of their operating expenses, based on the real costs of managing technology. It should be treated as part of overhead expenses, just like telephones and rent

A pilot study for the development of a diagnostic test for malignant hyperthermia : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Biochemistry at Massey University

The only definitive diagnostic test for Malignant Hyperthermia, a genetic disease that effects skeletal muscle, is the caffeine-contracture test. Alternative tests are being sought since this test is not totally satisfactory. It requires muscle biopsy, an invasive procedure and often produces results difficult to interpret. A test that could be used for wide spread screening of all patients about to undergo an operation would reduce the incidence of unexpected Malignant Hyperthermic episodes induced by anaesthetics, the most common cause of an episode. In this project the effect of mild stress induction on skeletal muscle, ischaemia produced by a tourniquet is studied. The tourniquet effect on a sample of five pre-diagnosed Malignant Hyperthermia susceptible subjects is compared to the effect on a sample of twelve normal subjects. The effect was determined by the measurment of serum metabolites before and after tourniquet application. The variables measured were creatine kinase, lactate dehydrogenase, AMP deaminase, total solids, total protein, potassium, osmolality, inorganic pyrophosphatase, creatine and erythrocyte pyrophosphatase. Between the two groups AMP-deaminase, creatine and osmolality showed no difference in response to tourniquet application. Inorganic pyrophosphate rose in the Malignant Hyperthermia group after tourniquet application but remained unaltered in the normal groups. All other Malignant Hyperthermia variables moved in a negative direction with respect to the normal levels. That is if the normal metabolites level rose the Malignant hyperthermia metabolites stayed the same, or if the normal levels stayed the same the MH levels dropped. A measurement of resting metabolite levels showed Creatine kinase was higher in the MH subjects compared to the normal subjects levels but creatine and pyrophosphatase were lower in the MH subjects. These differences may form the basis of a diagnostic test

Performance Measurement System Design Document

The objective of this document is to propose an overall design for an organizational performance measurement system that will enable each business unit to ‘plug in’ their own performance indicators while providing a coherent framework for the Board and senior management to manage performance for the organization as a whole. The expected users of this report are: - Senior management – for sections 1-3 - Staff with responsibilities for managing performance in each business unit – for the entire report including appendices - Board and volunteers will be presented with a slide deck that will summarize the main point

Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke : use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland

The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice. Methods A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention. Findings The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation. Conclusion Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake

Financial Literacy Outcome Indicators: Phase I of 'Strengthening Financial Literacy Program Evaluation in Canada'

This report describes the development of a set of recommended outcome indicators that can be used by organizations engaged in financial education. The outcome indicators comprise the first phase of a two-year project led by Prosper Canada and funded by the Canadian Bankers Association to strengthen the evaluation of financial literacy programs in Canada. The project is a collaboration between Prosper Canada, the Government of Canada (led by the Financial Consumer Agency of Canada (FCAC), and the Canadian Bankers Association (CBA)

Long-term cost implications for cochlear implant recipients

Thesis (MAud)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: Cochlear implantation is an expensive but cost-effective intervention which must be used for life. It can provide individuals with severe-to-profound hearing loss improved sound perception in comparison to that obtained using hearing aids. In South Africa implants are not state subsidised, and related costs need to be covered by implant recipients. Cochlear implant teams thus need to ensure that individuals, who are selected, will benefit from the device and will be able to use it for their lifetime. Implantees should know the immediate and potential future costs involved, to be able to decide on its affordability. The primary aim of this study was to determine the immediate and long-term costs of cochlear implantation. One hundred and fifty four implant recipients from the Tygerberg Hospital- University of Stellenbosch Cochlear Implant Unit in Cape Town, South Africa were surveyed. Costs were categorized according to the time period post implantation and were converted to Constant Rands (June 2010) using the Consumer Price Index to allow for comparison in real terms over time. In the first 10 years of implantation the average estimated costs incurred by adult implantees totalled R379 626, and children R455 225. The findings showed that the initial purchase of the implant system was the most substantial cost involved (currently R221 000). Upgrading the speech processor, which on the average took place every 7 years, was the second highest cost subjects encountered (currently R85 000). The cost of spares (on average R276 per year) and repairs (R3000 per repair) increased with duration of use. Battery costs ranged between R1200 and R3372 per year and insurance costs averaged R4040 per year. Most appointments took place in the first two years following implantation. Average travel costs during the first two years were R1024 for those within 50km of the implant unit and R8645 for those living more than 1000km away. Accommodation costs for non-local recipients, peaked during this period (on average R3390). Additional rehabilitation services for paediatric implantees cost an estimated R37 159 in the first five years after implantation. Subjects advised potential implantees to save, budget and plan for the high costs involved in implantation, as well as to join a medical aid which could assist with the costs involved. The findings of the study hold great relevance for both implantees and cochlear implant professionals. Careful consideration of the financial implications of cochlear implantation is critically important in the South African context to ensure that recipients are successful longterm cochlear implant users. Although the actual costs in the study were related to the one implant system used at Tygerberg Hospital-University of Stellenbosch Cochlear Implant Unit, it is believed that the types and amounts of costs involved hold relevance for all individuals implanted in South Africa.AFRIKAANSE OPSOMMING: Kogleêre inplantering is ‘n duur maar koste-effektiewe prosedure wat lewenslank gebruik moet word. Dit verskaf aan individue met erge-tot-uitermatige gehoorverlies verbeterde klankpersepsie in vergelyking met dié wat gehoorapparate gebruik. In Suid Afrika word kogleêre inplantings nie deur die staat gesubsidieer nie en koste moet deur die inplantgebruiker verhaal word. Kogleêre inplantingspanne moet gevolglik verseker dat individue wat geselekteer word daarby baat sal vind en lewenslank sal kan gebruik. Inplantgebruikers moet bewus wees van die onmiddelike, sowel as langtermyn onkoste. Die primêre doel van hierdie studie was om die onmiddelike en langtermyn onkoste van implanterings te bepaal. Een honderd vier en vyftig inplantgebruikers van die Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid in Kaapstad, Suid Afrika is gebruik vir die studie. Onkoste was gekatogoriseer ten opsigte van die periode van tyd postinplantering en dit is omgeskakel na konstante Randwaarde (Junie 2010) deur die Gebruikers Prys Indeks te gebruik sodat vergelykings gemaak kon word in reële terme oor tyd. Gedurende die eerste 10 jaar na inplantering was die geskatte onkoste by volwasse inplantgebruikers R379 626 en by die pediatriese groep was dit R455 225. Bevindings het aangedui dat die aanvanklike aankoop van die inplantsisteem die grootste onkoste behels het (huidig R221 000). Opgradering van die prosesseerder, gemiddeld elke 7 jaar, was die tweede hoogste onkoste, naamlik R85 000. Die gemiddelde koste van spaaronderdele was R276 per jaar. Herstelkoste het R3000 per herstelling beloop. Koste van spaaronderdele en herstelkoste het met duur van gebruik vermeerder. Batteryonkoste het gewissel tussen R1200 en R3372 per jaar. Onkoste van jaarlikse versekering was gemiddeld R4040. Meeste afsprake het gedurende die eerste twee jaar plaasgevind. Vervoeronkoste gedurende hierdie periode was R1024 vir die wat binne 50km woon en R8645 vir dié meer as ‘n 1000km ver. Akkommodasie koste het ‘n piek gedurende hierdie periode bereik (gemiddeld R3390). Addisionele rehabilitasie dienste vir pediatriese inplantgebruikers was gemiddeld R37159 gedurende die eerste vyf jaar. Die proefpersone het aanbeveel dat potensiële inplantgebruikers moet spaar, begroot en beplan vir die hoë onkoste en is aanbeveel om aan te sluit by ‘n mediese fonds. Die bevindinge van die studie is van belang vir beide ontvangers sowel as inplantingspanne. Bewusmaking van die finansiële implikasies van kogleêre inplantering is van kritiese belang om suksesvolle langtermyn gebruik te verseker. Alhoewel die werklike onkoste in die studie van toepassing is op een inplanting sisteem wat by Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid gebruik word, kan dit aangeneem word dat die tipes en hoeveelheid onkoste van toepassing is op alle individue in Suid Afrika wat kogleêre inplantings ontvang

An inexpensive device to treat postpartum hemorrhage: a preliminary proof of concept study of health provider opinion and training in Nepal

BACKGROUND: Obstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country. METHODS: Fifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use. RESULTS: Device placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting. CONCLUSIONS: Preliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted

Stroke survivors' interaction with hand rehabilitation devices : observational study

Background: The hand is crucial for carrying out activities of daily living as well as social interaction. Functional use of the upper limb is affected in up to 55% to 75% of stroke survivors 3 to 6 months after stroke. Rehabilitation can help restore function, and several rehabilitation devices have been designed to improve hand function. However, access to these devices is compromised in people with more severe loss of function. Objective: In this study, we aimed to observe stroke survivors with poor hand function interacting with a range of commonly used hand rehabilitation devices. Methods: Participants were engaged in an 8-week rehabilitation intervention at a technology-enriched rehabilitation gym. The participants spent 50-60 minutes of the 2-hour session in the upper limb section at least twice a week. Each participant communicated their rehabilitation goals, and an Action Research Arm Test (ARAT) was used to measure and categorize hand function as poor (scores of 0-9), moderate (scores of 10-56), or good (score of 57). Participants were observed during their interactions with 3 hand-based rehabilitation devices that focused on hand rehabilitation: the GripAble, NeuroBall, and Semi-Circular Peg Board. Observations of device interactions were recorded for each session. Results: A total of 29 participants were included in this study, of whom 10 (34%) had poor hand function, 17 (59%) had moderate hand function, and 2 (7%) had good hand function. There were no differences in the age and years after stroke among participants with poor hand function and those with moderate (P=.06 and P=.09, respectively) and good (P=.37 and P=.99, respectively) hand function. Regarding the ability of the 10 participants with poor hand function to interact with the 3 hand-based rehabilitation devices, 2 (20%) participants with an ARAT score greater than 0 were able to interact with the devices, whereas the other 8 (80%) who had an ARAT score of 0 could not. Their inability to interact with these devices was clinically examined, and the reason was determined to be a result of either the presence of (1) muscle tone or stiffness or (2) muscle weakness. Conclusions: Not all stroke survivors with impairments in their hands can make use of currently available rehabilitation technologies. Those with an ARAT score of 0 cannot actively interact with hand rehabilitation devices, as they cannot carry out the hand movement necessary for such interaction. The design of devices for hand rehabilitation should consider the accessibility needs of those with poor hand function