ObjectivesTo assess changes in quality of life and costs of patients undergoing primary total hip replacement using the Exeter prosthesis compared with a hypothetical ‘no surgery’ group.DesignThe incremental quality of life, quality-adjusted life years (QALYs) and cost of Exeter Primary Outcomes Study patients was compared with hypothetical ‘no surgery’ group over 5 years. Scores from annual SF-36 assessments were converted into utility scores using an established algorithm and the QALY gains calculated from pre-operative baseline scores. Costs included implant costs and length of stay.SettingSecondary care hospitals.ParticipantsPatients receiving a primary Exeter implant enrolled in five of seven Exeter Primary Outcomes Study centres.ResultsOn average, patients gained around 0.8 QALYs over 5 years. Younger and male patients or those with lower body mass index and poorer Oxford Hip Scores were significantly associated with increased QALYs. Treatment costs for a primary episode of care were just over £5000 (95% CI £4588 to £5812) per patient. Compared with ‘no surgery’, the cost per QALY was £7182 (95% CI £6470 to £7678), and this remained stable when key cost parameters were varied. The most likely cost per QALY was between £7058 and £7220. Older patients (age 75+) cost more, mainly due to longer average hospital stays and had a higher cost per QALY, although this remained below £10 000.Conclusions85% of cases had a cost of <£20 000 per QALY (with 70% having a cost per QALY under £10 000) compared with no surgery. Cases would be considered cost-effective under currently accepted thresholds (£25 000–£30 000) compared with ‘no surgery’. However, depending on age and severity, younger patients and more severe patients had below average cost per QALYs. These results help to confirm the long-term benefits and cost-effectiveness of total hip replacement in a wide variety of patients using well-established implant models such as the Exeter. However, further and ongoing economic appraisal of this and other models is required for comparative purposes.
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The indigenous Sámi languages of the Nordic countries and North-West Russia have gained official recognition after a long period of neglect and assimilation policies. In the context of positive changes in state or macro level indigenous policy and especially that regarding language policy, this paper investigates what subsequently happens at the grassroots or micro level. This investigation shows that despite more positive policies, there is a strong sentiment of defeatism with regard to Sámi. Sámi speakers face problems because of the lack of implementation of nationally decided laws at the local level, they encounter prejudice and neglect from other people, even in their families, and as a result they often experience difficulty in transmitting Sámi to their children. Nevertheless, they also express belief in Sámi and feel a need for this transmission, not only for affective reasons and for the sake of cultural maintenance, but also for instrumental reasons, i.e. to give their children better opportunities in the labor market where knowledge of Sámi is necessary.
The problem of integrating multiple overlapping models and data is pervasive in engineering, though often implicit. We consider this issue of model management in the context of the electrical power grid as it transitions towards a modern 'Smart Grid.' We present a methodology for specifying, managing, and reasoning within multiple models of distributed energy resources (DERs), entities which produce, consume, or store power, using categorical databases and symmetric monoidal categories. Considering the problem of distributing power on the grid in the presence of DERs, we show how to connect a generic problem specification with implementation-specific numerical solvers using the paradigm of categorical databases.
Whilst recent studies have provided pivotal insights into the relationship between Bretons and the principle languages of Brittany, Breton and French, this paper aims to shed light on the relationship between Brittany’s northern French near language (Oïl) variety, Gallo, and the identity of the inhabitants of the territory with which it is historically associated, Upper-Brittany. This is done through questionnaires of both a quantitative and qualitative nature and follow-up interviews with school pupils of Gallo and their parents in 2003 and 2004. Results suggest that although Gallo has been historically subject to a highly negative linguistic culture in both the French and Breton language contexts, for many respondents Gallo is perceived as continuing to play a role in their identity. This role, whilst it is restricted to the Upper-Breton region, tradition, the countryside and the family is of a positive nature for many respondents, but particularly for the younger generation. However, this identity role does not necessarily require it to be spoken and Gallo, which has up to recent years been socially marginalised in favour of Breton and French, may find a place for itself in Brittany’s identity consciousness as an ‘associated language’ to Upper-Breton identity.
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