A Descriptive Study of Nosocomial Infections in an Adult Intensive Care Unit in Fiji: 2011-12

Copyright © 2014 Keshni Naidu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji’s largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectru

The turbomachine blading design using S2-S1 approach

The boundary conditions corresponding to the design problem when the blades being simulated by the bound vorticity distribution are presented. The 3D flow is analyzed by the two steps S2 - S1 approach. In the first step, the number of blades is supposed to be infinite, the vortex distribution is transformed into an axisymmetric one, so that the flow field can be analyzed in a meridional plane. The thickness distribution of the blade producing the flow channel striction is taken into account by the modification of metric tensor in the continuity equation. Using the meridional stream function to define the flow field, the mass conservation is satisfied automatically. The governing equation is deduced from the relation between the azimuthal component of the vorticity and the meridional velocity. The value of the azimuthal component of the vorticity is provided by the hub to shroud equilibrium condition. This step leads to the determination of the axisymmetric stream sheets as well as the approximate camber surface of the blade. In the second step, the finite number of blades is taken into account, the inverse problem corresponding to the blade to blade flow confined in each stream sheet is analyzed. The momentum equation implies that the free vortex of the absolute velocity must be tangential to the stream sheet. The governing equation for the blade to blade flow stream function is deduced from this condition. At the beginning, the upper and the lower surfaces of the blades are created from the camber surface obtained from the first step with the assigned thickness distribution. The bound vorticity distribution and the penetrating flux conservation applied on the presumed blade surface constitute the boundary conditions of the inverse problem. The detection of this flux leads to the rectification of the geometry of the blades

Are the true impacts of adverse events considered in economic models of antineoplastic drugs? a systematic review

Background: Antineoplastic drugs for cancer are often associated with adverse events, which influence patients' physical health, quality of life and survival. However, the modelling of adverse events in cost-effectiveness analyses of antineoplastic drugs has not been examined. Aims: This article reviews published economic evaluations that include a calculated cost for adverse events of antineoplastic drugs. The aim is to identify how existing models manage four issues specific to antineoplastic drug adverse events: the selection of adverse events for inclusion in models, the influence of dose modifications on drug quantity and survival outcomes, the influence of adverse events on quality of life and the consideration of multiple simultaneous or recurring adverse events. Methods: A systematic literature search was conducted using MESH headings and key words in multiple electronic databases, covering the years 1999-2009. Inclusion criteria for eligibility were papers covering a population of adults with solid tumour cancers, the inclusion of at least one adverse event and the resource use and/or costs of adverse event treatment. Results: From 4,985 citations, 26 eligible articles were identified. Studies were generally of moderate quality and addressed a range of cancers and treatment types. While the four issues specific to antineoplastic drug adverse events were addressed by some studies, no study addressed all of the issues in the same model. Conclusion: This review indicates that current modelling assumptions may restrict our understanding of the true impact of adverse events on cost effectiveness of antineoplastic drugs. This understanding could be improved through consideration of the selection of adverse events, dose modifications, multiple events and quality of life in cost-effectiveness studies. © 2013 Springer International Publishing Switzerland

Natural variation in gene expression in the early development of dauer larvae of Caenorhabditis elegans

<p>Abstract</p> <p>Background</p> <p>The free-living nematode <it>Caenorhabditis elegans </it>makes a developmental decision based on environmental conditions: larvae either arrest as dauer larva, or continue development into reproductive adults. There is natural variation among <it>C. elegans </it>lines in the sensitivity of this decision to environmental conditions; that is, there is variation in the phenotypic plasticity of dauer larva development. We hypothesised that these differences may be transcriptionally controlled in early stage larvae. We investigated this by microarray analysis of different <it>C. elegans </it>lines under different environmental conditions, specifically the presence and absence of dauer larva-inducing pheromone.</p> <p>Results</p> <p>There were substantial transcriptional differences between four <it>C. elegans </it>lines under the same environmental conditions. The expression of approximately 2,000 genes differed between genetically different lines, with each line showing a largely line-specific transcriptional profile. The expression of genes that are markers of larval moulting suggested that the lines may be developing at different rates. The expression of a total of 89 genes was putatively affected by dauer larva or non-dauer larva-inducing conditions. Among the upstream regions of these genes there was an over-representation of DAF-16-binding motifs.</p> <p>Conclusion</p> <p>Under the same environmental conditions genetically different lines of <it>C. elegans </it>had substantial transcriptional differences. This variation may be due to differences in the developmental rates of the lines. Different environmental conditions had a rather smaller effect on transcription. The preponderance of DAF-16-binding motifs upstream of these genes was consistent with these genes playing a key role in the decision between development into dauer or into non-dauer larvae. There was little overlap between the genes whose expression was affected by environmental conditions and previously identified loci involved in the plasticity of dauer larva development.</p

Breaking up is hard to do: Why disinvestment in medical technology is harder than investment

Healthcare technology is a two-edged sword - it offers new and better treatment to a wider range of people and, at the same time, is a major driver of increasing costs in health systems. Many countries have developed sophisticated systems of health technology assessment (HTA) to inform decisions about new investments in new healthcare interventions. In this paper, we question whether HTA is also the appropriate framework for guiding or informing disinvestment decisions. In exploring the issues related to disinvestment, we first discuss the various HTA frameworks which have been suggested as a means of encouraging or facilitating disinvestment. We then describe available means of identifying candidates for disinvestment (comparative effectiveness research, clinical practice variations, clinical practice guidelines) and for implementing the disinvestment process (program budgeting and marginal analysis (PBMA) and related techniques). In considering the possible reasons for the lack of progress in active disinvestment, we suggest that HTA is not the right framework as disinvestment involves a different decision making context. The key to disinvestment is not just what to stop doing but how to make it happen - that is, decision makers need to be aware of funding disincentives. What is known about this topic? Disinvestment is an increasingly popular topic amongst academics and policy makers. Most discussions focus on the need to increase disinvestment as a corollary of investment, the lack of overt disinvestment decisions and the use of a framework based on health technology assessment (HTA) to implement disinvestment. What does this paper add? This paper focusses on the difficulties associated with deciding which technologies to disinvest in, and the problems in using an HTA framework to make such decisions, when disinvestment involves a different decision making context from that of investment. What are the implications for practitioners? The key to disinvestment is not just what to stop doing but how to implement such decisions. Making it happen means being aware of funding disincentives. © 2012 AHHA

Changing corporate attitudes towards environmental policy

Purpose – To report findings from an updated survey of environmental policy and practice among UK organizations. To draw conclusions about the relationship between environmental concerns and organizational strategy making. Design/methodology/approach – The paper reports findings from a 1999 survey of 911 UK organizations, updated by interviews conducted with participant organizations in 2004. The paper represents an extension of a ten-year longitudinal study of environmental policy and practice in UK organizations. Findings – The gap between policy formulation and implementation in the environmental area has continued to narrow, but environmental concerns appear not to have moved towards the centre of the strategy making process in many firms. Organizations are still primarily influenced by short-term rather than long-term imperatives, and although recognition of opportunity offered by the environment is increasing, organizations are still liable to adopt a reactive position, increasingly so as the size of the organization decreases. Research limitations/implications – It offers a contribution to the debate over the ongoing relationship between organizational strategy and environmental factors as a determinant of organizational strategy. It locates the debate in the wider discussion of determinants of organizational strategy. Practical implications – It highlights the complex decision-making processes facing managers in satisfying a variety of stakeholders who may be making competing demands of their organization. Originality/value – The paper offers a longitudinal review of changes to environmental policy and practice among UK organizations, providing an opportunity to explore the nature of change over a ten-year period

Conserving Water in Irrigated Agriculture: The Economics and Valuation of Water Rights

The effective management of water resources in Alberta is crucial to sustainable agriculture, industrial development, and environmental management. The historical water allocation mechanism, administrative apportionment, has been viewed in recent years as ineffective and cumbersome. Accordingly, the revision of the Water Act in 1996, included an attempt to improve the efficiency of water allocation. By making the transfer of water rights possible, the revised Act provides many new options for water use and flexibility. The implications of transferable water rights in Alberta water policy must be carefully considered in order to determine the viability and suitability of such a system in the provincial context. This project examines some of the economic aspects of transferable water rights and the potential for effective water allocation by way of transfers in an Alberta setting. As a major part of this project, a hedonic price model, focusing on land values in southern Alberta, was constructed based on similar models, which have been used elsewhere to value water rights or agricultural products. The hedonic approach to market analysis uses the relationship between the price of land and the attributes of the land, such as water availability, soil quality and location, to explain differences in land prices. In this process, the hedonic model is used to estimate the implicit marginal price or value of each land attribute -- in our case, the marginal value of irrigation water. This value will provide us with an indirect estimate of the value of water rights in the region studied. An advantage of the technique is that it estimates the value that farmers express for irrigation water in the market place for land. Such values, then, give us an indication of the anticipated prices, which might prevail for water rights in southern Alberta. The focus of the study was an area of southern Alberta encompassing the counties of Wheatland, Newell, Cypress, Forty Mile, Taber, Warner, Lethbridge and Vulcan and the irrigation districts of Western, Eastern, St.Mary's, Taber, Lethbridge Northern, and portions of Raymond. Information was collected on the physical and economic characteristics of 230 land parcels, which were sold in this region in 1993 and early 1994. A crude comparison of the value of irrigated agricultural land and non-irrigated agricultural land in the sample reveals that irrigated land was worth, on average, $325 more per acre than non-irrigated land. In the ensuing analysis, it was estimated that the value of a parcel of land was determined largely by the buildings on it, the number of acres in the parcel, the proximity of the parcel to a major city (in this case Calgary or Lethbridge), and by the availability of irrigation water. In the hedonic model, the coefficient values of the variables included represent the marginal impact of each of these characteristics on land prices holding all other things constant. For example, the value of water rights represents the average difference between land values of farms that have access to irrigation and farms that do not. This study estimated that every dollar of improvements to farm buildings translates to a one cent increase in the per acre price of the land parcel, where the addition of one extra acre of land to a land parcel lowers the price per acre by$5.17 per acre. Land prices were seen to increase with the proximity of the parcel to large cities. Similarly, the results of the preferred model indicate that the implicit value of having access to irrigation water in southern Alberta is approximately $190 per acre, or, using the conventional estimate that irrigating one acre of land requires 1.5 acre feet of water, this translates to$126 per acre foot of irrigation water. Accordingly, it is revealed that the existence of water rights adds approximately 35% to the value of non-irrigated land. Since this value represents the implicit amount farmers are willing to pay for access to water, it could also be construed as an indirect measure of the value of water rights. From these results, it is reasonable to conclude that water rights do have a measurable impact on land values. Accordingly, proper incentives may be needed to ensure that water is used efficiently and not incorrectly treated as a relatively free or cheap good. One possible method of policy reform to achieve such a system would be the institution of a system of transferable water rights, permitting water to be traded, or effectively sold, at its market price or scarcity value. Further work was done to determine the potential effects of transferable water rights on the Eastern Irrigation District in southern Alberta. Farm budget information was used to gather information and create twelve representative farm types whose financial performance was analysed using linear programming with increasing water quantity constraints. The resulting productive water values were then used to imply potential reallocations of water among farm types and cropping systems. Analysis of the data gathered revealed that all representative farms faced downward sloping demand functions for water. The overall value of water for a 1% reduction ranged from $8 to$250 per acre foot, with the lowest value belonging to largely pasture operations and the highest value attributed to specialty crop producers. This large range in water values for the region indicates that there is sufficient heterogeneity within the EID to accommodate a transferable rights system. Further analysis of the data reveals that the implementation of a transfer system would result in water being transferred to specialty crop producers and the acreage devoted to specialty crops would increase. Small irrigated pasture operations and cereal crop producers would be the first to give up their water allocations under a transfer system. The analysis indicates that there is considerable potential for economic gains from water trade within this district, the main constraint being the market limitations to expanded specialty crop production. Using these two major studies and other sources, this report concludes with a brief evaluation of the economic advantages, disadvantages and other issues involved in instituting a system of transferable water rights in Alberta. Experience elsewhere, primarily in Australia and the western United States, strongly suggests that transferable water rights, despite some drawbacks and problems of implementation, can be a very worthwhile water policy tool. Now that such tradable water rights are permissible under the revised Water Resources Act of 1996, it is recommended that a pilot project involving transferable water rights be instituted in a water short basin or sub-basin in southern Alberta once a water management plan for that basin is completed.Resource /Energy Economics and Policy,

Preferences for new and existing contraceptive products

New contraceptive methods provide greater choice in terms of effectiveness, management of side-effects, convenience and frequency of administration and flexibility, but make the decisions about contraception more complex. There are limited data on the factors that determine women's choices among these alternatives, to inform providers about the factors which are most important to women, or to predict uptake of new products. This paper reports on a choice experiment designed to elicit women's preferences in relation to prescribed contraception and to forecast the impact of the introduction of two new products into the Australian market. A generalised multinomial logit model is estimated and used in the simulation exercise. The model forecasts that the hormonal patch would be well received among women, achieving a greater market share than current non-pill products, but the vaginal ring would have limited appeal. Copyright © 2011 John Wiley & Sons, Ltd