REINFORCING THE TRANSFORMATION OF STEREOTYPICAL PERCEPTIONS OF IMPRISONED DRUG USERS ABOUT THE CAUSES OF CRIME: UTILIZING THE METHOD OF "TRANSFORMATIVE LEARNING THROUGH AESTHETIC EXPERIENCE"

The commission of criminal acts has always been a social problem, both socially and scientifically engaging. Many theories have been formulated from time to time about what is considered a criminal act, as well as about the factors that contribute to the occurrence of the phenomenon, varying according to the time and the social conditions that prevailed. The study was conducted at the Detention Centre of Patras, with the participation of seven drug users and members of the KETHEA consultation programme. Methodologically, the qualitative approach has been chosen and in particular the action research with the use of group-focused interviews. The research findings are relevant to what one may come across in the bibliography, while at the same time they highlight three basic cause factors of criminal behavior: individual characteristics, family and environmental reasons, with emphasis placed upon the substance abuse, and peer pressure. Moreover, the use of the “Transformative Learning through Aesthetic Experience” method has proven to be extremely functional as far as the alteration of perceptions among groups of users-prisoners is concerned. It can also complement the therapeutic procedure and the social integration of this particular group of people. Article visualizations

Hospital coordination and integration with social care in England: the effect on post-operative length of stay

In spite of significant policy interest in improving the integration of health and social care services, little is known about the economics of coordination across the two sectors. We specify a Markov queuing model and use data collected from administrative records to estimate the link between two proxy indicators of across-sector complexity of discharge arrangements and post-operative length of stay in hospital for older people undergoing hip replacements. The results suggest that the number of local authorities involved in care planning and commissioning of social care services for discharges from a given hospital is significantly positively correlated with longer post-operative lengths of stay. A particularly strong effect is found between variability through time in the number of authorities involved in discharges from a given hospital and lengths of stay. The results suggest that improving information systems and joint assessment processes used during the discharge of patients with social care needs is likely to achieve significant efficiency gains in the health care system as a whole

The avoiding late diagnosis of ovarian cancer (ALDO) project; A pilot national surveillance programme for women with pathogenic germline variants in BRCA1 and BRCA2

Background: Our study aimed to establish â € real-world' performance and cost-effectiveness of ovarian cancer (OC) surveillance in women with pathogenic germline BRCA1/2 variants who defer risk-reducing bilateral salpingo-oophorectomy (RRSO). Methods: Our study recruited 875 female BRCA1/2-heterozygotes at 13 UK centres and via an online media campaign, with 767 undergoing at least one 4-monthly surveillance test with the Risk of Ovarian Cancer Algorithm (ROCA) test. Surveillance performance was calculated with modelling of occult cancers detected at RRSO. The incremental cost-effectiveness ratio (ICER) was calculated using Markov population cohort simulation. Results: Our study identified 8 OCs during 1277 women screen years: 2 occult OCs at RRSO (both stage 1a), and 6 screen-detected; 3 of 6 (50%) were ≤stage 3a and 5 of 6 (83%) were completely surgically cytoreduced. Modelled sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for OC were 87.5% (95% CI, 47.3 to 99.7), 99.9% (99.9-100), 75% (34.9-96.8) and 99.9% (99.9-100), respectively. The predicted number of quality-Adjusted life years (QALY) gained by surveillance was 0.179 with an ICER cost-saving of-£102,496/QALY. Conclusion: OC surveillance for women deferring RRSO in a â € real-world' setting is feasible and demonstrates similar performance to research trials; it down-stages OC, leading to a high complete cytoreduction rate and is cost-saving in the UK National Health Service (NHS) setting. While RRSO remains recommended management, ROCA-based surveillance may be considered for female BRCA-heterozygotes who are deferring such surgery

The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Background: To assess the within trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy. Methods: Within trial economic evaluation of no screening (C) versus either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model. Results: Using a CA125-ROCA cost of £20, the within trial results show USS to be strictly dominated by MMS, with the MMS versus C comparison returning an Incremental Cost-Effectiveness ratio (ICER) of £91,452 per life year gained (LYG). If the CA125-ROCA unit cost is reduced to £15 the ICER becomes £77,818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30,033 per LYG, while Markov modelling produces an ICER of £46,922 per QALY. Conclusions: Analysis suggests that, after accounting for the lead-time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared to the within trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort

Cost-effectiveness of Population Screening for BRCA Mutations in Ashkenazi Jewish Women Compared With Family History-Based Testing

BACKGROUND: Population-based testing for BRCA1/2 mutations detects the high proportion of carriers not identified by cancer family history (FH)-based testing. We compared the cost-effectiveness of population-based BRCA testing with the standard FH-based approach in Ashkenazi Jewish (AJ) women. METHODS: A decision-analytic model was developed to compare lifetime costs and effects amongst AJ women in the UK of BRCA founder-mutation testing amongst: 1) all women in the population age 30 years or older and 2) just those with a strong FH (≥10% mutation risk). The model assumes that BRCA carriers are offered risk-reducing salpingo-oophorectomy and annual MRI/mammography screening or risk-reducing mastectomy. Model probabilities utilize the Genetic Cancer Prediction through Population Screening trial/published literature to estimate total costs, effects in terms of quality-adjusted life-years (QALYs), cancer incidence, incremental cost-effectiveness ratio (ICER), and population impact. Costs are reported at 2010 prices. Costs/outcomes were discounted at 3.5%. We used deterministic/probabilistic sensitivity analysis (PSA) to evaluate model uncertainty. RESULTS: Compared with FH-based testing, population-screening saved 0.090 more life-years and 0.101 more QALYs resulting in 33 days' gain in life expectancy. Population screening was found to be cost saving with a baseline-discounted ICER of -£2079/QALY. Population-based screening lowered ovarian and breast cancer incidence by 0.34% and 0.62%. Assuming 71% testing uptake, this leads to 276 fewer ovarian and 508 fewer breast cancer cases. Overall, reduction in treatment costs led to a discounted cost savings of £3.7 million. Deterministic sensitivity analysis and 94% of simulations on PSA (threshold £20000) indicated that population screening is cost-effective, compared with current NHS policy. CONCLUSION: Population-based screening for BRCA mutations is highly cost-effective compared with an FH-based approach in AJ women age 30 years and older

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Parametric estimation of medical care costs under conditions of censoring

This paper is concerned with a set of parametric estimators that attempt to provide consistent estimates of average medical care costs under conditions of censoring. The main finding is that incorporation of the inverse of the probability of an individual not being censored in the estimating equations is instrumental in deriving unbiased cost estimates. The success of the approach is dependent on the amount of available information on the cost history process. The value of this information increases as the degree of censoring increases

Inferring the value of medical research to the UK

The aim of this paper is to estimate the return to the UK from health sector R&D drawing on the value of life methodology and the work by Murphy and Topel (2003). While acknowledging the caveats arising in making such calculations, not least the lack of consideration given to spillover effects from R&D undertaken elsewhere, this method is useful in at least attempting to initiate a quantification of the returns to medical R&D. Using life cycle consumption information, value of life estimates for the UK and changes in survival probabilities, the value of improved longevity in the UK over the years 1970-2000 is estimated at approximately £2.84 trillion, or £2.58 trillion after netting out health care expenditure. This is approximately double the current yearly GDP of the UK. The estimated gains are greatest for the period 1980- 1990. Given that the UK spends less than 0.5% of its GDP per annum (approximating £0.2 trillion over the 30-year period) on medical R&D, while clearly not all the gains in longevity can be attributed solely to medical R&D, the inference is that the returns to such investments are substantial. While such gains might be considered an upper estimate, given that the approach attributes all gains in life expectancy as a return to medical R&D over the period, gains in morbidity attributable to improved health delivery arising from medical R&D are not included in the estimate thus imparting a downward bias on the estimates as well as highlighting an obvious extension to this research

Technology diffusion and health care productivity: angioplasty in the UK

The adoption of new medical technologies is argued to be a major contributory factor to the rising cost of health care although there is little empirical work devoted to exploring the mechanism of how this process works. This study builds on recent research by Cutler and Huckman to establish the degree to which a new technology, percutaneous transluminal coronary angioplasty (PTCA), substitutes for an older one (Cutler, D. and Huckman, R., 2003, Technological development and medical productivity: the diffusion of angioplasty in New York state, Journal of Health Economics, 22, 187-217). Using patient specific data over a 15- year follow-up period the mortality and morbidity impacts of PTCA relative to coronary artery by-pass grafting (CABG) are established. In considering the substitution process, hospital level data and control for medical management of CHD improves on the empirical specification suggested by the earlier research and the analysis explicitly controls for the endogeneity problems in estimating the process of substituting one hospital technology for another. Such improvements give robust estimates of the degree to which PTCA has substituted for CABG, as opposed to expanding surgical treatment to the potential patient population. Thus PTCA, although acting to reduce treatment costs through the process of substitution for the more expensive procedure is shown to increase overall costs through increasing the potential patient population that could be treated for CHD with surgery

Estimating medical care costs : an examination under conditions of censoring

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