Hospital expenditure at the end-of-life: what are the impacts of health status and health risks?

Background: It is important for health policy and expenditure projections to understand the relationship between age, death and expenditure on health care (HC). Research has shown that older age groups incur lower hospital costs than previously anticipated and that remaining time to death (TTD) was a much stronger indicator for expenditure than age. How health behaviour or risk factors impact on HC utilisation and costs at the end of life is relatively unknown. Smoking and Body Mass Index (BMI) have featured most prominently and mixed findings exist as to the exact nature of this association.<p></p> Methods: This paper considers the relationship between TTD, age and expenditure for inpatient care in the last 12 quarters of life; and introduces measures of health status and risks. A longitudinal dataset covering 35 years is utilised, including baseline survey data linked to hospital and death records. The effect of age, TTD and health indicators on expenditure for inpatient care is estimated using a two-part model.<p></p> Results: As individuals approach death costs increase. This effect is highly significant (p<0.01) from the last until the 8th quarter before death and influenced by age. Statistically significant effects on costs were found for: smoking status, systolic blood pressure and lung function (FEV1). On average, smokers incurred lower quarterly costs in their last 12 quarters of life than non-smokers (~7%). Participants’ BMI at baseline did show a negative association with probability of HC utilisation however this effect disappeared when costs were estimated.<p></p> Conclusions: Health risk measures obtained at baseline provide a good indication of individuals’ probability of needing medical attention later in life and incurring costs, despite the small size of the effect. Utilising a linked dataset, where such measures are available can add substantially to our ability to explain the relationship between TTD and costs.<p></p&gt

Total synthesis of (±)-paroxetine by diastereoconvergent cobalt-catalysed arylation

A total synthesis of paroxetine is reported, with a diastereoselective and diastereoconvergent cobalt-catalysed sp3–sp2 coupling reaction involving a 3-substituted 4-bromo-N-Boc-piperidine (Boc = tert-butoxycarbonyl) substrate as a key step. A 9:1 diastereoselectivity was obtained, while a control experiment involving a conformationally locked 3-substituted 4-bromo-tert-butyl cyclohexane ring proceeded with essentially complete stereoselectivit

Superhumps in Low-Mass X-Ray Binaries

We propose a mechanism for the superhump modulations observed in optical photometry of at least two black hole X-ray transients (SXTs). As in extreme mass-ratio cataclysmic variables (CVs), superhumps are assumed to result from the presence of the 3:1 orbital resonance in the accretion disc. This causes the disc to become non-axisymmetric and precess. However the mechanism for superhump luminosity variations in low mass X-ray binaries (LMXBs) must differ from that in CVs, where it is attributed to a tidally-driven modulation of the disc's viscous dissipation, varying on the beat between the orbital and disc precession period. By contrast in LMXBs, tidal dissipation in the outer accretion disc is negligible: the optical emission is overwhelming dominated by reprocessing of intercepted central X-rays. Thus a different origin for the superhump modulation is required. Recent observations and numerical simulations indicate that in an extreme mass-ratio system the disc area changes on the superhump period. We deduce that the superhumps observed in SXTs arise from a modulation of the reprocessed flux by the changing area. Therefore, unlike the situation in CVs, where the superhump amplitude is inclination-independent, superhumps should be best seen in low-inclination LMXBs, whereas an orbital modulation from the heated face of the secondary star should be more prominent at high inclinations. Modulation at the disc precession period (10s of days) may indicate disc asymmetries such as warping. We comment on the orbital period determinations of LMXBs, and the possibility and significance of possible permanent superhump LMXBs.Comment: 6 pages, 1 encapsulated figure. MNRAS in press; replaced to correct typographical error

Statut résidentiel et durée de chômage : une comparaison<br />microéconométrique entre la Grande-Bretagne et la France

Working Paper du GATE 2006-13The objective of this paper is to provide microeconomic evidence for the so called “Oswald's hypothesis”, which is whether homeownership results in negative outcomes in the labour market. To estimate this effect we use two data base, comparing results from British Household Permanent Survey and French part of European Household Panel Survey. In a first step, a multinomial logit model for the choice of tenure status is estimated. Estimated probabilities of being either homeowner,public or private renter are then used to explain the length of an individual unemployment spell. This flexible method of estimation accounts for both censoring and selection bias, without constraining the shape of the hazard rate of leaving unemployment. Results suggested strong differences between French and British household behaviour. Home-ownership has a positive effect on unemployment duration in France but no significant effect is detected in Britain. However we find a positive impact of public renters on unemployment duration in Britain. These stylised facts seems to confirm theexistence of a real spillover effect between labour market and housing market.Des études sur données agrégées ont mis en évidence une corrélation positive entre le taux de propriétaires et le taux de chômage en Europe et aux Etats-Unis. Ce fait stylisé a donné lieu à de nombreux travaux économétriques sur données individuelles américaines, danoises ou anglaises, plus rarement sur données françaises, qui ont conduit à des résultats contradictoires. L'étude économétrique proposée dans cet article s'inscrit dans cette réflexion en proposant une analyse comparée sur données individuelles britanniques et françaises des effets du statut résidentiel sur la durée des épisodes de chômage. L'influence des différents modes d'occupation du logement sur la durée de séjour dans l'état de chômage est estimée pour la France à partir du Panel Européen des Ménages et pour la Grande-Bretagne à partir du British Household Panel Survey. On contrôle lors des estimations les sources de biais relevant de la censure, de l'auto sélection et des sources d'hétérogénéité inobservable. Les résultats économétriques font apparaître des effets très discriminants entre les deux pays. Si la propension à la propriété immobilière augmente la durée de chômage en France, elle n'induit en revanche aucun effet statistiquement significatif en Angleterre, les accédants à la propriété manifestantmême, toutes choses égales par ailleurs, les durées de chômage les plus basses. En Grande-Bretagne, ce sont plutôt les locataires du secteur social qui manifestent les durées de chômage les plus longues, résultat qui ne réfute pas l'observation faite dans d'autres études d'une plus faible mobilité des locataires du secteur social par rapport aux locataires du secteur privé

Good practice for enhancing the engagement and success of commencing students

There is widespread recognition that higher education institutions (HEIs) must actively support commencing students to ensure equity in access to the opportunities afforded by higher education. This role is particularly critical for students who because of educational, cultural or financial disadvantage or because they are members of social groups currently under-represented in higher education, may require additional transitional support to “level the playing field.” The challenge faced by HEIs is to provide this “support” in a way that is integrated into regular teaching and learning practices and reaches all commencing students. The Student Success Program (SSP) is an intervention in operation at the Queensland University of Technology (QUT) designed to identify and support those students deemed to be at risk of disengaging from their learning and their institution. Two sets of evidence of the impact of the SSP are presented: First, its expansion (a) from a one-faculty pilot project (Nelson, Duncan &amp; Clarke, 2009) to all faculties and (b) into a variety of applications mirroring the student life cycle; and second, an evaluation of the impact of the SSP on students exposed to it. The outcomes suggest that: the SSP is an example of good practice that can be successfully applied to a variety of learning contexts and student enrolment situations; and the impact of the intervention on student persistence is sustained for at least 12 months and positively influences student retention. It is claimed that the good practice evidenced by the SSP is dependent on its integration into the broader First Year Experience Program at QUT as an example of transition pedagogy in action

Testing for mean and correlation changes in microarray experiments: an application for pathway analysis

<p>Abstract</p> <p>Background</p> <p>Microarray experiments examine the change in transcript levels of tens of thousands of genes simultaneously. To derive meaningful data, biologists investigate the response of genes within specific pathways. Pathways are comprised of genes that interact to carry out a particular biological function. Existing methods for analyzing pathways focus on detecting changes in the mean or over-representation of the number of differentially expressed genes relative to the total of genes within the pathway. The issue of how to incorporate the influence of correlation among the genes is not generally addressed.</p> <p>Results</p> <p>In this paper, we propose a non-parametric rank test for analyzing pathways that takes into account the correlation among the genes and compared two existing methods, Global and Gene Set Enrichment Analysis (GSEA), using two publicly available data sets. A simulation study was conducted to demonstrate the advantage of the rank test method.</p> <p>Conclusions</p> <p>The data indicate the advantages of the rank test. The method can distinguish significant changes in pathways due to either correlations or changes in the mean or both. From the simulation study the rank test out performed Global and GSEA. The greatest gain in performance was for the sample size case which makes the application of the rank test ideal for microarray experiments.</p

Statut résidentiel et durée de chômage en France et au Royaume-Uni

Des études sur données agrégées ont mis en évidence une corrélation positive entre le taux de propriétaires et le taux de chômage en Europe et aux Etats-Unis. Les nombreux travaux économétriques sur données individuelles américaines, danoises, hollandaises ou anglaises, plus rarement sur données françaises, qui ont été développé dans la littérature ont conduit à des résultats très contradictoires. L'étude économétrique proposée dans cet article s'inscrit dans cette réflexion en proposant une analyse comparée, sur données individuelles britanniques et françaises, des effets du statut résidentiel sur la durée des épisodes de chômage. L'influence des différents modes d'occupation du logement sur la durée de séjour dans l'état de chômage est estimée pour la France à partir du Panel Européen des Ménages et pour le Royaume Uni à partir du British Household Panel Survey. On contrôle lors des estimations les sources de biais relevant de la censure et de l'auto sélection. Les résultats économétriques font apparaître des effets très discriminants entre les deux pays. Si la propension à la propriété immobilière augmente la durée de chômage en France, elle n'induit en revanche aucun effet statistiquement significatif en Angleterre. Dans les deux pays les accédants à la propriété manifestent, toutes choses égales par ailleurs, les durées de chômage les plus basses, témoignage de salaires de réserves différenciés au sein des propriétaires. Au Royaume Uni, ce sont plutôt les locataires du secteur social qui enregistrent les durées de chômage les plus longues, résultat qui ne réfute pas l'observation faite dans d'autres études d'une plus faible mobilité des locataires du secteur social par rapport aux locataires du secteur privé.durée de chômage; statut résidentiel; mobilité; France; Royaume-Uni

Differences in access to evidence-based practice training among health professionals

0813-053