BOOTSTRAPPING YOUR FISH OR FISHING FOR BOOTSTRAPS?: PRECISION OF WELFARE LOSS ESTIMATES FROM A GLOBALLY CONCAVE INVERSE DEMAND MODEL OF COMMERCIAL FISH LANDINGS IN THE U.S. GREAT LAKES

Replaced with revised version of paper 06/30/04.Demand and Price Analysis, Resource /Energy Economics and Policy,

Measuring well-being: W3 indicators to complement GDP

"Numerous people in Germany, including politicians and researchers, believe that the gross domestic product (GDP) is an outdated indicator of a society’s prosperity. Therefore, at the end of 2010, the German Bundestag, the federal parliament, established a study commission (Enquete-Kommission) tasked with developing an alternative to the GDP for measuring growth, prosperity, and quality of life. This commission has now submitted a proposal: to supplement the GDP with nine additional indicators, including a wide range of factors such as the distribution of income, biodiversity, and life expectancy. The ten indicators cover three dimensions of well-being-economy, ecology, and social wealth-and hence are called W3 Indicators. Replacing the gross domestic product by a single alternative index was rejected by the commission, however, since it is not possible to reduce citizens' very different wishes and expectations to "a common denominator". A representative survey of registered voters conducted by DIW Berlin and TNS Infratest shows that citizens consider the indicators proposed by the commission to be important. Respondents ranked preserving "democracy and freedom" as the most relevant indicator and "further increasing life expectancy" as the least relevant. The average per capita income -as an indicator of the gross domestic product- is the second least relevant factor as far as registered voters in Germany are concerned. However, the study also shows that opinions on the importance of different indicators vary widely. Moreover, there are systematic differences in the relevance of various policy areas for different social groups." (author's abstract

Evaluation of the Prescribing Skills Assessment implementation, performance and medical student experience in Australia and New Zealand

Aims: The UK Prescribing Safety Assessment was modified for use in Australia and New Zealand (ANZ) as the Prescribing Skills Assessment (PSA). We investigated the implementation, student performance and acceptability of the ANZ PSA for final-year medical students. Methods:This study used a mixed-method approach involving student data (n = 6440) for 2017–2019 (PSA overall score and 8 domain subscores). Data were also aggregated by medical school and included student evaluation survey results. Quantitative data were analysed using descriptive and multivariate analyses. The pass rate was established by a modified Angoff method. Thematic analyses of open-ended survey comments were conducted. Results:The average pass rate was slightly higher in 2017 (89%) which used a different examination to 2018 (85%) and 2019 (86%). Little difference was identified between schools for the PSA overall performance or domain subscores. There was low intercorrelation between subscores. Most students provided positive feedback about the PSA regarding the interface and clarity of questions, but an average of 35% reported insufficient time for completion. Further, 70% on average felt unprepared by their school curricula for the PSA, which is in part explained by the low prescribing experience; 69% reported completing ≤10 prescriptions during training. Conclusion:The ANZ PSA was associated with high pass rates and acceptability, although student preparedness was highlighted as a concern for further investigation. We demonstrate how a collaboration of medical schools can adapt a medical education assessment resource (UK PSA) as a means for fulfilling an unmet need.</p

Drug burden index and its association with hip fracture among older adults:a national population-based study

Background: The Drug Burden Index (DBI) calculates the total sedative and anticholinergic load of prescribed medications and is associated with functional decline and hip fractures in older adults. However, it is unknown if confounding factors influence the relationship between the DBI and hip fractures. The objective of this study was to evaluate the association between the DBI and hip fractures, after correcting for mortality and multiple potential confounding factors. Methods: A competing-risks regression analysis conducted on a prospectively recruited New Zealand community-dwelling older population who had a standardized (International Resident Assessment Instrument) assessment between September 1, 2012, and October 31, 2015, the study's end date. Outcome measures were survival status and hip fracture, with time-varying DBI exposure derived from 90-day time intervals. The multivariable competing-risks regression model was adjusted for a large number of medical comorbidities and activities of daily living. Results: Among 70,553 adults assessed, 2,249 (3.2%) experienced at least one hip fracture, 20,194 (28.6%) died without experiencing a fracture, and 48,110 (68.2%) survived without a fracture. The mean follow-up time was 14.9 months (range: 1 day, 37.9 months). The overall DBI distribution was highly skewed, with median time-varying DBI exposure ranging from 0.93 (Q = 0.0, Q = 1.84) to 0.96 (Q = 0.0, Q = 1.90). DBI was significantly related to fracture incidence in unadjusted (

Development of a Core Outcome Set for effectiveness trials aimed at optimising prescribing in older adults in care homes

Background: Prescribing medicines for older adults in care homes is known to be sub-optimal. Whilst trials testing interventions to optimise prescribing in this setting have been published, heterogeneity in outcome reporting has hindered comparison of interventions, thus limiting evidence synthesis. The aim of this study was to develop a core outcome set (COS), a list of outcomes which should be measured and reported, as a minimum, for all effectiveness trials involving optimising prescribing in care homes. The COS was developed as part of the Care Homes Independent Pharmacist Prescribing Study (CHIPPS). Methods: A long-list of outcomes was identified through a review of published literature and stakeholder input. Outcomes were reviewed and refined prior to entering a two-round online Delphi exercise and then distributed via a web link to the CHIPPS Management Team, a multidisciplinary team including pharmacists, doctors and Patient Public Involvement representatives (amongst others), who comprised the Delphi panel. The Delphi panellists (n = 19) rated the importance of outcomes on a 9-point Likert scale from 1 (not important) to 9 (critically important). Consensus for an outcome being included in the COS was defined as ≥70% participants scoring 7–9 and <15% scoring 1–3. Exclusion was defined as ≥70% scoring 1–3 and <15% 7–9. Individual and group scores were fed back to participants alongside the second questionnaire round, which included outcomes for which no consensus had been achieved. Results: A long-list of 63 potential outcomes was identified. Refinement of this long-list of outcomes resulted in 29 outcomes, which were included in the Delphi questionnaire (round 1). Following both rounds of the Delphi exercise, 13 outcomes (organised into seven overarching domains: medication appropriateness, adverse drug events, prescribing errors, falls, quality of life, all-cause mortality and admissions to hospital (and associated costs)) met the criteria for inclusion in the final COS. Conclusions: We have developed a COS for effectiveness trials aimed at optimising prescribing in older adults in care homes using robust methodology. Widespread adoption of this COS will facilitate evidence synthesis between trials. Future work should focus on evaluating appropriate tools for these key outcomes to further reduce heterogeneity in outcome measurement in this context

Feasibility and reliability of frailty assessment in the critically ill: a systematic review

Background. For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. Methods. Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. Results. Data from 11 study publications are included, representing eight study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58- 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (Frailty Index, FI). Conventional elements of Frailty Phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the Clinical Frailty Scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single centre study. Conclusion. Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and a FI-based assessment may be difficult to deliver by the critical care team on a routine basis. There is a high reliance on proxies for frailty assessment, and the reliability of frailty assessment tools in critical care needs further evaluation. PROSPERO CRD42016052073

Europa vor der EU-Wahl - in Sorge vereint: Was Wählerinnen und Wähler denken

Die EU durchlebt vor der Europawahl am 23. Mai schwierige Zeiten: Der Brexit droht chaotisch zu werden, der US-Präsident droht mit Handelskrieg, rechtspopulistisch dominierte Regierungen strapazieren die Geduld der europäischen Partner. Nichtsdestoweniger bringen die meisten Deutschen dem europäischen Projekt Wohlwollen entgegen. Das zeigt eine repräsentative Befragung von rund 2700 Wahlberechtigten, die das Berliner Forschungsinstitut policy matters im Auftrag der Hans-Böckler-Stiftung durchgeführt hat. Wichtige Einzelergebnisse: Die EU sollte sich nach Ansicht der Befragten neben sicherheitspolitischen Zielen mehr Lohngerechtigkeit und Arbeitnehmerrechte auf die Fahnen schreiben

Einstellung und soziale Lebenslage: Eine Spurensuche nach Gründen für rechtspopulistische Orientierung, auch unter Gewerkschaftsmitgliedern

Was bewegt die Bürgerinnen und Bürger? Wie sehen und bewerten sie ihre Lebenssituation, und welchen Einfluss hat das auf ihre Einstellungen, Wertorientierung und ihre politische Nähe zu rechtspopulistischen Parteien? Die Untersuchung gibt auf Basis einer Befragung unter ca. 5000 Bürgerinnen und Bürgern Auskunft über die politische Grundstimmung in der Bevölkerung im Januar 2017, benennt Ursachen für die Nähe zum Rechtspopulismus sowie Faktoren, die eine demokratische und partizipative Haltung ausmachen. Ein Fokus liegt auf der Rolle der Arbeitswelt für die politische Orientierung und der Frage, inwiefern Gewerkschaftsmitglieder Besonderheiten mit Blick auf Gerechtigkeitsfragen am Arbeitsplatz aufweisen