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MicroLink Devices manufactures triple-junction inverted metamorphic (IMM) solar cells on GaAs wafers with a selectively etched release layer in an epitaxial lift-off (ELO) process to create ultra-thin foils of semiconductor with a metal backing. To improve radiation tolerance, each absorber layer is thinned and doping levels are reduced. The bottom subcell employs a mirror structure to maintain current, while the middle subcell requires a distributed Bragg reflector (DBR) to increase the absorption path length and maintain current. MicroLink utilizes a non-conventional Inx(AlyGa1-y)1-xP/GaAs DBR that is compatible with ELO. The DBR has a bandwidth of ~110nm and a peak reflectance in air near 95%. Average cell efficiencies of 28% (1-sun AM0) are achieved with a power retention of 84% after 1E15cm-2 electron dosing (1MeV energy). Large-area cells and coupons underwent internal thermal stress testing and showed no degradation. Clear pathways to achieve >29% efficient cells with >85% power retention are discussed.

Ex post moral hazard arises when the insured has an unobservable influence on the size of a loss after its occurrence. In automobile (property) insurance, ex post moral hazard could increase in the scope of the repairs and/or the value of the repairs. Both vehicle owners and auto repairers could gain from increasing the scope of repairs, while auto repairers would gain from an increase in the value of repairs. An analysis of 994 Australian road traffic crashes found that ex post moral hazard increased the value of repairs by 46.8 per cent of which 9 percentage points was explained by an increase in the scope of the repairs, which was defined as an increased from 2 to 2.4 parts per auto repair.

This article discusses metal–organic vapor phase epitaxy growth of all-phosphide (AlInP–InGaP) distributed Bragg reflectors (DBRs) and their applications for thin flexible multijunction solar cell devices. DBRs with a peak reflectance of 884 nm—close to the GaAs bandgap energy—were grown. This all-phosphide DBR was monolithically integrated with a dual-junction (DJ) InGaP/GaAs solar cell. The DJ cell with a DBR exhibited a 3% increase in short-circuit current density ( J sc), in comparison with the DJ without a DBR. Both open-circuit voltage ( V oc) and fill factor ( FF) values of the solar cell did not change with the DBR integration.

Building on previous simulation results, this work examines experimentally the incorporation of a longpass (LP) distributed Bragg reflector (DBR), as compared to a standard matched pair DBR, between the GaAs and InGaAs subcells of a triple junction inverted metamorphic design. The GaAs cell was not optically thick, to improve radiation tolerance, and contained InGaAs quantum wells, to increase subcell current generation. Both DBR structures improved bulk GaAs subcell collection in the physically thin absorber, however the LPDBR significantly reduced optical loss in the bottom junction caused by parasitic low energy reflections present in the standard DBR. This shifted the current limiting junction from the bottom InGaAs junction in the case of the DBR to the top InGaP junction, as designed. Simulation and experimental results of external quantum efficiency are presented and discussed.

Background This study aims to investigate the impact of multidisciplinary Saturday rehabilitation (MSR) on length of stay, functional independence, gait and balance when compared to a 6-day physiotherapy-only service in a pragmatic setting. An economic evaluation of the intervention conducted from the perspective of the healthcare provider is included.Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit to compare a multidisciplinary and physiotherapy-only 6-day rehabilitation service. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (MSR) had 192 participants and the historical control group (physiotherapy Saturday rehabilitation) had 174 participants). Participants in the historical control group had lower total and cognitive Functional Independence Measure scores (p Conclusions Implementation of MSR results in a more efficient service, enabling a greater amount of therapy to be provided over a shorter length of stay. The provision of a multi-disciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.Trial registration not applicable.

IntroductionYoung children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial.Methods and analysis60 children with BCP aged 2–5 years, Gross Motor Function Classification System (GMFCS) II–IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales–Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function—Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models.Ethics and disseminationEthics approval has been granted by the Medical Research Ethics Committee Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/59444) and The University of Queensland (2020000336/HREC/19/QCHQ/59444).Trial registration numberACTRN126200000719.

Objectives: The objective of this discussion paper is two-fold. The first is to quantify if the non-medical surgical assistant increases access to surgery by investigating what percentages of cases these clinicians undertake in the private sector surgical units where they work. The second is to examine procedural and distributive justice and how they impact on private sector surgical care. Aim: The aim of this paper is to investigate if the non-medical surgical assistant increases equity via access, for the patient, to private sector surgical care; and if government policy has an impact on equity in the form of access. Background: The private healthcare sector completes approximately two-thirds of all elective surgery in Australia; without this contribution, there would be more pressure on the public healthcare sector. In the private sector, recognition and federal funding of the surgical assistant differs depending on whether this clinician has a medical or non-medical, eg. nursing, qualification. The role of the non-medical surgical assistant is well established internationally and this role has been practiced in Australia for more than 20 years. Discussion: Inequity; as a result of the procedural injustice of government funding policy, impacts the private sector surgical patient causing distributive injustice. This distributive injustice results in an out-of-pocket expense to the patient. Rising outof-pocket expenses has started a trend of patients moving away from private health insurance and into the public sector. The registered nurse and nurse practitioner are qualified to practise as a non-medical surgical assistant and provide increased access to care, and effective care compared to the medical surgical assistant. The nurse practitioner is an eligible provider of Medical Benefits Schedule services but restricted from accessing the intraoperative assisting item numbers. Conclusion: The non-medical surgical assistant; or at least the nurse practitioner as non-medical surgical assistant; require access to the Medical Benefits Schedule intraoperative item numbers. Access would alleviate the out-of-pocket expense incurred by Australian patients when a non-medical surgical assistant assists with their surgery. Lack of access to these item numbers means patients may have their surgery delayed until an appropriately skilled medical surgical assistant is available, or the public healthcare sector can accommodate them. Implications for research, policy and practice: This paper illustrates a need for change in Australian government policy to reflect contemporary, evidencebased practice. What is already known about the topic? • The international literature reports that advanced practice nursing roles increase access to healthcare. • The nurse practitioner role in Australia is now well established, and the Australian literature illustrates increased access to care. • The Medical Benefits Schedule Review Taskforce was formed to investigate a system that is not consistent with contemporary, evidence-based healthcare. What this paper adds: • The nurse practitioner and registered nurse, in the role of non-medical surgical assistant, increase access to private sector surgical care. • Australian government policy limits access to private sector surgical care through its inequitable policies that contravene the spirit of fair trade. • According to peak professional bodies’ policy and position statements, the nurse practitioner and registered nurse are legitimate providers of surgical assisting services.

MicroLink Devices has deposited screen printed silver contacts on bulk pseudomorphic InGaAs and for the first time on epitaxial thin film foils. MicroLink has achieved contact resistances of 1E-6 Ohms·cm−2 on bulk InGaAs, and 4E-2 Ohms·cm−2 on solar cell foils. Ink formulations with tin are also explored. This work shows an alternative, low-cost, and high-throughput method for contacting III-V solar cells.

The aim of this study is to test what effect the weather may have on medications prescribed to treat Parkinson's disease. Twenty-three years of monthly time, series data was sourced from the Pharmaceutical Benefits Scheme (PBS) and the Bureau of Meteorology (BOM). Data were available for eight states and territories and their corresponding capital cities. The dependent variable was the aggregate levodopa equivalent dose (LED) for 51 Parkinson's medications identified on the PBS. Two explanatory variables of interest, temperature and solar exposure, were identified in the BOM data set. Linear and cosinor models were estimated with fixed and random effects, respectively. The prescribed LED was 4.2% greater in January and 4.5% lower in July. Statistical analysis showed that temperature was associated with the prescription of Parkinson medications. Our results suggest seasonality exists in Parkinson's disease symptoms and this may be related to temperature. Further work is needed to confirm these findings and understand the underlying mechanisms as a better understanding of the causes of any seasonal variation in Parkinson's disease may help clinicians and patients manage the disease more effectively.

To investigate effectiveness of the nurse clinician as a Non-Medical Surgical Assistant compared with the Medical Surgical Assistant. Non-Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non-Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. The nurse clinician in the role of Non-Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.

The authors report on the metal-organic vapor phase epitaxial (MOVPE) growth of all III-phosphide (AlInPInGaP) Distributed Bragg Reflectors (DBRs) on large GaAs substrates and their application for multijunction (MJ) solar cell device. DBRs with peak reflectance of 890 nm at GaAs bandgap energy were grown on top of inverted GaAs single junctions. All phosphide DBRs are compatible with epitaxial lift off processing of solar cells. The DBRs grown on 150 mm (6") substrates exhibited smooth surfaces and high degree of homogeneity. In the preliminary integration tests, the dual junction InGaP/GaAs solar cells with AlInP-GaInP DBR resulted in an increase of 3% in J sc and 44% increase in the integrated EL intensity of both GaAs and InGaP peaks when testing under high injection currents. The V oc and FF did not change with the DBR integration into the 2J cells.

Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette’s syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication. To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS. We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate. DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon. Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.

Background Movement disorders (MDs) are increasingly being managed with deep brain stimulation (DBS). High‐quality economic evaluations (EEs) are necessary to evaluate the cost‐effectiveness of DBS. We conducted a systematic review of published EEs of the treatment of MDs with DBS. The review compares and contrasts the reported incremental cost‐effectiveness ratios (ICERs) and methodology employed by trial‐based evaluations (TBEs) and model‐based evaluations (MBEs). Methods MeSH and search terms relevant to “MDs,” “DBS,” and “EEs” were used to search biomedical and economics databases. Studies that used a comparative design to evaluate DBS, including before‐after studies, were included. Quality and reporting assessments were conducted independently by 2 authors. Seventeen studies that targeted Parkinson's disease (PD), dystonia, and essential tremor (ET), met our selection criteria. Results Mean scores for methodological and reporting quality were 73% and 76%, respectively. The ICERs for DBS compared with best medical therapy to treat PD patients obtained from MBEs had a lower mean and range compared with those obtained from TBEs ($55,461–$735,192 per quality‐adjusted life‐year [QALY] vs. $9,301–$65,111 per QALY). Pre‐post ICER for DBS to treat dystonia was $64,742 per QALY. DBS was not cost‐effective in treating ET compared with focused‐ultrasound surgery. Cost‐effectiveness outcomes were sensitive to assumptions in health utilities, surgical costs, battery life‐span, model time horizons, and the discount rate. Conclusions The infrequent use of randomized, controlled trials to evaluate DBS efficacy, the paucity of data reporting the long‐term effectiveness and/or utility of DBS, and the uncertainty surrounding cost data limit our ability to report cost‐effectiveness summaries that are robust.

MicroLink Devices has deposited Ag contacts via screen printing on n-GaAs epilayers on 150 mm GaAs wafers. We print either directly on n-GaAs or on an electron-beam evaporated seed layer. After annealing and self-aligned etch back, we achieve printed spaces of ~70 $\mu$m, contact resistances of

MicroLink Devices has developed two-terminal monolithic three-junction (3J) GaInP/GaAs/GaInAs epitaxial liftoff (ELO) solar cells with certified 37.75 ± 0.53% AM1.5G 1-Sun power conversion efficiency at 25°C. Additionally, MicroLink is developing two-terminal monolithic four-junction (4J) ELO solar cells based on GaInP/GaAs/GaInAs/GaInAs subcells with a peak preliminary AM0 1-Sun efficiency of 34.31%. All of these ELO solar cells were manufactured entirely with production tools and processes on reusable 150 mm diameter GaAs substrates.

The objective of this study was to review the literature for malignant melanoma, basal and squamous cell carcinomas to understand: (a) national estimates of the direct health system costs of skin cancer and (b) the cost-effectiveness of interventions for skin cancer prevention or early detection. A systematic review was performed using Medline, Cochrane Library and the National Health Service Economic Evaluation Databases as well as a manual search of reference lists to identify relevant studies up to 31 August 2013. A narrative synthesis approach was used to summarize the data. National cost estimates were adjusted for country-specific inflation and presented in 2013 euros. The CHEERS statement was used to assess the quality of the economic evaluation studies. Sixteen studies reporting national estimates of skin cancer costs and 11 cost-effectiveness studies on skin cancer prevention or early detection were identified. Relative to the size of their respective populations, the annual direct health system costs for skin cancer were highest for Australia, New Zealand, Sweden and Denmark (2013 euros). Skin cancer prevention initiatives are highly cost-effective and may also be cost-saving. Melanoma early detection programmes aimed at high-risk individuals may also be cost-effective; however, updated analyses are needed. There is a significant cost burden of skin cancer for many countries and health expenditure for this disease will grow as incidence increases. Public investment in skin cancer prevention and early detection programmes show strong potential for health and economic benefits.

Back-contact solar cells potentially achieve higher efficiency by moving all the electrical connections to the rear of the cell, thus eliminating shadow losses as well as enabling new array assembly approaches. In spite of the many advantages of this technology, as demonstrated in commercial manufacturing of silicon cells, the process complexity to create through wafer vias has limited its use in III-V solar cells. We present a simple, three-mask process flow for fabricating through-epitaxial via (TEV) back-contact multi-junction epitaxial liftoff (ELO) solar cells in this paper. Electrical characterization showed 3J cells with 25.9% efficiency (1 sun AM1.5 spectrum) without AR coating and similar performance to standard top-contact devices.

Empirically separating the phenomena of moral hazard and adverse selection in insurance markets has occupied researchers in this field for decades. Recently, the potential benefits of using survey data instead of claims data to control for the different dimensions of private information when testing for evidence of asymmetric information have been explored in the insurance literature. This article extends that approach to present two tests for ex ante moral hazard in a market for automobile insurance. In this article we specify (1) a recursive model and (2) an instrumental variables model to address endogeneity with respect to policy selection in cross-sectional road traffic crash (RTC) survey data. We report a statistically significant ex ante moral hazard effect with both models. This result is then subjected to a falsification test, whereby the analysis is repeated in subsamples of at-fault and not-at-fault RTCs. Our antitest produces no evidence of ex ante moral hazard in the sub-sample of not-at-fault RTCs, in which the true moral hazard may reasonably be assumed to be zero, thus supporting the interpretation of the results of our two models. Our extension of the existing literature via these two specifications may have useful analogs in other insurance markets for which survey data are available.

Objectives:The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers.Methods:We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers.Results:Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis.Conclusion:Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference.

Our objective was to estimate the cost of inpatient malnutrition conditional upon admitting diagnosis and recorded nutritional treatment. We analysed an anonymised administrative data set for inpatients treated in hospitals in Victoria, Australia 2003-2004. The data set included patient-level cost, clinical markers, demographic and episode variables. The data set was analysed to identify codes, which indicated the presence of malnutrition or its treatment. Linear regression was used to ascertain to what extent malnutrition affected the cost of admission. Controlling for the underlying condition and any treatment administered, recorded malnutrition is estimated to add AU $1,745 per admission. The total cost of coded malnutrition to the Victorian public hospital system in 2003-2004 was estimated to be least AU $10.7 million. Only 1.87% of inpatients were coded as malnourished. As administrative data are known to underreport the prevalence of malnutrition, our estimate represents a credible lower boundary on the true cost of inpatient malnutrition.

The medical record is a repository of clinical data, which can greatly enhance the quality of health and healthcare analysis. Administrative data are collected for the purpose of billing and reimbursement, and are valued by health researchers because the data are routinely audited to maintain accurate financial records. However, the quantity of incorporated clinical data can be variable. In this paper we reconstruct the medical record from health service invoices to estimate the cost of treating keratinocytic cancer (KC). The data from an epidemiological survey were linked to an administrative data set supplied by the national health insurer. A matched sampling technique with multivariable analysis was used to estimate cost. A KC treatment was identified with 42 service codes which explicitly nominated treatment of a KC. Algorithms identifying comorbities potentially correlated with KC were constructed from the service codes. The annual cost of a KC treatment was estimated to be AU$667 per individual. The average cost of explicit KC treatments was AU$231, while the cost of generic procedures used to treat KC was AU$436. Our ability to accurately control for the medical history enabled our analysis to quantify and describe the constituent costs of KC treatment. Electronic supplementary material The online version of this article (doi:10.1186/s13561-015-0042-x) contains supplementary material, which is available to authorized users.

Habitual gambling with electronic gaming machines can generate negative externalities. However, it is not the gambling process (wagers placed) but the outcome (revenue lost), which is a principal cause of these externalities. The specification of a quadratic externality function implies the existence of a corner solution, whereby actuarially fair electronic gaming machines that offer wagers at zero prices, could affect a reduction in the gambling externalities produced. In this paper we explore under what conditions might the introduction of actuarially fair electronic gaming machines reduce externalities associated with electronic gaming machines gambling.

This descriptive paper identifies some salient trends in the Australian management of osteoporosis. Changes in pharmaceutical consumption and medical utilisation are analysed. The total national consumption of four pharmaceuticals is estimated. From 2001 to 2011, the consumption of bisphosphonates and vitamin D increased. After 2006, the management rate for osteoporosis decreased.During the first decade of the millennia, the total cost of vitamin D tests has increased significantly within many health care jurisdictions worldwide. Australia reports a 100-fold increase. Legitimately, concerns regarding the economic effectiveness of this test exist. The purpose of this paper is to identify what other salient clinical trends could affect the efficacy of this test when treating osteoporosis.Longitudinal data from two Australian datasets are analysed. The first are data obtained from Medicare Australia, which report pharmaceutical consumption. The second are data obtained from a national survey of general practitioners.The management of osteoporosis has been characterised by a movement away from single to combination formularies. The consumption of calcium carbonate has declined, and the use of bisphosphonates has increased. While the gross consumption of risedronate increased steadily over the decade (8.4 to 186.5 kg), the consumption of alendronate declined after 2007. The consumption of vitamin D (over-the-counter and prescription) has increased from 0.58 to 2.8 kg over the decade. While prescription vitamin D comprised just 10% of the total, its consumption has undergone a 20-fold increase since 2006. Importantly, we can also report that the management of osteoporosis by Australia's general practitioners increased steadily until 2007-2008, before declining by 36%.Further research is required to determine possible casual relationships that may exist between these data. Until a formal economic evaluation of vitamin D testing in this clinical setting is completed, no conclusions regarding its economic effectiveness should be drawn.

The term "moral hazard" when interpreted literally has a strong rhetorical tone, which has been used by stakeholders to influence public attitudes to insurance. In contrast, economists have treated moral hazard as an idiom that has little, if anything, to do with morality. This article traces the genesis of moral hazard, by identifying salient changes in economic thought, which are identified within the medieval theological and probability literatures. The focus then shifts to compare and contrast the predominantly, normative conception of moral hazard found within the insurance-industry literature with the largely positive interpretations found within the economic literature. © The Journal of Risk and Insurance, 2012.

Objective To estimate the relative inpatient costs of hospital-acquired conditions. Methods Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset’ flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n 5 1,699,997) treated in Australian public hospitals in Victoria (2005/ 06) and Queensland (2006/07). Results The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

The consequences of spinal cord injury are profound and extend well beyond the immediate loss ofmobility and sensation. Employment is a well-recognised rehabilitation goal. In this study, we examine the impact of a publicly funded "package" of services that is designed to enable people with a spinal cord injury to return to the workplace. Specifically, this package of services provided client directed assistance for assisting the recipient with the activities of daily living (e.g., bathing, food preparation, etc.).Wecombine primary data collection methods well developed in other scientific disciplines, but less frequently utilised within economics, with traditional econometric techniques, to present a novel approach to this methodological issue. The Spinal Injuries Survey Instrument was developed and administered using amatched sampling approach. Collected data included, labour market outcomes, exposure to the packages, as well as clinical and demographic covariates commonly identified by the spinal cord injury literature. Concern for endogeneity was addressed by collecting data on several variables that might serve as suitable instruments for the econometric work and measures of otherwise-unobserved sources of heterogeneity. For example, a psychological measure of "attributional style was adapted from the field of psychology in order to control for a potentially confounding source of latent individual heterogeneity, viz. " motivation". While our results find zero marginal effect of support packages on labour market outcomes, we find that training undertaken post-injury and age are both positively correlated with labour market participation. © 2010 Elsevier B.V. All rights reserved.

Introduction Patient safety efforts are often recommended solely on judgments about the relative importance of particular adverse events in hospital care, without considering the frequency and costs of all hospital-acquired illness and injury. The objective of the study was to use patient-level cost data to estimate relative economic priorities for hospital inpatient safety efforts. Methods Patient level costs are estimated using computerized patient costing systems that initially log individual utilization of inpatient services, and then apply sophisticated cost estimates from the hospital's general ledger. The occurrence of a hospital-acquired diagnosis is identified using a new Australian 'condition-onset' flag for all diagnoses not present on admission. These diagnoses are grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions, using a recently-developed algorithm to summarize data coded with ICD-10-AM. Standard linear regression techniques are used to identify the independent contribution to inpatient costs of hospital- acquired conditions, taking into account the case mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results The most costly types of adverse events were post-procedure endocrine and metabolic disorders, adding $A 21,869 to the cost of an episode, followed by (methicillinresistant staphylococcus aureus) MRSA (+$A 19,892) and enterocolitis due to Clostridium difficile (+$A 19,745). Aggregate additional costs to the system were highest for septicaemia (+$A 41.5 mil), complications of cardiac and vascular implants other than septicaemia (+$A 28.7 mil), acute lower respiratory infections -- including influenza and pneumonia ($A 28.0 mil) -- and UTI (+$A 24.7 mil). Hospital acquired complications are estimated to add 17.1% to the costs of treatment in this sample. Conclusion Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harms. Adding an economic dimension to priority-setting could result in changes to the priorities of patient safety programs. It could also provide guidance as to other areas where research into causes and prevention strategies may prove a productive investment. Financial information should be combined with information on patient harms to allow for cost-utility evaluation of future programs.

Summary Objectives To undertake a cost–benefit analysis of ‘Stay on Your Feet’, a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program. Methods Cost–benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes. Results The total direct costs of the program were estimated at A$781 829. Both methods identified clear overall net benefits ranging from A$5.4 million for avoided hospitalizations alone to A$16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1. Conclusions These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

The incidence and cost of complications occurring in older and younger inpatients were compared.Secondary analysis of hospital-recorded diagnosis and costs for multiday-stay inpatients in 68 public hospitals in two Australian states.A complication is defined as a hospital-acquired diagnosis that required additional treatment. The Australian Classification of Hospital-Acquired Diagnoses system is used to identify these complications.Inpatients aged70 years have a 10.9% complication rate, which is not substantially different from the 10.89% complication rate found in patients aged70 years. Examination of the probability by single years, however, showed that the peak incidence associated with the neonatal period and childbirth is balanced by rates of up to 20% in patients80 years. Examining the adult patient population (40-70 years), we found that while some common complications are not age specific (electrolyte disorders and cardiac arrhythmias), others (urinary tract and lower respiratory tract infections) are more common in the older adult inpatient.For inpatients aged70 years, the risks of complications increase. The incidence of hospital-acquired diagnoses in older adults differs significantly from incidence rates found in younger cohorts. Urinary tract infection and alteration to mental state are more common in older adult inpatients. Surprisingly, these complexities do not result in additional costs when compared with costs for the same complications in younger adults. Greater awareness of these differing patterns will allow patient safety efforts for older patients to focus on complications with the highest incidence and cost.

This is a comprehensive, three-volume textbook of general opthalmology intended for residents and practicing physicians. Volume 1 is divided into three parts—"Anatomy," "Optics and Refraction," and "Anterior Segment Disease." Each chapter usually contains an introduction and sections on anatomy and physiology, techniques of examination, and various clinical entities with appropriate diagnostic and therapeutic interventions. This lends a uniformity to the book that one seldom encounters with multiple authorship. In general, the chapters are well written, contain excellent photographs, drawings, and tables, and are well referenced. There are more descriptions and illustrations of surgical techniques than can be found in most textbooks. Useful tables that are not easily available elsewhere abound. For example, tables on commonly used histologic stains and eponymic designation of the eyelid glands in the "Anatomy" chapter; a table on incidence of legal blindness and its cause in the low-vision portion of the "Optics and Refraction" chapter