Response to Queensland Water Commission Report 'Evaluation of ISF / Cardno report: Review of water supply-demand options for South East Queensland'

In February 2007, the Institute for Sustainable Futures (ISF) and Cardno Australia released a Review of Water Supply-Demand Options for South East Queensland (the Review). The Review was submitted to the Senate Rural & Regional Affairs and Transport (RRAT) Committee Inquiry into Additional Water Supplies for South East Queensland. The key finding of the ISF/Cardno Review is that Traveston Crossing Dam will not be useful to provide water security in the current drought and is unnecessary to ensure water security for South East Queensland after the drought and for decades to come. The suite of supply and demand options â excluding Traveston Dam â which are currently being implemented as part of the South East Queensland Regional Water Supply Strategy (SEQRWSS) sufficient to ensure the supply-demand balance to around 2030. For the period 2030-2050, ISF/Cardno suggest a number of enhanced demand management programs that will maintain the supplydemand balance to 2050. The demand management measures suggested by ISF/Cardno are more cost effective than Traveston Dam (in terms of $ per kilolitre) and perform significantly better than Traveston Dam when assessed on social and environmental criteria including greenhouse impact. In the event that a period of water scarcity worse than the current drought occurs, ISF/Cardno propose that a âreadinessâ strategy be adopted whereby water supply projects with relatively short construction and delivery times are planned and approved but only built if and when absolutely necessary to defer a crisis in water supplies. This strategy avoids investing in infrastructure that may not be needed. This represents a lower cost strategy than building capital works pre-emptively. It is important to note that the water supply projects outlined in the ISF/Cardno Review are suggestions of appropriate âreadinessâ options

Review of water supply-demand options for South East Queensland

This independent review aims to assess the Queensland Government's proposed strategy for meeting the long-term water supply-demand balance for South East Queensland, of which the Traveston Crossing scheme is a major and controversial component. The review, conducted by a team from the ISF at the UTS and Cardno, concludes that a diverse portfolio of options can ensure supply security for South East Queensland (SEQ) well into the future, certainly to 2050. Such options include: increasing water supply availability (supply-side options); decreasing the demand for water (demand-side options); and meeting water supply needs during deep droughts (drought response options). A number of the elements of such a portfolio are already being implemented as part of the current Queensland Government strategy. With the extension and addition of low unit cost demand-side options and supply-side drought response readiness options, a clear conclusion of this study is that the proposed dam at Traveston Crossing on the Mary River is neither necessary nor desirable as a part of the portfolio for ensuring supply security to 2050. The increase in supply from this proposed dam will not assist in the short-term during the current severe drought in which water (from savings and supply) is needed over the next two to three years. Planned completion of the Traveston Crossing Dam Stage 1 is in 2012. Additional time will be needed for the dam to fill, which could take an additional two years, resulting in the yield from this source only potentially being available in 2014. Neither is the Traveston Crossing scheme needed for supply-demand balance in the longer term with the suite of other more appropriate drought response measures being implemented by the Queensland Government and strategy being proposed as part of this study. The proposed dam at Traveston Crossing on the Mary River represents a high total cost, high unit cost, high risk and high environmental and social impact option

Effects of comorbidities on quality of life in Filipino people with tuberculosis.

BACKGROUND: We investigated health-related quality of life (HrQoL) in Filipino people undergoing TB treatment, and whether HrQoL was negatively impacted by comorbidity with undernutrition, diabetes (DM) and anaemia.METHODS: Adult participants were enrolled in public facilities in Metro Manila (three sites) and Negros Occidental (two sites). Multivariate linear regression was used to model the four correlated domain scores from a WHOQOL-BREF questionnaire (physical, psychological, social, environmental). A forward-stepwise approach was used to select a final multivariable model with inclusion based on global tests of significance at P < 0.1.RESULTS: In 446 people on drug-susceptible TB treatment, DM and moderate/severe anaemia were not associated with HrQoL. After adjustment for age, sex, education, food insecurity, treatment adherence, inflammation, Category I or II TB treatment, treatment phase, current side effects and inhibited ability to work, moderate/severe undernutrition (body mass index < 17 kg/m²) was associated with lower HrQoL (P = 0.003) with reduced psychological (coefficient: -1.02, 95% CI -1.54 to -0.51), physical (-0.62, 95% CI -1.14 to -0.09) and environmental domain scores (-0.45, 95% CI -0.88 to -0.01). In 225 patients with known HIV status in Metro Manila, HIV was associated with modestly reduced HrQoL (P = 0.014).CONCLUSION: Nutritional status and food insecurity represent modifiable risk factors for poor HrQoL that may be alleviated through interventions

Causal inference for long-term survival in randomised trials with treatment switching: Should re-censoring be applied when estimating counterfactual survival times?

Treatment switching often has a crucial impact on estimates of effectiveness and cost-effectiveness of new oncology treatments. Rank preserving structural failure time models (RPSFTM) and two-stage estimation (TSE) methods estimate ‘counterfactual’ (i.e. had there been no switching) survival times and incorporate re-censoring to guard against informative censoring in the counterfactual dataset. However, re-censoring causes a loss of longer term survival information which is problematic when estimates of long-term survival effects are required, as is often the case for health technology assessment decision making. We present a simulation study designed to investigate applications of the RPSFTM and TSE with and without re-censoring, to determine whether re-censoring should always be recommended within adjustment analyses. We investigate a context where switching is from the control group onto the experimental treatment in scenarios with varying switch proportions, treatment effect sizes and time-dependencies, disease severity and switcher prognosis. Methods were assessed according to their estimation of control group restricted mean survival (that would be observed in the absence of switching) at the end of the simulated trial follow-up. We found that RPSFTM and TSE analyses which incorporated re-censoring usually produced negative bias (i.e. under-estimating control group restricted mean survival and therefore over-estimating the treatment effect). RPSFTM and TSE analyses that did not incorporate re-censoring consistently produced positive bias (i.e. under-estimating the treatment effect) which was often smaller in magnitude than the bias associated with the re-censored analyses. We believe that analyses should be conducted with and without re-censoring, as this may provide decision makers with useful information on where the true treatment effect is likely to lie. Analyses that incorporate re-censoring should not always represent the default approach when the objective is to estimate long-term survival times and treatment effects on long-term survival

The effects of publishing emergency department wait time on patient utilization patterns in a community with two emergency department sites: a retrospective, quasi-experiment design

BACKGROUND: Providing emergency department (ED) wait time information to the public has been suggested as a mechanism to reduce lengthy ED wait times (by enabling patients to select the ED site with shorter wait time), but the effects of such a program have not been evaluated. We evaluated the effects of such a program in a community with two ED sites. METHODS: Descriptive statistics for wait times of the two sites before and after the publication of wait time information were used to evaluate the effects of the publication of wait time information on wait times. Multivariate logistical regression was used to test whether or not individual patients used published wait time to decide which site to visit. RESULTS: We found that the rates of wait times exceeding 4 h, and the 95th percentile of wait times in the two sites decreased after the publication of wait time information, even though the average wait times experienced a slight increase. We also found that after controlling for other factors, the site with shorter wait time had a higher likelihood of being selected after the publication of wait time information, but there was no such relationship before the publication. CONCLUSIONS: These findings were consistent with the hypothesis that the publication of wait time information leads to patients selecting the site with shorter wait time. While publishing ED wait time information did not improve average wait time, it reduced the rates of lengthy wait times