Jinhu Li

We study the impact of school disruptions on children's developmental outcomes, exploiting Covid-19-induced school closures as an exogenous shock to early childhood education. Using population-wide Australian school census data on children in their first year of formal schooling and a difference-indifferences (DID) design, we find that school disruptions negatively affect developmental outcomes. We further examine the role of parental input using a difference-indifference in differences (DDD) framework. We find that the adverse effects of school closures are larger for children from low-resource families, widening developmental inequalities across socioeconomic groups. To explore underlying mechanisms, we investigate parents' behavioural and mental health responses to school closures. Parents in areas with more intensive school closures spent more time with their children, suggesting that parental input partly substitutes for school-based learning. However, they were less likely to engage in high-return educational activities. While low-resource parents increased time investments more than high-resource parents, they remained substantially less likely to undertake high-return educational activities. Our findings highlight the limits of parental input as a substitute for formal schooling and suggest that policies supporting effective home-based learning may be more effective than income support alone in mitigating the adverse effects of future school disruptions.

Objective: To establish a dataset of the speech pathology workforce in the Australian Capital Territory, addressing gaps in workforce data caused by the absence of National Registration and Accreditation Scheme regulation. Methods: A 21-question online survey was adapted and distributed by subject matter and health workforce experts, based on existing workforce survey data for National Registration and Accreditation Scheme regulated allied health professionals, and previous allied health and speech pathology workforce surveys in other Australian health jurisdictions. Descriptive statistics and regression analysis were performed to examine the relationship between demographic and employment characteristics. Results: The survey revealed an emerging speech pathology workforce requiring structured supervision and support, that is inequitably distributed across the Australia Capital Territory. The collected demographic and basic employment characteristics of speech pathologists in the Australian Capital Territory were largely consistent with 2021 Census data and Speech Pathology Australia estimates. The survey provided greater granularity of speech pathology workforce data that aligns more closely with datasets used for other AH professions under the National Registration and Accreditation Scheme. Conclusions: This research has established a purpose-built dataset of the speech pathology workforce in the Australian Capital Territory. The granularity of this data can better inform workforce planning for speech pathology and other allied health professions not covered by the National Registration and Accreditation Scheme. A public online register based on this framework for speech pathologists and allied health professions would enhance the understanding of critical workforce dynamics over time and allow more robust planning of the allied health workforce.

With aid agencies' support, Sub-Saharan African governments have prioritized improving access to post-primary education after the widespread adoption of free primary education. However, there needs to be more evidence on the impacts of such post-primary education expansion policies. We evaluate the long-term effects of Uganda's Universal Secondary Education (USE) expansion policy on women's educational achievements and empowerment. This USE policy, introduced in 2007, aims to improve access to secondary school education through the abolition of fees and increased school capacity at the community level. We exploit both birth cohort variation and regional variations in the exposure to the program and employ a difference-in-differences model to identify the causal effects of the policy. Our results indicate that women eligible for the program in areas with higher program intensity experienced a significant increase in educational attainment and improvement in women's empowerment. The effect on women's empowerment is most pronounced in the domain of human and social assets (precisely age at first sex, birth, cohabitation, and spouse schooling attainment difference) and less significant in gendered beliefs and attitudes. We further explore the potential channels underlying these effects and find that the USE program had a significant impact on women’s labour market outcomes and access to information. These findings establish the potential for governments in SSA to leverage secondary education investments in generating sustained improvement in women’s empowerment.

Objective This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services. Methods A DCE with 160 choice sets of two quality-of-life state–survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation. Results In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range − 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states. Conclusion The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation.

PDZ-binding kinase (PBK) encodes a serine/threonine protein kinase related to the dual specific mitogen-activated protein kinase kinase (MAPKK) family. There is evidence that overexpression of this gene is associated with tumorigenesis. However, the role of PBK in hepatocellular carcinoma (HCC) remains unclear. Therefore, we evaluated the prognostic role of PBK and its correlation with immune infiltrates in hepatocellular carcinoma. The expression of PBK in pan-cancers was studied by Onconmine and TIMER. The expression of PBK in HCC patients and its relationship with clinicopathological characteristics were analyzed using The Gene Expression Profiling Interactive Analysis (GEPIA), The human protein atlas database (HPA), The Cancer Genome Atlas (TCGA), and Gene Expression Omnibus (GEO) databases. Receiver operating characteristic (ROC) curve was used to determine the diagnostic value of PBK in HCC patients. The relationship between PBK and prognosis of HCC was performed by GEPIA and Kaplan Meier plotter web tool. The correlations between the clinical characteristics and overall survival were analyzed by Univariate Cox regression and Multivariate Cox hazards regression to identify possible prognostic factors for HCC patients. LinkedOmics was applied to investigate co-expression associated with PBK and to analyze Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The network map of PBK and related genes is constructed by GeneMANIA. Finally, TIMER and TISIDB were used to analyze the correlations between PBK and tumor-infiltrating immune cells. Multiple database analysis shows that PBK was highly expressed in many types of tumors, including hepatocellular carcinoma, and was significantly related to tumor stage (P=0.0089), age (P=0.0131), and race (P=0.0024) of HCC patients. The receiver operating characteristic (ROC) curve analysis showed that PBK had high diagnostic potential to HCC in GSE76427 (AUC=0.8799), GSE121248 (AUC=0.9224), GSE62232 (AUC=0.9975), and GSE84402 (AUC=0.9541). Multivariate Cox hazards regression showed that high expression of PBK may be an independent risk factor for overall survival in HCC patients (HR = 1.566, 95% CI=1.062–2.311, P= 0.024). The Protein–protein interaction network showed that PBK significantly interacted with LRRC47, ARAF, LGALS9B, TTK, DLG1, and other essential genes. Furthermore, enrichment analysis showed that PBK and co-expressed genes participated in many biological processes, cell composition, molecular functions, and pathways in HCC. Finally, the immune infiltration analysis by TIMER and TISIDB indicated that a significant tightly correlation between PBK and macrophages, neutrophils, as well as chemokines and receptors. High expression of PBK is significantly correlated with poor survival and immune infiltrates in hepatocellular carcinoma. Our study suggests that PBK can be used as a biomarker of poor prognosis and potential immune therapy target in hepatocellular carcinoma.

Objective To measure the trade-off between risk of complications versus patient improvement in pain and function in orthopaedic surgeons’ decisions about whether to undertake total knee arthroplasty (TKA). Methods A discrete choice experiment asking surgeons to make choices between experimentally-designed scenarios describing different levels of operative risk and dimensions of pain and physical function. Variation in preferences and trade-offs according to surgeon-specific characteristics were also examined. Results The experiment was completed by a representative sample of 333 orthopaedic surgeons (n=333): median age 52 years, 94% male, 91% fully qualified. Orthopaedic surgeons were willing to accept substantial increases in absolute risk associated with TKA surgery for greater improvements in a patient’s pain and function. The maximum risk surgeons were willing to accept was 40% for reoperation and 102% for the need to seek further treatment from a general practitioner or specialist in return for a change from postoperative severe night-time pain at baseline to no night-time pain at 12 months. With a few exceptions, surgeon-specific characteristics were not associated with how much risk a surgeon is willing to accept in a patient undergoing TKA. Conclusion This is the first study to quantify risk-benefit trade-offs among orthopaedic surgeons performing TKA, using a discrete choice experiment. This study provides insight into the risk tolerance of surgeons.

Background: This study aimed to explore the effectiveness of acupuncture combined with tuina therapy in patients with migraine. Methods: A prospective, randomized controlled assessor-blind clinical trial was performed between January 2017 and May 2018, and 135 patients were assigned into acupuncture combined with tuina (A), acupuncture (B), and control (flunarizine hydrochloride) (C) groups, each with 45 patients. Treatments were performed for 12 weeks and a 4-week follow-up. Frequency of attacks, severity of pain, duration of migraine, associated symptoms, patient-reported outcome (PRO) scores, and frequency of analgesic consumption were assessed. Results: The total effective rate was 95.6, 88.9, and 75.6% for group A, B, and C, respectively, with a significant reduction in attack frequency, severity of pain, duration of migraine, and associated symptoms at post-treatment and follow-up compared to pre-treatment. The PRO scores and frequency of analgesic consumption were significantly improved (group A, p < 0.01; groups B and C, ­ p < 0.05). The differences in pre-/post-treatment and in pre-treatment/follow-up in groups A and B were significantly improved compared to group C (A vs. C, p < 0.01; B vs. C, A vs. B, p < 0.05). No significant adverse events occurred. Conclusion: Acupuncture combined with tuina could significantly increase the therapeutic effect of acupuncture in migraine treatment.