How cost-effective is the Family Nurse Partnership?

Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration: ISRCTN23019866 (20/04/2009)

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Rumen Sampling Methods Bias Bacterial Communities Observed

10.1101/2021.09.22.461352 ◽

2021 ◽

Author(s):

Jill V. Hagey ◽

Maia Laabs ◽

Elizabeth A. Maga ◽

Edward J. DePeters

Keyword(s):

Relative Abundance ◽

Critical Role ◽

Cost Effective ◽

Feed Additives ◽

Rrna Gene ◽

Stomach Tube ◽

Fecal Samples ◽

Rumen Microbes ◽

Lower Abundance ◽

The Family

AbstractThe rumen is a complex ecosystem that plays a critical role in our efforts to improve feed efficiency of cattle and reduce their environmental impacts. Sequencing of the 16S rRNA gene provides a powerful tool to survey shifts in the microbial community in response to feed additives and dietary changes. Oral stomach tubing a cow for a rumen sample is a rapid, cost-effective alternative to rumen cannulation for acquiring rumen samples. In this study, we determined how sampling method, as well as type of sample collected (liquid vs solid), bias the microbial populations observed. The abundance of major archaeal populations was not different at the family level in samples acquired via rumen cannula or stomach tube. Liquid samples were enriched for the order WCHB1-41 (phylum Kiritimatiellaeota) as well as the family Prevotellaceae and had significantly lower abundance of Lachnospiraceae compared with grab samples from the rumen cannula. Solid samples most closely resembled the grab samples; therefore, inclusion of particulate matter is important for an accurate representation of the rumen microbes. Stomach tube samples were the most variable and were most representative of the liquid phase. In comparison with a grab sample, stomach tube samples had significantly lower abundance of Lachnospiraceae, Fibrobacter and Treponema. Fecal samples did not reflect the community composition of the rumen, as fecal samples had significantly higher relative abundance of Ruminococcaceae and significantly lower relative abundance of Lachnospiraceae compared with samples from the rumen.

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Evaluating the real-world implementation of the Family Nurse Partnership in England: protocol for a data linkage study

BMJ Open ◽

10.1136/bmjopen-2020-038530 ◽

2020 ◽

Vol 10 (5) ◽

pp. e038530

Author(s):

Francesca L Cavallaro ◽

Ruth Gilbert ◽

Linda Wijlaars ◽

Eilis Kennedy ◽

Ailsa Swarbrick ◽

...

Keyword(s):

Real World ◽

Home Visiting ◽

Data Linkage ◽

Hospital Admissions ◽

Maternal Characteristics ◽

The Real ◽

Wide Range ◽

The Family ◽

Children In Care ◽

Family Nurse Partnership

IntroductionAlmost 20 000 babies are born to teenage mothers each year in England, with poorer outcomes for mothers and babies than among older mothers. A nurse home visitation programme in the USA was found to improve a wide range of outcomes for young mothers and their children. However, a randomised controlled trial in England found no effect on short-term primary outcomes, although cognitive development up to age 2 showed improvement. Our study will use linked routinely collected health, education and social care data to evaluate the real-world effects of the Family Nurse Partnership (FNP) on child outcomes up to age 7, with a focus on identifying whether the FNP works better for particular groups of families, thereby informing programme targeting and resource allocation.Methods and analysisWe will construct a retrospective cohort of all women aged 13–24 years giving birth in English NHS hospitals between 2010 and 2017, linking information on mothers and children from FNP programme data, Hospital Episodes Statistics and the National Pupil Database. To assess the effectiveness of FNP, we will compare outcomes for eligible mothers ever and never enrolled in FNP, and their children, using two analysis strategies to adjust for measured confounding: propensity score matching and analyses adjusting for maternal characteristics up to enrolment/28 weeks gestation. Outcomes of interest include early childhood development, childhood unplanned hospital admissions for injury or maltreatment-related diagnoses and children in care. Subgroup analyses will determine whether the effect of FNP varied according to maternal characteristics (eg, age and education).Ethics and disseminationThe Nottingham Research Ethics Committee approved this study. Mothers participating in FNP were supportive of our planned research. Results will inform policy-makers for targeting home visiting programmes. Methodological findings on the accuracy and reliability of cross-sectoral data linkage will be of interest to researchers.

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A Trial of Family Therapy v. a Relatives Group for Schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.154.1.58 ◽

1989 ◽

Vol 154 (1) ◽

pp. 58-66 ◽

Cited By ~ 169

Author(s):

Julian Leff ◽

Ruth Berkowitz ◽

Naomi Shavit ◽

Angus Strachan ◽

Ilana Glass ◽

...

Keyword(s):

Family Therapy ◽

Relapse Rate ◽

Expressed Emotion ◽

Cost Effective ◽

Or Education ◽

Face To Face ◽

Social Interventions ◽

The Family ◽

Schizophrenic Patients ◽

Therapy Sessions

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

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Data Placement and Query for Cloud Computing Based on MyHeawood Network

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.543-547.3100 ◽

2014 ◽

Vol 543-547 ◽

pp. 3100-3104

Author(s):

Xin Huang ◽

Yu Xing Peng ◽

Peng Fei You

Keyword(s):

Cloud Computing ◽

Interconnection Network ◽

Cost Effective ◽

Data Placement ◽

Cloud Services ◽

Massive Data ◽

Massive Datasets ◽

The Family ◽

The Cost ◽

Hashing Algorithm

The massive data in Data centers network will be frequently accessed massive datasets for cloud services, which will lead to some new requirements and becomes an important issue for interconnection topology and data management in cloud computing. According to the cost-effective, the paper proposes a new interconnection network MyHeawood for cloud computing. MyHeawood is constructed by small switches and servers with dual-port NIC according to recursive method. The data placement strategy in MyHeawood is a hashing algorithm based on the family of hash functions. MyHeawood uses three replicas strategy base on master copy, which is allocated in different sub layer to improve the reliability of data.

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Technology And Its Role In Supporting Tuberculosis Treatment Adherence

10.1101/2021.12.22.21268290 ◽

2021 ◽

Author(s):

Era Dorihi Kale ◽

Moses Pandin

Keyword(s):

Treatment Adherence ◽

Economic Condition ◽

Cost Effective ◽

Adherence Rate ◽

Remote Areas ◽

Tb Treatment ◽

Use Of Technology ◽

The Family ◽

Mdr Tb ◽

Selection Of

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application. Keywords: Technology, Adherence, Tuberculosis

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Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment

International Journal for Population Data Science ◽

10.23889/ijpds.v5i1.1154 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Fiona V Lugg-Widger ◽

Michael Robling ◽

Mandy Lau ◽

Shantini Paranjothy ◽

Jill Pell ◽

...

Keyword(s):

Home Visiting ◽

Natural Experiment ◽

Routine Data ◽

Young Mothers ◽

Data Systems ◽

Multilevel Regression ◽

Eligibility Criteria ◽

Prenatal Health ◽

The Family ◽

Family Nurse Partnership

Introduction: Individual, social and economic circumstances faced by young mothers can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which aims to improve prenatal health behaviours, birth outcomes, child development and health outcomes, and maternal life course. Establishing evidence of effectiveness beyond the original US setting is important to understand where further adaptation is required within a country specific context. Objective: This study will form one strand of the Scottish Governments’ plan to evaluate the effectiveness of FNP as compared to usual care for mothers and their children in Scotland and will focus only on outcomes that can be identified using routine administrative data systems. Methods: This study is a natural experiment with a case-cohort design using linked anonymised routine health, educational and social care data. Cases will be women enrolled as FNP Clients in ten NHS Health Boards in Scotland and Controls will be women who met FNP eligibility criteria but were pregnant at a time when the programme was not recruiting. Outcomes are mapped to the Scottish FNP logic model. All comparative analyses will be pre-specified, conducted on an intention to treat basis and will use multilevel regression models to compare outcomes between groups. Discussion: The study protocol is based upon the specification of FNP commissioned by the Scottish Government. This study design is novel for the evaluation of the FNP/NFP programmes which are primarily evaluated with an RCT. Outcomes included within the study have been selected on the basis that they are outcomes FNP aims to influence and where there is routine data available to assess the outcome.

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A cost-effective robotic solution for the cleaning of ships' hulls

Robotica ◽

10.1017/s0263574709005797 ◽

2009 ◽

Vol 28 (3) ◽

pp. 453-464 ◽

Cited By ~ 25

Author(s):

A. Iborra ◽

J. A. Pastor ◽

D. Alonso ◽

B. Alvarez ◽

F. J. Ortiz ◽

...

Keyword(s):

High Pressure ◽

Mechanical Design ◽

Cost Effective ◽

Control Architecture ◽

Global System ◽

Operative Results ◽

Standard Practice ◽

Ultra High Pressure ◽

The Family ◽

Pressure Water

SUMMARYHull cleaning before repainting is a key operation in the maintenance of ships. For more than a decade, a means to improve this operation has been sought through robotization and the use of different techniques such as grit blasting and ultra high pressure water jetting. Despite this, it continues to be standard practice in shipyards that this process is carried out manually. This paper presents a family of robots that aims to offer important improvements to the process as well as satisfying, to a great extent, all the operative requirements of efficiency, security, and respect for the environment that shipyards nowadays demand. It is described the family of devices with emphasis on the mechanical design. This set consists of two vertical robotic towers and a robot climber. In addition, it is shown the control architecture of the global system. Finally, operative results are presented together with a comparison between the performance achieved in shipyards through the use of these robots and those obtained with a manual process.

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