ORCID Profile
0000-0002-7745-2545
Current Organisation
University of South Australia
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Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPHTH-2019-000278
Abstract: Glaucoma filtering schemes such as the Manchester Glaucoma Enhanced Referral Scheme (GERS) aim to reduce the number of false positive cases referred to Hospital Eye Services. Such schemes can also have wider system benefits, as they may reduce waiting times for other patients. However, previous studies of the cost consequences and wider system benefits of glaucoma filtering schemes are inconclusive. We investigate the cost consequences of the Manchester GERS. Observational study. A cost analysis from the perspective of the National Health Service (NHS) was conducted using audit data from the Manchester GERS. 2405 patients passed through the Manchester GERS from April 2013 to November 2016. 53.3% were not referred on to Manchester Royal Eye Hospital (MREH). Assuming an average of 2.3 outpatient visits to MREH were avoided for each filtered patient, the scheme saved the NHS approximately £2.76 per patient passing through the scheme. Our results indicate that glaucoma filtering schemes have the potential to reduce false positive referrals and costs to the NHS.
Publisher: Royal College of General Practitioners
Date: 08-10-2019
Abstract: There is widespread concern over the recruitment and retention of GPs in England. Income is a fundamental consideration affecting the attractiveness of working in general practice. To report on trends in average incomes earned by GPs in England, adjusted for inflation and contracted time commitment. Postal surveys of random s les of GPs working in England in 2008, 2010, 2012, 2015, and 2017. Trends in average reported incomes of partner and salaried GPs were directly standardised for the reported number of sessions worked per week and adjusted for inflation. Data were obtained from between 1000 and 1300 responders each year, representing response rates between 25% and 44%. Almost all responders (96%) reported the income they earned from their job as a GP. Mean nominal annual income decreased by 1.1% from £99 437 in 2008 to £98 373 in 2017 for partner GPs and increased by 4.4% from £49 061 to £51 208 for salaried GPs. Mean sessions worked decreased from 7.7 to 7.0 per week for partner GPs and decreased from 5.6 to 5.3 per week for salaried GPs. Mean income adjusted for sessions worked and inflation decreased by 10.0% for partner GPs and by 7.0% for salaried GPs, between 2008 and 2017. The decrease in GP income adjusted for sessions worked and inflation over the last decade may have contributed to the current problems with recruitment and retention.
Publisher: Royal College of General Practitioners
Date: 17-12-2019
Abstract: The Care Quality Commission regulates, inspects, and rates general practice providers in England. Inspections are costly and infrequent, and are supplemented by a system of routine quality indicators, measuring patient satisfaction and the management of chronic conditions. These indicators can be used to prioritise or target inspections. To determine whether this set of indicators can be used to predict the ratings awarded in subsequent inspections. This cross-sectional study was conducted using a dataset of 6860 general practice providers in England. The indicators and first-inspection ratings were used to build ordered logistic regression models to predict inspection outcomes on the four-level rating system (‘outstanding’, ‘good’, ‘requires improvement’, and ‘inadequate’) for domain ratings and the ‘overall’ rating. Predictive accuracy was assessed using the percentage of correct predictions and a measure of agreement (weighted κ ). The model correctly predicted 79.7% of the ‘overall’ practice ratings. However, 78.8% of all practices were rated ‘good’ on ‘overall’, and the weighted κ measure of agreement was very low (0.097) as such, predictions were little more than chance. This lack of predictive power was also found for each of the in idual domain ratings. The poor power of performance of these indicators to predict subsequent inspection ratings may call into question the validity and reliability of the indicators, inspection ratings, or both. A number of changes to the way data relating to performance indicators are collected and used are suggested to improve the predictive value of indicators. It is also recommended that assessments of predictive power be undertaken prospectively when sets of indicators are being designed and selected by regulators.
Publisher: Elsevier
Date: 2016
Publisher: American Scientific Publishers
Date: 12-2013
Publisher: Emerald
Date: 07-01-2021
DOI: 10.1108/JHOM-05-2020-0208
Abstract: Three types of payment methods have been introduced across European countries in attempts to encourage better, more integrated care of persons with multimorbidity: pay-for-performance pay-for-coordination and an all-inclusive payment method. We examine whether there are differences in the way these payment methods affect health and healthcare use in persons with multimorbidity. Using in idual-level survey data from twenty European countries, we examine unadjusted differences in average outcomes for the years 2011–2015 by whether countries adopted new payment methods for integrated care. We then test for a differential effect for multimorbid persons using linear, in idual random effects regressions, including country and time fixed effects and clustering standard errors at the country level. We find little effect of varying payment methods on key outcomes for multimorbid in iduals despite the theoretical predictions and the rhetoric in many policy documents. Policymakers should bear in mind that the success of the payment method relies on the specific design of the incentives and their implementation. New effective models of care and how to incentivise these for multimorbid patients is an ongoing research priority. This paper is the first to study the effects of payments for integration on the dimensions and populations these schemes intend to affect health and healthcare use at the in idual level for multimorbid in iduals.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.CHEMOSPHERE.2017.04.014
Abstract: In this study, an acidic biochar and a neutral biochar were applied at 5 wt% into two soils for an 11-month incubation experiment. One Ferrosol soil (Ba) was slightly acidic with low organic matter and the other Dermosol soil (Mt) was slightly alkaline with high organic matter. The acidic (pH = 3.25) wood shaving (WS) biochar had no marked impact on nutrient levels, cation exchange capacity (CEC), pH and acid neutralization capacity (ANC) of either soil. By contrast, the neutral (pH = 7.00) chicken litter (CL) biochar significantly increased major soluble nutrients, pH, ANC of soil Ba. In terms of C storage, 87.9% and 69.5% WS biochar-C can be sequestrated as TOC by soil Ba and Mt, respectively, whereas only 24.0% of CL biochar-C stored in soil Ba and negligible amount in Mt as TOC. Biochars did not have significant effects on soil sorption capacity and sorption reversibility except that CL biochar increased sorption of soil Ba by around 25.4% and decreased desorption by around 50.0%. Overall, the studied acidic C rich WS biochar held little agricultural or remedial values but was favourable for C sequestration. The neutral mineral rich CL biochar may provide short-term agricultural benefit and certain sorption capacities of lower sorption capacity soils, but may be unlikely to result in heightened C sequestration in soils. This is the first study comprehensively examining functions of acidic and neutral biochars for their benefits as a soil amendment and suggests the importance of pre-testing biochars for target purposes prior to their large scale production.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.SCITOTENV.2017.10.223
Abstract: Biochar (BC) is gaining attention as a soil amendment that can remediate metal polluted soils. The simultaneous effects of BC on copper (Cu) mobility, microbial activities in soil using metallophytes have scarcely been addressed. The objective of this study was to evaluate the effects of biochar BCs on Cu immobilization and over soil microbial communities in a Cu-contaminated soil evaluated over a two-year trial. A Cu-contaminated soil (338mgkg
Publisher: Springer Science and Business Media LLC
Date: 29-01-2016
Publisher: Springer Science and Business Media LLC
Date: 10-10-2019
DOI: 10.1007/S10653-019-00436-X
Abstract: Biochar (BC) is a porous, carbonaceous material produced by slow pyrolysis of biomass under oxygen-limited conditions. BC production has been attracting research interest because it modifies soil physicochemical characteristics and improves the growth of plants in problem soils. These benefits may be best actualized for soils contaminated by metals, where remediation is h ered by metal toxicity to both plants and soil microbial communities. The objectives of this study were to evaluate the impact of the addition of chicken manure biochar (CMB), oat hull biochar (OHB), or pine bark biochar (PBB) on copper (Cu) bioavailability in a Cu-contaminated soil, the effectiveness of these BCs promoting plant growth, and its effects on soil microbial communities supporting these plants. A sandy soil (338 mg Cu kg
Publisher: Elsevier
Date: 2016
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.CHEMOSPHERE.2015.04.086
Abstract: Ammonia (NH3) volatilization is a major nitrogen (N) loss from the soil, especially under tropical conditions, NH3 volatilization results in low N use efficiency by crops. Incubation experiments were conducted using five soils (pH 5.5-9.0), three N sources such as, urea, di-ammonium phosphate (DAP), and poultry manure (PM) and two biochars such as, poultry litter biochar (PL-BC) and macadamia nut shell biochar (MS-BC). Ammonia volatilization was higher at soil with higher pH (pH exceeding 8) due to the increased hydroxyl ions. Among the N sources, urea recorded the highest NH3 volatilization (151.6 mg kg(-1)soil) followed by PM (124.2 mg kg(-1)soil) and DAP (99 mg kg(-1)soil). Ammonia volatilization was reduced by approximately 70% with PL-BC and MS-BC. The decreased NH3 volatilization with biochars is attributed to multiple mechanisms such as NH3 adsorption/immobilization, and nitrification. Moreover, biochar increased wheat dry weight and N uptake as high as by 24.24% and 76.11%, respectively. This study unravels the immense potential of biochar in decreasing N volatilization from soils and simultaneously improving use efficiency by wheat.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2020
DOI: 10.1186/S12889-020-08596-7
Abstract: Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa’s largest Unconditional Cash Transfer (UCT) programme, on mental health. We use biennial data on 10,925 in iduals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme’s eligibility criteria to estimate instrumental variable Fixed Effects models. We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0–30 scale), 4.1% of the s le mean. Our findings show that UCT programmes have strong mental health benefits for the poor adult population.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2019
DOI: 10.1186/S13063-019-3710-Z
Abstract: Recruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to ‘map’ the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials and to identify key research topics for the future. The scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives. The issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system who the incentive should be directed towards what the incentive should be linked to the form of incentive the incentive size the structure of the incentive system the timing and frequency of incentive payouts and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base. Our findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.
Publisher: Springer Science and Business Media LLC
Date: 06-08-2015
Publisher: Springer Science and Business Media LLC
Date: 06-10-2015
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-042236
Abstract: The UK faces major problems in retaining general practitioners (GPs). Scotland introduced a new GP contract in April 2018, intended to better support GPs. This study compares the career intentions and working lives of GPs in Scotland with GPs in England, shortly after the new Scotland contract was introduced. Comparison of cross-sectional analysis of survey responses of GPs in England and Scotland in 2017 and 2018, respectively, using linear regression to adjust the differences for gender, age, ethnicity, urbanicity and deprivation. 2048 GPs in Scotland and 879 GPs in England. Four intentions to reduce work participation (5-point scales: 1=‘none’, 5=‘high’): reducing working hours leaving medical work entirely leaving direct patient care or continuing medical work but outside the UK. Four domains of working life: job satisfaction (7-point scale: 1=‘extremely dissatisfied’, 7=‘extremely satisfied’) job stressors (5-point-scale: 1=‘no pressure’, 5=‘high pressure) positive and negative job attributes (5-point scales: 1=‘strongly disagree’, 5=‘strongly agree’). Compared with England, GPs in Scotland had lower intention to reduce work participation, including a lower likelihood of reducing work hours (2.78 vs 3.54 adjusted difference=−0.52 95% CI −0.64 to −0.41), a lower likelihood of leaving medical work entirely (2.11 vs 2.76 adjusted difference=−0.32 95% CI −0.42 to −0.22), a lower likelihood of leaving direct patient care (2.23 vs 2.93 adjusted difference=−0.37 95% CI −0.47 to −0.27), and a lower likelihood of continuing medical work but outside of the UK (1.41 vs 1.61 adjusted difference=−0.2 95% CI −0.28 to −0.12). GPs in Scotland reported higher job satisfaction, lower job stressors, similar positive job attributes and lower negative job attributes. Following the introduction of the new contract in Scotland, GPs in Scotland reported significantly better working lives and lower intention to reduce work participation than England.
Publisher: Springer Science and Business Media LLC
Date: 18-03-2020
DOI: 10.1186/S12955-020-01323-1
Abstract: The Short Form Survey 12-item (SF12) mental and physical health version has been applied in several studies on populations from Sub-Saharan Africa. However, the SF12 has not been computed and validated for these populations. We address in this paper these gaps in the literature and use a health intervention ex le in Malawi to show the importance of our analysis for health policy. We firstly compute the weights of the SF12 physical and mental health measure for the Malawian population using principal component analysis on a s le of 2838 adults from wave four (2006) of Malawian Longitudinal Study of Aging (MLSFH). We secondly test the construct validity of our computed and the US-population weighted SF12 measures using regression analysis and Fixed Effect estimation on waves four, seven (2012) and eight (2013) of the MLSFH. Finally, we use a Malawian cash transfer programme to exemplify the implications of using US- and Malawi-weighted SF12 mental health measures in policy evaluation. We find that the Malawian SF12 health measure weighted by our computed Malawian population weights is strongly associated with other mental health measures ( Depression:-0.501, p = 0.001 Anxiety:-1.755 p = 0.001 ) and shows better construct validity in comparison to the US-weighted SF12 mental health component ( rs = 0.675 versus rs = 0.495 ). None of the SF12 measures shows strong associations with other measures of physical health. The estimated average effect of the cash transfer is significant when using the Malawi-weighted SF12 mental health measure ( treatment effect: 1.124 p = 0.1 ), but not when using the US-weighted counterpart ( treatment effect: 1.129 p 0.1 ). The weightings affect the size of the impacts across mental health quantiles suggesting that the weighting scheme matters for empirical health policy analysis. Mental health shows more pronounced associations with the physical health dimension in a Low-Income Country like Malawi compared to the US. This is important for the construct validity of the SF12 health measures and has strong implications in health policy analysis. Further analysis is required for the physical health dimension of the SF12.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.BIORTECH.2014.02.123
Abstract: Several maturity indices were evaluated for in-vessel co-composting of chicken manure and pine sawdust with three different biochars. All the seven mixtures (piles) contained chicken manure and sawdust. Six of these piles contained biochar each biochar was added at two rates, 5% and 10% wet weight. The maturity of composts was assessed by C/N, dissolved organic carbon (DOC), seed germination, NO3(-)-N/NH4(+)-N, and the Solvita test. The C/N values of finished composts were from 31.5 to 35.7, which were much higher than the optimum value of 21 for matured compost. Nevertheless, the rest of the parameters indicated that the composts were matured. The C/N values were high because of the high amount of recalcitrant carbon present in the feedstocks: biochar and sawdust. Biochar treated piles showed higher respiration as well as decomposition of DOC indicating higher microbial activity. Use of biochar in composting may reduce NH3 emission and nitrate leaching.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.CHEMOSPHERE.2015.05.065
Abstract: Two experiments were conducted where three biochars, made from macadamia nutshell (MS), hardwood shaving (WS) and chicken litter (CL), were co-composted with chicken manure and sawdust, and also incubated with a chicken litter based commercial compost. Biochars were added at the rates of 5% and 10% in the co-composting and 10% and 20% in the incubation experiment. The rates of biochar had no consistent effect on the change in element contents of composted- or incubated-biochars. The biochar C demonstrated recalcitrance in both composting and incubation systems. Composting increased the CEC of biochars probably due to thermophilic oxidation. The increases in CEC of WS and CL were 6.5 and 2.2 times, respectively, for composting. Translocation of elements, between biochar and compost medium, occurred in both directions. In most cases, biochars gained elements under the influence of positive difference of concentrations (i.e., when compost medium had higher concentration of elements than biochar), while in some cases they lost elements despite a positive difference. Biochar lost some elements (WS: B CL: B, Mg and S) under the influence of negative difference of concentrations. Some biochars showed strong affinity for B, C, N and S: the concentration of these elements gained by biochars surpassed the concentration in the respective composting medium. The material difference in the biochars did not have influence on N retention: all three netbag-biochars increased their N content. The cost of production of biochar-compost will be lower in co-composting than incubation, which involves two separate processes, i.e., composting and subsequent incubation.
No related grants have been discovered for Naser Khan.