Submission to the Legal Affairs and Community Safety Committee: Youth Justice (Boot Camp Orders) and Other Legislation Amendment Bill 2012

This submission addresses the Youth Justice (Boot Camp Orders) and Other Legislation Amendment Bill 2012 which has as its objectives (1) the introduction of a Boot Camp Order as an option instead of detention for young offenders and (2) the removal of the option of court referred youth justice conferencing for young offenders. As members of the QUT Faculty of Law Centre for Crime and Justice we welcome the invitation to participate in the discussion of these issues which are critically important to the Queensland community at large but especially to our young people

Understanding the patient's perspective on rapid and routine HIV testing in an inner-city urgent care center

The purpose of this study was to explore patient perspectives of rapid and routine HIV-testing in an urgent care center at an urban public hospital. We conducted structured focus groups during a clinical trial comparing routinely offered rapid HIV-testing, routinely offered enzyme immunoassay (EIA) testing, and conventional EIA testing. Participants of the six focus groups were 89% African American, 60% uninsured, and had a low educational status. Four independent coders analyzed the data using iterative content analysis. Rapid testing was preferred to EIA testing because it reduced the need for a return visit and stress of waiting for test results, though there were concerns about accuracy. Participants supported routinely offering testing, but there were concerns about privacy and cost. Fear and stigma were common reasons for refusing testing and not returning for results. Distrust and misconceptions about HIV, particularly regarding the importance of testing, were very common

Perspectives of Canadian Teacher Candidates on Inclusion of Children with Developmental Disabilities: A Mixed-Methods Study

This mixed-methods study reports on the perspectives of 208 teacher candidates on teaching children with developmental disabilities and delays (DD) in inclusive classrooms from Kindergarten to Grade 6. The questionnaire included items on demographics, experience, knowledge, and feelings of competence, advocacy, and sense of efficacy. Open-ended questions addressed challenges and successes experienced when including children with DD. Findings suggest that qualitative items elicited more positive responses than traditional questionnaire items and elicited more nuanced and sophisticated understanding of the challenges and successes associated with social inclusion. In the qualitative data, respondents showed understanding of dilemmas associated with inclusive education. Feelings of competence about teaching children with DD and about collaborating with colleagues predicted general sense of efficacy scores; those with experience advocating for individuals with disabilities reported greater knowledge, experience, and confidence related to teaching students with DD. Knowledge, experience, and confidence were highly correlated. Implications for teacher education are discussed

Rethinking Thorne-\.Zytkow Object Formation: The Fate of X-ray Binary LMC X-4 and Implications for Ultra-long Gamma-ray Bursts

We present a start-to-end simulation aimed at studying the long-term fate of high mass X-ray binaries and whether a Thorne-\.Zytkow object (T\.ZO) might ultimately be produced. We analyze results from a 3D hydrodynamical simulation that models the eventual fate of LMC X-4, a compact high mass X-ray binary system, after the primary fills its Roche lobe and engulfs the neutron star companion. We discuss the outcome of this engulfment within the standard paradigm of T\.ZO formation. The post-merger angular momentum content of the stellar core is a key ingredient, as even a small amount of rotation can break spherical symmetry and produce a centrifugally supported accretion disk. Our findings suggest the inspiraling neutron star, upon merging with the core, can accrete efficiently via a disk at high rates ($\approx 10^{-2}M_\odot/{\rm s}$), subsequently collapsing into a black hole and triggering a bright transient with a luminosity and duration typical of an ultra-long gamma-ray burst. We propose that the canonical framework for T\.ZO formation via common envelope needs to be revised, as the significant post-merger accretion feedback will unavoidably unbind the vast majority of the surrounding envelope

How co-production underpinned the development of a logic model and testing of novel statistical methods for evidence synthesis

Background: The CEPHI project sought to develop and test four methods for synthesizing evidence that better accounted for context than standard statistical meta-analysis approaches. To explore context, we had to understand what was important in different contexts. We identified co-production as an approach to achieve this. / Methods: Supported by the Co-Production Collective, we worked closely with an Advisory Group of people with lived, professional, and/or academic expertise. We held a series of workshops with others bringing lived, professional, and/or academic expertise, to co-produce a logic model that subsequently informed novel synthesis methods. Evaluation of the co-production element was through reflexive notes, feedback from participants, and discussions during and after the project. / Results: The impact of co-production was profound. It fundamentally redesigned the entire logic model. This enabled novel statistical methods to answer important questions about context and impact. There were emotional impacts (highs and lows) and resource implications. / Discussion: Co-production is a powerful way to develop logic models and to inform synthesis methods development, by focusing on what is important to the affected communities. We will discuss lessons learned, what we would do differently next time, and what might be some of the key conditions and mechanisms for meaningful co-production

Cost-Effectiveness of Newborn Circumcision in Reducing Lifetime HIV Risk among U.S. Males

BACKGROUND: HIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved. METHODOLOGY/PRINCIPAL FINDINGS: Given published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005-2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs) among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost. CONCLUSIONS/SIGNIFICANCE: Newborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful

A new Liassophlebiidae (Odonata: Heterophlebioidea) from strata close to the Triassic-Jurassic boundary in Somerset, UK

Liassophlebiidae is an extinct family of damsel-dragonflies found in Upper Triassic and Lower Jurassic strata of Europe, Asia and Antarctica. Whilst Liassophlebiidae is well represented by Lower Jurassic fossils, their lowest occurrence in the Upper Triassic has hitherto only been suggested by three fragmentary specimens. These were originally ascribed to two species: Liassophlebia withersi and Liassophlebia batheri, but the latter is now considered nomen dubium. Here we describe a fourth, better preserved specimen that is likely to be Rhaetian (Late Triassic) in age. The specimen, BRSMG Cg3101 a+b, was collected from Bowdens Quarry, Somerset, UK, from the lower part of the White Lias Formation. The specimen comprises an incomplete forewing attributed to Liassophlebia due to: the small number of antenodals, antesubnodals and crossveins between RP and MA based RP3/4 in the base of RP2 opposite the subnodus; a straight and elongate secondary longitudinal vein in the postdiscoidal area; numerous cells and secondary veins in radial and median areas. The specimen is likely to represent a new species and provides stronger evidence than the previous three specimens of the presence of Liassophlebiidae during the late Rhaetian. Its stratigraphical position suggests that Liassophlebiidae arose in the immediate aftermath of the Triassic-Jurassic mass extinction

Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies Using a Reduced-Intensity Conditioning Regimen and Third-Party Mesenchymal Stromal Cells

AbstractAllogeneic hematopoietic stem cell transplantation for patients with a hemoglobinopathy can be curative but is limited by donor availability. Although positive results are frequently observed in those with an HLA-matched sibling donor, use of unrelated donors has been complicated by poor engraftment, excessive regimen-related toxicity, and graft-versus-host disease (GVHD). As a potential strategy to address these obstacles, a pilot study was designed that incorporated both a reduced-intensity conditioning and mesenchymal stromal cells (MSCs). Six patients were enrolled, including 4 with high-risk sickle cell disease (SCD) and 2 with transfusion-dependent thalassemia major. Conditioning consisted of fludarabine (150 mg/m2), melphalan (140 mg/m2), and alemtuzumab (60 mg for patients weighing > 30 kg and .9 mg/kg for patients weighing <30 kg). Two patients received HLA 7/8 allele matched bone marrow and 4 received 4-5/6 HLA matched umbilical cord blood as the source of HSCs. MSCs were of bone marrow origin and derived from a parent in 1 patient and from an unrelated third-party donor in the remaining 5 patients. GVHD prophylaxis consisted of cyclosporine A and mycophenolate mofetil. One patient had neutropenic graft failure, 2 had autologous hematopoietic recovery, and 3 had hematopoietic recovery with complete chimerism. The 2 SCD patients with autologous hematopoietic recovery are alive. The remaining 4 died either from opportunistic infection, GVHD, or intracranial hemorrhage. Although no infusion-related toxicity was seen, the cotransplantation of MSCs was not sufficient for reliable engraftment in patients with advanced hemoglobinopathy. Although poor engraftment has been observed in nearly all such trials to date in this patient population, there was no evidence to suggest that MSCs had any positive impact on engraftment. Because of the lack of improved engraftment and unacceptably high transplant-related mortality, the study was prematurely terminated. Further investigations into understanding the mechanisms of graft resistance and development of strategies to overcome this barrier are needed to move this field forward

Cost-Effectiveness of HIV Screening in STD Clinics, Emergency Departments, and Inpatient Units: A Model-Based Analysis

Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations.We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death. We used program characteristics for each setting to compare the incremental cost per quality-adjusted life year gained from early versus late diagnosis and treatment. We ran the model for 10,000 index patients for each setting, examining alternative scenarios, excluding and including transmission to partners, and assuming HAART was initiated at a CD4 count of either 350 or 500 cells/µL. Screening in STD clinics and EDs was cost-effective compared with diagnosing inpatients, even when including only the benefits to the index patients. Screening patients in STD clinics, who have less-advanced disease, was cost-effective compared with ED screening when treatment with HAART was initiated at a CD4 count of 500 cells/µL. When the benefits of reduced transmission to partners from early diagnosis were included, screening in settings with less-advanced disease stages was cost-saving compared with screening later in the course of infection. The study was limited by a small number of observations on CD4 count at diagnosis and by including transmission only to first generation partners of the index patients.HIV prevention efforts can be advanced by screening in settings where patients present with less-advanced stages of HIV infection and by initiating treatment with HAART earlier in the course of infection

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

Background: Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions. Objectives: To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day. Design: A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation. Setting: Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland. Participants: A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group. Intervention: The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity. Main outcome measures: The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources. Results: The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008). Limitations: Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity. Conclusions: Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions. Trial registration: Current Controlled Trials ISRCTN17975376. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information