R&G Associates

In this paper, we examine the potential economic impact of coal mine and power station closures on the Gippsland region in Victoria, Australia. We evaluate this economic impact using time-series analysis focusing on Gross Regional Production (GRP), Value-added, and employment statistics. As the first step, we investigate the long-run nexus between the coal mine sector and these regional economic parameters using the Autoregressive Distributed Lag (ARDL) approach. After confirming the cointegration properties among the variables, we then employ an Autoregressive Integrated Moving Average with Explanatory Variable (ARIMAX) method to forecast the long-term economic impacts. The findings confirmed the existence of cointegration between the mining sector and GRP, Value-added, and employment in the Gippsland region. The Toda Yamamoto causality test, employed to establish robust causal links, revealed noteworthy results, including a unidirectional causality running from Mining sector to GRP, which supports the ARIMAX model for accurate economic forecasting. The subsequent ARIMAX projections indicate that if no comprehensive plan is developed to compensate for lost value-add, the Gippsland economy will face a potential deficit of approximately AUD 4.5 billion by 2050. This loss necessitates that the region generates an annual investment of between eighty million to $100 million in current value to maintain economic stability. The results highlight the urgent need for the State and local government, along with regional industry and stakeholders, to develop a comprehensive plan to address and minimize the adverse economic impact of the mining and power station closures.

The death of a loved one is one of life's most ubiquitous events that can increase risk of mental health difficulties. Bereavement support is one of the few factors influencing grief-related mental health outcomes that can be modified after bereavement. This study sought to determine the proportion of bereaved people that want and receive support from different sources following a bereavement, and the bereavement and mental health-related factors associated with wanting and receiving bereavement support. Data was derived from a cross-sectional survey of bereaved adults (n = 1170) living in Ontario, Canada. Over a third of the sample (38.9%; n = 455) reported wanting support in coping with their loss. These individuals exhibited distinct loss-related characteristics and reported higher levels of anxiety, depression, and prolonged grief symptoms. Most of these individuals received support and a small number of participants who didn't want support received it regardless. The most common sources of support were family members, friends, and other bereaved individuals, and these sources were generally found to be helpful. Those who accessed multiple types of support were those with the highest levels of anxiety, depression, and prolonged grief symptoms. Most individuals wanting support after a loss can access it and find it beneficial. The desire for support is closely tied to psychological distress, highlighting the need to prioritize formal support for those in distress and rely on existing social networks for those who are not. Such an approach embodies an 'assets-based' bereavement model, enhancing community capacity for effective support provision.

IntroductionPainful diabetic peripheral neuropathy (pDPN) affects approximately 25% of individuals with diabetes in the UK and remains underdiagnosed and suboptimally managed in primary care. The condition causes chronic pain, limits daily functioning, impairs quality of life, and increases the risk of complications like foot ulcers and amputations due to underlying neuropathy. Current care pathways are fragmented, leading to delays in diagnosis and limited access to evidence-based therapies. This article aims to address the challenges of screening, diagnosis, and management of pDPN in UK primary care by proposing a consensus-driven, five-step pragmatic strategy.MethodsAn expert panel of general practitioners and a diabetes nurse practitioner from across the UK convened to review and discuss strategies for improving pDPN care. Consensus was reached through an evaluation of barriers in clinical practice, supported by real-world experience and examples of innovative care delivery models, resulting in the development of practical recommendations and workflow.ResultsKey barriers identified include insufficient training of healthcare professionals in pDPN, underutilisation of validated screening tools such as the DN4 questionnaire, and inconsistent and outdated treatment guidelines. To address these challenges, a five-step approach was proposed to include screening high-risk patients using validated questionnaires, following up on these patients to enable early diagnoses, initiating early treatments with first-line therapies while monitoring responses, referring complex cases to secondary care on the basis of structured criteria, and ensuring coordinated follow-up to streamline and optimise care delivery. Case studies demonstrate the practical application of these strategies in improving early detection, treatment adherence, and long-term care for individuals with pDPN.ConclusionCurrent practices have fallen short in providing adequate care for one in four individuals with diabetes. Implementing a straightforward five-step approach can significantly improve diagnostic accuracy and treatment outcomes, reducing the burden of pDPN on both patients and society.

We investigated the host range of Cassytha filiformis L. in the heath forests using six 50-metre transects. Sixteen shrubs and tree species were infected by C. filiformis vines, including two exotic Acacia species. This paper also examined the density and vigour of C. filiformis when infecting the two most preferred and common hosts, the heath native Dillenia suffruticosa (Griff. ex Hook. f. and Thomson) Martelli, and the invasive Acacia mangium Willd. The results suggested that C. filiformis has higher vigour when infecting native hosts than in exotic A. mangium albeit being not statistically significant. The long thread-like stems of parasite were present at relatively high density when infecting A. mangium, regardless of the host conditions. We also assessed the functionality of the haustoria on both D. suffruticosa and A. mangium using histological methods. It was found that C. filiformis can establish a true haustorial endophytic connection with studied hosts. Under controlled conditions, C. filiformis pose as a possible candidate for a biological control agent of A. mangium to curtail the fast spreading of this introduced species in tropical Borneo.

A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowing or preventing the onset of long-term cardiovascular, renal and metabolic (CVRM) complications, making their use highly applicable for organ protection and the maintenance of long-term health outcomes. SGLT2is have shown cost-effectiveness in T2DM management and economic savings over other glucose-lowering therapies due to reduced incidence of cardiovascular and renal events. National and international guidelines advocate SGLT2i use early in the T2DM management pathway, based upon a plethora of supporting data from large-scale cardiovascular outcome trials, renal outcomes trials and real-world studies. While most people with T2DM would benefit from CVRM protection through SGLT2i use, prescribing hesitancy remains, potentially due to confusion concerning their place in the complex therapeutic paradigm, variation in licensed indications or safety perceptions/misunderstandings associated with historical data that have since been superseded by robust clinical evidence and long-term pharmacovigilance reporting. This latest narrative review developed by the Improving Diabetes Steering Committee (IDSC) outlines the place of SGLT2is within current evidence-informed guidelines, examines their potential as the standard of care for the majority of newly diagnosed people with T2DM and sets into context the perceived risks and proven advantages of SGLT2is in terms of sustained health outcomes. The authors discuss the cost-effectiveness case for SGLT2is and provide user-friendly tools to support healthcare professionals in the correct application of these medicines in T2DM management. The previously published IDSC SGLT2i Prescribing Tool for T2DM Management has undergone updates and reformatting and is now available as a Decision Tool in an interactive pdf format as well as an abbreviated printable A4 poster/wall chart.

Magnetic resonance imaging-based technologies are non-invasive diagnostic tests that can be used to assess non-alcoholic fatty liver disease. The study objectives were to assess the diagnostic test accuracy, clinical impact and cost-effectiveness of two magnetic resonance imaging-based technologies (LiverMultiScan and magnetic resonance elastography) for patients with non-alcoholic fatty liver disease for whom advanced fibrosis or cirrhosis had not been diagnosed and who had indeterminate results from fibrosis testing, or for whom transient elastography or acoustic radiation force impulse was unsuitable, or who had discordant results from fibrosis testing. The data sources searched were MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Database of Controlled Trials, Database of Abstracts of Reviews of Effects and the Health Technology Assessment. A systematic review was conducted using established methods. Diagnostic test accuracy estimates were calculated using bivariate models and a summary receiver operating characteristic curve was calculated using a hierarchical model. A simple decision-tree model was developed to generate cost-effectiveness results. The diagnostic test accuracy review (13 studies) and the clinical impact review (11 studies) only included one study that provided evidence for patients who had indeterminate or discordant results from fibrosis testing. No studies of patients for whom transient elastography or acoustic radiation force impulse were unsuitable were identified. Depending on fibrosis level, relevant published LiverMultiScan diagnostic test accuracy results ranged from 50% to 88% (sensitivity) and from 42% to 75% (specificity). No magnetic resonance elastography diagnostic test accuracy data were available for the specific population of interest. Results from the clinical impact review suggested that acceptability of LiverMultiScan was generally positive. To explore how the decision to proceed to biopsy is influenced by magnetic resonance imaging-based technologies, the External Assessment Group presented cost-effectiveness analyses for LiverMultiScan plus biopsy versus biopsy only. Base-case incremental cost-effectiveness ratio per quality-adjusted life year gained results for seven of the eight diagnostic test strategies considered showed that LiverMultiScan plus biopsy was dominated by biopsy only; for the remaining strategy (Brunt grade ≥2), the incremental cost-effectiveness ratio per quality-adjusted life year gained was £1,266,511. Results from threshold and scenario analyses demonstrated that External Assessment Group base-case results were robust to plausible variations in the magnitude of key parameters. Diagnostic test accuracy, clinical impact and cost-effectiveness data for magnetic resonance imaging-based technologies for the population that is the focus of this assessment were limited. Magnetic resonance imaging-based technologies may be useful to identify patients who may benefit from additional testing in the form of liver biopsy and those for whom this additional testing may not be necessary. However, there is a paucity of diagnostic test accuracy and clinical impact data for patients who have indeterminate results from fibrosis testing, for whom transient elastography or acoustic radiation force impulse are unsuitable or who had discordant results from fibrosis testing. Given the External Assessment Group cost-effectiveness analyses assumptions, the use of LiverMultiScan and magnetic resonance elastography for assessing non-alcoholic fatty liver disease for patients with inconclusive results from previous fibrosis testing is unlikely to be a cost-effective use of National Health Service resources compared with liver biopsy only. This study is registered as PROSPERO CRD42021286891. Funding for this study was provided by the Evidence Synthesis Programme of the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 10. See the NIHR Journals Library website for further project information.