The need to “carer proof” healthcare decisions

yesPopulation ageing and fiscal austerity are set to increase the reliance on family carers, who already provide much of the support for people with long term health conditions. Although most carers are willing, providing care can be hugely stressful, affecting mental and physical health1 and resulting in social isolation and financial hardship.2 When under strain, carers are less likely to be effective, increasing the risk that the care recipient is admitted to hospital or a care home.3 Health systems could reduce strain on family carers by routinely considering carers’ needs alongside patients’ needs in everyday healthcare decisions—a concept we term “carer proofing”.non

A framework for including family health spillovers in economic evaluation

Health care interventions may affect the health of patients' family networks. It has been suggested that these health spillovers? should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the health care perspective?). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effect

What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up

Government policies to shift care into the community and demographic changes mean that unpaid (informal) carers will increasingly be relied on to deliver care, particularly to older people. As a result, careful consideration needs to be given to informal care in economic evaluations. Current methods for economic evaluations may neglect important aspects of informal care. This paper reports the development of a simple measure of the caring experience for use in economic evaluations. A meta-ethnography was used to reduce qualitative research to six conceptual attributes of caring. Sixteen semi-structured interviews were then conducted with carers of older people, to check the attributes and develop them into the measure. Six attributes of the caring experience comprise the final measure: getting on, organisational assistance, social support, activities, control, and fulfilment. The final measure (the Carer Experience Scale) focuses on the process of providing care, rather than health outcomes from caring. Arguably this provides a more direct assessment of carers' welfare. Following work to test and scale the measure, it may offer a promising way of incorporating the impact on carers in economic evaluations. © 2008 Elsevier Ltd. All rights reserved

Quantifying the Relationship between Capability and Health in Older People: Can't Map, Won't Map

BACKGROUND: Intuitively, health and capability are distinct but linked concepts. This study aimed to quantify the link between a measure of health status (EQ-5D-3L) and capability (ICECAP-O) using regression-based methods. METHODS: EQ-5D-3L and ICECAP-O data were collected from a sample of older people ( n = 584), aged over 65 years, requiring a hospital visit and/or care home resident, and recruited to one of 3 studies forming the Medical Crisis in Older People (MCOP) program in England. The link of EQ-5D-3L with 1) ICECAP-O tariff scores were estimated using ordinary least squares (OLS) or censored least absolute deviation (CLAD) regression models; and 2) ICECAP-O domain scores was estimated using multinomial logistic (MNL) regression. Mean absolute error (MAE), root mean squared error (RMSE), absolute difference (AD) between mean observed and estimated values, and the R(2) statistic were used to judge model performance. RESULTS: In this sample of older people ( n = 584), higher scores on the EQ-5D-3L were shown to be linked with higher ICECAP-O scores when using linear regression. An OLS-regression model was identified to be the best performing model with the lowest error statistics (AD = 0.0000; MAE = 0.1208; MSE = 0.1626) and highest goodness of fit ( R(2) = 0.3532); model performance was poor when predicting the lower ICECAP-O tariff scores. The three domains of the EQ-5D-3L showing a statistically significant quantifiable link with the ICECAP-O tariff score were self-care, usual activities, and anxiety/depression. CONCLUSION: A quantifiable, but weak, link between health (EQ-5D-3L) and capability (ICECAP-O) was identified. The findings from this study add further support that the ICECAP-O is providing complimentary information to the EQ-5D-3L. Mapping between the 2 measures is not advisable and the measures should not be used as direct substitutes to capture the impact of interventions in economic evaluations

Effect of exogenous proline on drought stress tolerance in wheat (Triticum aestivum L.) cultivars

Due to the scarcity of irrigation water and to achieve maximum benefit from the available irrigation water, this study investigated the impact of exogenous proline application on drought tolerance in three wheat (Triticum aestivum L.) cultivars and evaluated their water use under stress conditions. A factorial field experiment was conducted using a split-split plot design with three factors at three levels each. The main plot factor was drought stress, with three levels: S1 (control) involved irrigation with 50 % of the available water between field capacity (FC) and wilting point(WP); S2 represented mild drought with 30 % available water (70 % reduction); S3 represented severe drought with 10 % available water (90 % reduction). The second factor (subplot) was proline concentration: P1 (0 mg L-1), P2 (25 mg L-1) and P3 (50 mg L-1). The third factor (sub-subplot) was wheat cultivar: Ibaa 99, Adnaniyah and Sham 6. A 90 % reduction in available water significantly decreased vegetative and yield parameters, including plant height (58.53 cm), spikes per plant (3.98), seeds per spike (37.86), total yield (3.47 tons·ha-1), flag leaf area (25.75 cm²), chlorophyllcontent and water use efficiency (1.6 kg grains m-3 water). The highest water use efficiency was recorded under 30 % available water, while the maximum grain yield (6.07 tons ha-1) was achieved under 50 % available water. Foliar application of 50 mg L-1 proline (P3) increased grain yield and improved water use efficiency to 1.61 kg grains m-3 water. Although interactions between drought stress and proline concentration were not statistically significant, Sham 6 consistently outperformed Ibaa 99 and Adnaniyah across most growth and yield parameters

The service required quality ensure model of LTE technology downlink

У статті запропонована математична модель розподілу ресурсних блоків у низхідному каналі зв’яз- ку технології LTE. Запропонована модель спрямована на забезпечення гарантованої якості обслуговування користувачів безпроводової мережі шляхом виділення для користувацьких станцій необхідних швидкостей передачі. Проведено порівняльний аналіз отриманих рішень при використанні різних цільових функційВ статье представлена математическая модель распределения ресурсных блоков в нисходящем кана- ле связи технологии LTE. Предложенная модель направлена на обеспечение гарантированного каче- ства обслуживания пользователей беспроводной сети путем выделения пользовательским станциям требуемых скоростей передачи. Проведен сравни- тельный анализ получаемых решений при использова- нии различных целевых функци

Childhood accidental poisoning in western Iraq: Pattern and risk factors

No Abstrac

Measuring Health Spillovers for Economic Evaluation: A Case Study in Meningitis

The health of carers and others close to the patient will often be relevant to economic evaluation, but it is very rarely considered in practice. This may reflect a lack of understanding of how the spillover effect of illness can be appropriately quantified. In this study we used three different approaches to quantify health spillovers resulting from meningitis. We conducted a survey of 1218 family networks affected by meningitis and used regression modelling to estimate spillover effects. The findings show that meningitis had long-term effects on family members' health, particularly affecting the likelihood of family members reporting anxiety and depression. These effects extended beyond a single close family member. These findings suggest that vaccinating against meningitis will bring significant health benefits not just to those that might have contracted the illness but also to their family networks. In methodological terms, different approaches for quantifying health spillovers provided broadly consistent results. The choice of method will be influenced by the ease of collecting primary data from family members in intervention contexts

EXPERIMENTAL INVESTIGATION OF CRYSTALLIZATION FOULING ON GROOVED STAINLESS STEEL SURFACES DURING CONVECTIVE HEAT TRANSFER

The beneficial aspects of enhanced or extended heat transfer surfaces may be off-set if operated under fouling conditions. In the present paper, preliminary experimental results for crystallization fouling of CaSO4 solutions onto surfaces with different structures are reported. Flat stainless steel plates (50 mm x 59 mm) with \u27V\u27 shaped grooves on the side of fluid flow were used as heat transfer surfaces. Experiments were carried out both under clean and fouling conditions to discern how the same surface structures perform under such circumstances. In addition, the impact of both, the direction of grooves with respect to fluid flow (crossed, longitudinal and mixed flow grooves) and the groove dimensions has also been investigated. Fouling trends are discussed in terms of delay time and fouling rate. Significant differences have been found for the various flow conditions