Posttraumatic stress disorder (PTSD) in the armed forces : health economic considerations.

This paper addresses the use of health economics in relation to posttraumatic stress disorder (PTSD) in the Armed Forces, with a view to assessing the feasibility of carrying out future evaluative studies. Although psychological and pharmacological interventions can be used to treat PTSD, no economic evaluations are known to exist. There is an economic ‘burden’ associated with PTSD and treatments require the use of scarce resources. Health economics provides tools (including cost-effectiveness, cost-benefit and cost utility analyses) to ascertain the relative efficiency of different treatment options. The paper concludes that the quality of life and resource consequences of PTSD require a better understanding of the economics of the disorder and the alternative ways to treat it.

The Effects of Super-dosing Phytase on Nursery and Grower Pigs

To determine the effects of super-dosing on pigs fed phosphorous and calcium adequate or deficient diets (Experiment 1); the optimum level of corn express phytase (CEP, Experiment 2); and the effects of xylanase/phytase on growth performance (Experiment 3) in pigs fed reduce nutrient diets, weaned pigs were blocked with initial body weight (BW) and allotted to dietary treatments. Treatments were: Positive control (PC), P/Ca adequate diets (NRC 2012); Negative Control (NC), low P (-0.15%) and Ca (-0.12%), +0, 1000, and 4000 FTU/kg of CEP in both PC and NC (Experiment 1); PC, P/Ca adequate diets; NC, decreased P (0.15%) and Ca (0.1%),+ 500, 1000, and 1500 FTU/kg CEP or NC+500 FTU/kg of Hiphos GT (Experiment 2); PC, P/Ca adequate diet (+500 FTU/kg of phytase); NC, reduced ME and AA of feed; NC+15,000 FTU/kg of phytase, +0, 12,000 or 16,000 DXU/kg of xylanase (Experiment 3). Data were analyzed by MIXED procedures of SAS (SAS inst., Cary, NC) with treatments as fixed effect and initial BW as random effect. In Exp. 1, ADG (P \u3c 0.05) and BW (P \u3c 0.05) were linearly increased with increasing level of CEP in pigs fed NC diets, but not in those fed PC diets (CEP x P/Ca-level interaction). CEP supplementation improved percentage bone ash (P \u3c 0.05) quadratically, independent of P/Ca levels. For Exp. 2, increasing CEP increased ADG (P\u3c0.01), G:F (P \u3c 0.05), and BW (P \u3c 0.05) linearly, and added both phytase at 500 FTU/kg (CEP and HiPhos) restored growth performance phenotypes to PC diets. In Exp. 3, adding the combination of 16,000 DXU/kg xylanase and super-dosing phytase restored BW (P \u3e 0.10) similar to the PC when pigs fed reduced ME and AA diets. Pigs fed diets supplement with 16,000 DXU/kg xylanase or super-dosing phytase alone had similar G:F to the PC fed pigs. In addition, pigs fed 16,000 DXU/kg of xylanase diet had similar carcass composition compared to the NC (P \u3e 0.10). These experiments suggest phytase in nutrient deficient diets restores growth performance similar to pigs fed an adequate diet, and corn expressed phytase is as effective as microbial phytase in pigs

Multidisciplinary Safety Team (MDST) Factors of Success

This project included a literature review and summary that focused on subjects related to team building, team/committee member motivational strategies, and tools for effective and efficient committee meetings. It also completed an online survey of multidisciplinary safety team (MDST) members that focused on methods to increase meeting attendance and the identification of factors that make MDSTs successful. The survey had a response rate of about 15 percent. Finally, three small MDST focus groups were held and the participants discussed information similar to that investigated by the online survey. The results of these three activities were similar and complementary. In general, the outcomes of all three tasks show that a well-designed agenda that has items relevant to the meeting attendees is very important. In addition, the literature, online survey, and focus group results identified other characteristics that define a good team or MDST. Some of these characteristics included effective and consistent leadership, members that are allowed to provide input and have an impact, members that are vested in the activities of the group, and a match between the interests of the members and the focus/mission/purpose of the meetings/group. Meetings that are scheduled well in advance of the meeting date, include time for networking, local safety activity discussions, hands-on activities/tasks, and/or some type of educational or informational presentation or activity also appeared to be the most desirable. Lastly, it was shown that MDSTs can thrive and be successful through various means, but the ability to focus on a specific safety issue when the group is first organized was suggested as a benefit that could be of assistance for long-term sustainability

The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Mental health: future challenges

The aim of the Foresight Project on Mental Capital and Wellbeing(www.foresight.gov.uk) is to advise the Government on how to achieve the best possible mental development and mental wellbeing for everyone in the UK in the future. The starting point of the Project was to generate an understanding of the science of mental capital and wellbeing (MCW) and to develop a vision for how the size and nature of the challenges exposed by the Project could evolve over the next 20 years. To make this analysis tractable, the work was divided into five broad areas: ● Mental capital through life ● Learning through life ● Mental health ● Wellbeing and work, and ● Learning difficulties. This report presents the findings for “Mental health” and draws upon a comprehensive assessment of the scientific state-of-the art: overall, around 80 reviews have been commissioned across the five areas. Mental health is a term which is used in a number of different ways and which has unfortunately acquired a substantial stigma in all layers of society. While the main focus of this report is on mental ill-health, positive mental health is also vitally important and is also discussed. However, a more comprehensive consideration of positive mental health has been performed in other parts of the Project (as commissioned reviews and in the context of the future of work. This report starts by looking at the situation today, examining the prevalence of important categories of mental disorder. It then considers the risk and protective factors which influence mental ill health, and determines how its prevalence and impact could change in the future, if existing policies and expenditure remain broadly unchanged. An assessment of strategic choices and interventions to meet the future challenges of mental health (and the challenges associated with the other four areas listed above) will be documented in the final Project report which is due for publication in the autumn of 2008

Assessing ecological sensitivities of marine assets to oil spill by means of expert knowledge

__Abstract__ Existing methodologies to assess risk due to vessel traffic often do not account for damages to marine assets in case of oil or chemical spills from ships. While some socio-economic damages can be quantified in monetary terms, expert knowledge is often the only way to assess potential damages to the marine ecology. The use of expert knowledge introduces a source of uncertainty. We propose a method which minimizes recognized flaws in subjective assessments by eliciting sensitivity ratings from multiple assessors and recognizing their differences of opinion as a source of uncertainty. We also explore various scoring options to reflect overall expert opinions. We develop and apply the methodology to the Victorian coastline in Australia and believe that improved assessment can assist policy makers of any maritime nation to make better informed decisions

Evaluation of Pavement Markings on Low-Volume Rural Roadways in Iowa

Many rural roadways in Iowa have centerline and/or edgeline pavement markings. The current Manual on Uniform Traffic Control Devices (MUTCD), however, requires centerline and/or edgeline pavement markings only along streets and roadways with traffic volumes much greater than 400 vehicles per day (the volume-based definition of a low-volume roadway in the MUTCD). This project was initiated to gather and summarize information about the state of practice related to the installation and maintenance of pavement markings along low-volume rural roadways in Iowa. Additional information was also collected to provide more guidance in the pavement-marking decision-making process. The tasks completed include an examination and summary of past research, the collection of legal input related to the use of pavement markings in Iowa, and a survey of Iowa county engineers that focused on their current pavement-marking practices. A basic safety benefit-cost evaluation of pavementmarking applications was also performed. Overall, the literature on the effectiveness of pavement markings and their safety impacts is limited. A number of studies have been completed with varying levels of robustness and reliability in their results. The Highway Safety Manual includes crash modification factors for the installation of centerline markings that it indicates should be used with caution, and one for the installation of edgeline and centerline markings that equates to a 24 percent total serious and minor-injury crash reduction. A more recent study from Louisiana also found a 15 percent reduction in total crashes after the addition of edgelines. The legal input acquired as part of this project was generally common knowledge. It indicated that once a traffic control device has been installed, the jurisdiction must properly and adequately maintain it. The survey completed found that, of the great majority of the respondents (97 percent), painted centerline/no passing zones and edgelines on at least some of their paved low-volume rural roadways. A much smaller percentage took this approach, or just painted centerlines/no passing zones, along their seal-coated roadways. The basic cost-benefit evaluation found that the percentage of crash reduction needed from pavement markings to make them beneficial was very low (i.e., 5.1 percent, at most). Overall, it was concluded that pavement markings are widely used in Iowa along low-volume paved roadways and sometimes seal-coated roadways. In addition, there is a safety benefit to the installation of pavement markings. but the research into that impact is limited, particularly along low-volume roadways. It is recommended that further analysis be completed on potential pavement-marking safety impacts, that a pavement-marking database be developed, and that a committee be initiated to help develop policies related to pavement-marking removal

Effects of digital engagement on the quality of life of older people

It is often asserted that older people's quality of life (QOL) is improved when they adopt information and communication technology (ICT) such as the Internet, mobile phones and computers. Similar assumptions are made about older people's use of ICT-based care such as telecare and telehealth. To examine the evidence around these claims, we conducted a scoping review of the academic and grey literature, coving the period between January 2007 and August 2014. A framework analysis approach, based on six domains of QOL derived from the ASCOT and WHOQOL models, was adopted to deductively code and analyse relevant literature. The review revealed mixed results. Older people's use of ICT in both mainstream and care contexts has been shown to have both positive and negative impacts on several aspects of QOL. Studies which have rigorously assessed the impact of older people's use of ICT on their QOL mostly demonstrate little effect. A number of qualitative studies have reported on the positive effects for older people who use ICT such as email or Skype to keep in touch with family and friends. Overall, the review unearthed several inconsistencies around the effects of older people's ICT use on their QOL, suggesting that implicit agreement is needed on the best research methods and instrumentation to adequately describe older people's experiences in today's digital age. Moreover, the available evidence does not consider the large number of older people who do not use ICT and how non-use affects QOL