La sécurité privée et le problème de la confiance : l’expérience australienne

The private security industry in Australia, as in many jurisdictions, has been beset by allegations of fraud, abuse of powers and incompetence. These problems are illustrated through trade practices, prosecutions, government inquiries, incident reports and other sources. Causation is analysed in terms of Shapiro's (1987) formulation of the problem of "policing trust". The substantial delegation of responsibility entailed in security work makes it highly vulnerable to exploitation and fraud, and this potential is exacerbated by the inadequate regulation of security services. Mitigation of these problems is suggested though an enhanced partnership approach of government and the security industry to regulatory control, an through an assessment of the benefits of in-house security

Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia

Because of an elevated serum phosphate level, patients who suffer from chronic kidney failure frequently tend to have cardiovascular calcification and are therefore exposed to a higher probability of a fatal event. Phosphate binders are able to reduce these negative effects. Currently, there are primarily two groups of phosphate binders (calcium-containing and calcium-free phosphate binders) which are considered to be almost equally effective in terms of binding of free phosphate. There are, however, a few disadvantages of the two groups. While the calcium-containing binders are associated with an increased risk of hypercalcaemia, which is dose dependent, calcium-free binders have been criticized as being too expensive. As the expenditure for patients suffering from chronic kidney failure increases from year to year, as a result of increasing prevalence, there is a growing need for an alternative to existing phosphate binders. The study presented here therefore summarizes available information for the novel combination preparation OsvaRen® (calcium acetate/magnesium carbonate) as an alternative therapy to the calcium-free phosphate binder Renagel® (sevelamer-hydrochloride) and to calcium-containing preparations. The results of this systematic review showed that OsvaRen® is at least equally effective in the regulation of serum phosphate level as Renagel®. In particular, OsvaRen® shows no clinically relevant difference in terms of the control of the serum calcium levels compared to Renagel® and thereby does not increase the risk of a hypercalcaemia, in contrast to pure calcium-based phosphate binders. On the other hand, Renagel® therapy is much more frequently associated with gastrointestinal side-effects, a tendency to result in higher tablet burden for patients and high medication costs. The CALMAG study showed that OsvaRen® was at least as effective and safe in terms of controlling serum phosphate and serum calcium levels as Renagel® while, at the same time, resulting in about 80% lower costs. In addition, OsvaRen® offers a lower risk of hypercalcaemia and associated subsequent costs and is thereby also superior to pure calcium-containing phosphate binders. Because of the effectiveness and tolerability of calcium acetate/magnesium carbonate, OsvaRen® offers a clinically suitable and, at the same time, cost-effective therapeutic option in the therapy of hyperphosphataemia.Fresenius Medical Care Deutschland Gmb

Developments in the Australian Private Security Industry

Police necessarily retain the major role in enforcing the law after crimes have been committed and offenders have been apprehended. However, given that public sector policing draws heavily on equipment and personnel services supplied by private providers, and that public police officers have many offenders handed over to them by the private sector, private security could be considered ‘the primary protective resource’ (Pastor 2003, p. 44). Despite this, there is very little information publicly available on the range, size and scope of security industries in Australia and there is no comprehensive study of the growth of these industries, the functions of their different components, how they relate to each other and the effectiveness of different regulatory strategies. This paper reports on current aspects of the security industry in Australia as part of a wider study of these issues more generally

Konzepte der Kalkulation direkter und indirekter Kosten im Rahmen gesundheitsökonomischer Evaluationen

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Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Objectives: In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods: To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results: In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions: Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance

Genome sequencing: a systematic review of health economic evidence

Recently the sequencing of the human genome has become a major biological and clinical research field. However, the public health impact of this new technology with focus on the financial effect is not yet to be foreseen. To provide an overview of the current health economic evidence for genome sequencing, we conducted a thorough systematic review of the literature from 17 databases. In addition, we conducted a hand search. Starting with 5 520 records we ultimately included five full-text publications and one internet source, all focused on cost calculations. The results were very heterogeneous and, therefore, difficult to compare. Furthermore, because the methodology of the publications was quite poor, the reliability and validity of the results were questionable. The real costs for the whole sequencing workflow, including data management and analysis, remain unknown. Overall, our review indicates that the current health economic evidence for genome sequencing is quite poor. Therefore, we listed aspects that needed to be considered when conducting health economic analyses of genome sequencing. Thereby, specifics regarding the overall aim, technology, population, indication, comparator, alternatives after sequencing, outcomes, probabilities, and costs with respect to genome sequencing are discussed. For further research, at the outset, a comprehensive cost calculation of genome sequencing is needed, because all further health economic studies rely on valid cost data. The results will serve as an input parameter for budget-impact analyses or cost-effectiveness analyses.Marsilius KollegDF

Conciliation Versus Mediation of Complaints Against Police: Lessons from the Queensland Experience

Objective: to analyze the dispute resolution practices for dealing with citizen-initiated complaints against police in Queensland, Australia.Methods: dialectical approach to cognition of social phenomena, allowing to analyze them in historical development and functioning in the context of the totality of objective and subjective factors, which predetermined the choice of the following research methods: formal-logical, comparative-legal, and sociological. Results: since the 1990s, alternative dispute resolution practices for dealing with citizen-initiated complaints against police, such as conciliation, have progressively been trialed and implemented in police services across Australia. The Queensland Police Service was one of the most proactive services in trialing independently facilitated complaints mediation programs - in collaboration with its oversight agency. However, despite repeated positive outcomes, the Service refrained from actively using mediation, preferring instead to use management dominated informal resolution (conciliation). This process, characterized by police investigating police, continues to limit complainant participation by denying them the opportunity to meet face- to-face with the subject officer. Yet the literature cites mediation, especially practices based on restorative principles as beneficial because it brings disputing parties together in dialogue that is educative for both parties, reparatory, and better satisfies complainants’ aspirations for an inclusive and neutral complaints system, while data from mediated complaints can also be used to inform police conduct improvement strategies. Complaints mediation is available upon request within the Queensland Police Service, however, it is not widely promoted, and is internally facilitated.Scientific novelty: this article presents an historical account of the application of mediation and conciliation to the Queensland Police Service complaints system. The authors answer the question why conciliation has become the default approach and mediation continues to be largely ignored. This is done through a qualitative analysis of publicly available documents and semi-structured interviews with key stakeholders. The findings reveal that the 1992 Mediation Pilot was very successful. However, the Queensland Police Service adopted conciliation because it was cheaper and, they claim, better aligned with managing behavioral improvements. Three decades on, there has been little evidence of this, while the literature clearly shows that mediation should be a key component of any police complaints and discipline system. The findings reveal that the 1992 Mediation Pilot was very successful. However, the Queensland Police Service adopted conciliation because it was cheaper and, they claim, better aligned with managing behavioral improvements. Three decades on, there has been little evidence of this, while the literature clearly shows that mediation should be a key component of any police complaints and discipline system.Practical significance: the main provisions and conclusions of the article can be used in scientific, pedagogical and law enforcement activities when considering issues related to the citizens’ claims on the actions of law enforcers

Phytosterol, tocopherol and carotenoid retention during commercial processing of brassica napus (canola) oil

Brassica napus (canola) seed is a rich source of phytosterols, tocopherols and carotenoids, which all have recognized health benefits, although these are reduced or lost during crude oil refinement. Many studies are now outdated, so new research to monitor bioactive retention through current processing techniques is warranted. In this work, canola seed, in-process seed, and oil samples were collected from the major stages of five commercial canola oil processes. Analysis of phytosterols, tocopherols and carotenoids indicated seed pre-treatment enhanced bioactive concentrations in the crude oil. Although the bleaching step in each process eliminated all carotenoids, high concentrations of phytosterols and tocopherols remained in the refined oil across all processes, with losses notably lower than those found in previous reports. Moreover, crude oil samples from a two-stage cold pressing process showed greatly enriched concentrations of tocopherols (+122%), sterols (+140%) and carotenoids (+217%). The results show that modern Australian canola oil processing retains high phytosterol and tocopherol concentrations and warrants further investigation into bioactive enrichment strategies. Given the growing interest in health-enhanced foods, this study provides opportunities for nutrition and health-enhanced oil products and the potential for adding value in the edible oil industry

Aspects of outpatient palliative care in Germany - a survey among office-based physicians

Background: Currently, palliative care is widely discussed. The aim of this study is to explore different aspects of the ambulatory treatment environment of palliative care patients and its structure in Germany from the viewpoint of caring physicians. Methods: A structured questionnaire was developed and sent to 1,003 office-based physicians in Germany. Topics were the delivery and effort of care, cooperation among health care providers, the subjective assessment of existing health care structures, the reimbursement system, as well as an assessment of future developments. Sub-group analyses were conducted. Results: Three hundred fourteen questionnaires were included in the statistical analyses. Fifty percent of physicians estimate the additional time and effort for palliative care patients compared to non-palliative care patients to be 50% and more. The best cooperation is seen with caregivers; however, cooperation with psycho-social care providers should be improved. Fifty percent describe the outpatient health care situation as (very) insufficient, but improvements are expected in the future. Ninety percent assess German reimbursement structures as (very) insufficient. Conclusions: This study gives an insight into the German outpatient health care setting for palliative care patients. Palliative care patients have higher and more complex needs with respect to health care than other patients. Further studies should focus on the collection of longitudinal patient data for more comprehensive insight

A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC)

Background: Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. Methods: A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Results: Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality. Conclusion: First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well.BMB