Constructed wetlands: Prediction of performance with case-based reasoning (part B)

The aim of this research was to assess the treatment efficiencies for gully pot liquor of experimental vertical- flow constructed wetland filters containing Phragmites australis (Cav.) Trin. ex Steud. (common reed) and filter media of different adsorption capacities. Six out of 12 filters received inflow water spiked with metals. For 2 years, hydrated nickel and copper nitrate were added to sieved gully pot liquor to simulate contaminated primary treated storm runoff. The findings were analyzed and discussed in a previous paper (Part A). Case-based reasoning (CBR) methods were applied to predict 5 days at 20°C N-Allylthiourea biochemical oxygen demand (BOD) and suspended solids (SS), and to demonstrate an alternative method of analyzing water quality performance indicators. The CBR method was successful in predicting if outflow concentrations were either above or below the thresholds set for water-quality variables. Relatively small case bases of approximately 60 entries are sufficient to yield relatively high predictions of compliance of at least 90% for BOD. Biochemical oxygen demand and SS are expensive to estimate, and can be cost-effectively controlled by applying CBR with the input variables turbidity and conductivity

Improving consultations in oncology: The development of a novel consultation aid

Background: The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered. Methods: We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid. Results: A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid. Conclusions: Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations

A cost-effectiveness analysis of school-based suicide prevention programmes

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer’s perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation. Trial registration number DRKS00000214