Strong Equivalence Relations for Iterated Models

The Iterated Immediate Snapshot model (IIS), due to its elegant geometrical representation, has become standard for applying topological reasoning to distributed computing. Its modular structure makes it easier to analyze than the more realistic (non-iterated) read-write Atomic-Snapshot memory model (AS). It is known that AS and IIS are equivalent with respect to \emph{wait-free task} computability: a distributed task is solvable in AS if and only if it solvable in IIS. We observe, however, that this equivalence is not sufficient in order to explore solvability of tasks in \emph{sub-models} of AS (i.e. proper subsets of its runs) or computability of \emph{long-lived} objects, and a stronger equivalence relation is needed. In this paper, we consider \emph{adversarial} sub-models of AS and IIS specified by the sets of processes that can be \emph{correct} in a model run. We show that AS and IIS are equivalent in a strong way: a (possibly long-lived) object is implementable in AS under a given adversary if and only if it is implementable in IIS under the same adversary. %This holds whether the object is one-shot or long-lived. Therefore, the computability of any object in shared memory under an adversarial AS scheduler can be equivalently investigated in IIS

Preparations for Independence and Financial Security in Later Life: A Conceptual Framework and Application to Canada

In this paper, we develop a conceptual framework to describe an individual's preparations for later life. Situated in the life course perspective, this provides a framework that invites a more comprehensive and systematic study of preparations for later life. It describes a dynamic process that portrays the interplay between social structure and human agency. Through its consideration of collective preparations (the public protection programs offered by the state), individual preparations (financial and non- financial), and the interplay between the two, this framework provides fresh insight into the existing literature on retirement planning, the timing of retirement, savings, and consumption behaviour in later life. Moreover, the model may be used to structure research questions, to guide policy decision making and to point the direction for the design and content of future research studies. While the purpose of this paper is primarily the development of a conceptual model, we draw on empirical examples from the 1991 Survey of Aging and Independence (SAI) to illustrate some aspects of the model to Canada. We conclude by suggesting a number of research and questions that may be generated from the model.retirement planning; savings; SAI

Relating L-Resilience and Wait-Freedom via Hitting Sets

The condition of t-resilience stipulates that an n-process program is only obliged to make progress when at least n-t processes are correct. Put another way, the live sets, the collection of process sets such that progress is required if all the processes in one of these sets are correct, are all sets with at least n-t processes. We show that the ability of arbitrary collection of live sets L to solve distributed tasks is tightly related to the minimum hitting set of L, a minimum cardinality subset of processes that has a non-empty intersection with every live set. Thus, finding the computing power of L is NP-complete. For the special case of colorless tasks that allow participating processes to adopt input or output values of each other, we use a simple simulation to show that a task can be solved L-resiliently if and only if it can be solved (h-1)-resiliently, where h is the size of the minimum hitting set of L. For general tasks, we characterize L-resilient solvability of tasks with respect to a limited notion of weak solvability: in every execution where all processes in some set in L are correct, outputs must be produced for every process in some (possibly different) participating set in L. Given a task T, we construct another task T_L such that T is solvable weakly L-resiliently if and only if T_L is solvable weakly wait-free

Evaluating Unpaid Time Contributions by Seniors: A Conceptual Framework

In the past, considerable research in gerontology has focused on services provided to seniors. Recently, however, there has a been a growing recognition of the contributions made by seniors to their families, communities and to society. Empirical estimates have been provided by researchers to show how much these contributions are worth in terms of savings in dollar amounts. A critical review of the literature identifies unresolved issues concerning which contributions to count and how to measure and value these contributions. As yet, no clear criteria exist that readily identify the distinction between volunteer activities and unpaid work, what specifically should be counted as an unpaid time contribution, how it should be quantified, and how this unit of contribution should be monetarily valued. The market replacement approach and the opportunity cost approach that are used to assign value to unpaid work often use very different wage rates or levels of income loss. This paper reviews the relevant literature and identifies important issues in evaluating unpaid time contribution of seniors. The authors propose a framework which addresses some of the methodological shortcomings identified in previous research and which provides a guide for future research in this area.seniors; valuing unpaid work

Recognizing Preference Diversity: The Use of Preference Sub-Groups in Cost-Effectiveness Analysis

Societal preferences are typically incorporated into cost-effectiveness analyses (CEA) on the basis of the average health state utilities of a sample of public raters. The cost-effectiveness of a program is then assessed on an >all-or-nothing= basis: the program is declared either cost-effective or not for all patients in clinically homogenous sub-groups. However, this approach fails to recognize variability between individuals in their preferences. In this conceptual paper, we consider how the preferences of the individual can be handled within a societal CEA. The concept of preference sub-group analysis is described and its implications assessed. Consider, for example, the choice between lumpectomy and mastectomy for a group of women with breast cancer who are homogeneous clinically but heterogeneous in preferences, and assume that lumpectomy is the more costly procedure. If the incremental cost-effectiveness ratio (ICER) for lumpectomy on the basis of the public=s average preferences is considered acceptable, it would seem unreasonable to refuse mastectomy to those patients who would prefer mastectomy, the cheaper treatment. If the ICER of lumpectomy is not considered acceptable, should it be refused to all patients regardless of the strength of preference of those wanting the procedure? We argue that, in this situation, it is important to explore if sub-groups of individuals, from amongst the sample of public raters, exist (characterized by age, marital status etc.) whose preferences are sufficiently different to the average to generate an acceptable ICER. We address some important practical and conceptual issues of this framework including the implications of the search for sub-groups for the design of valuation studies. The framework has important implications for the practice of CEA and, in particular, for the use of health state valuation systems.

The effectiveness and efficiency of home-based nursing health promotion for older people: A review of the literature

Despite the large potential role that community nurses have in providing individualized health promotion to older people, there is a lack of consensus in the literature regarding this role's effectiveness and efficiency. This article presents a literature review and synthesis of 12 randomized controlled trials selected from 344 published studies on preventive home visitation programs for older people. The findings suggest that a diversity of home visiting interventions carried out by nurses can favorably affect health and functional status, mortality rates, use of hospitalization and nursing homes, and costs. Further research is needed that focuses on the outcomes of quality of life, mental health, social support, caregiver burden, the acceptability of intervention, and specific subgroups of clients who benefit most. Findings also indicate the need for a theoretical foundation, increased emphasis on health-promotion strategies, and more research using a more complete economic evaluation to establish efficiency

Ethics, economics and the regulation and adoption of new medical devices: case studies in pelvic floor surgery

<p>Abstract</p> <p>Background</p> <p>Concern has been growing in the academic literature and popular media about the licensing, introduction and adoption of surgical devices before full effectiveness and safety evidence is available to inform clinical practice. Our research will seek empirical survey evidence about the roles, responsibilities, and information and policy needs of the key stakeholders in the introduction into clinical practice of new surgical devices for pelvic floor surgery, in terms of the underlying ethical principals involved in the economic decision-making process, using the example of pelvic floor procedures.</p> <p>Methods/Design</p> <p>Our study involves three linked case studies using, as examples, selected pelvic floor surgery devices representing Health Canada device safety risk classes: low, medium and high risk. Data collection will focus on stakeholder roles and responsibilities, information and policy needs, and perceptions of those of other key stakeholders, in seeking and using evidence about new surgical devices when licensing and adopting them into practice. For each class of device, interviews will be used to seek the opinions of stakeholders. The following stakeholders and ethical and economic principles provide the theoretical framework for the study:</p> <p indent="1"><b>Stakeholders </b>- federal regulatory body, device manufacturers, clinicians, patients, health care institutions, provincial health departments, and professional societies. Clinical settings in two centres (in different provinces) will be included.</p> <p indent="1"><b>Ethics </b>- beneficence, non-maleficence, autonomy, justice.</p> <p indent="1"><b>Economics </b>- scarcity of resources, choices, opportunity costs.</p> <p>For each class of device, responses will be analysed to compare and contrast between stakeholders. Applied ethics and economic theory, analysis and critical interpretation will be used to further illuminate the case study material.</p> <p>Discussion</p> <p>The significance of our research in this new area of ethics will lie in providing recommendations for regulatory bodies, device manufacturers, clinicians, health care institutions, policy makers and professional societies, to ensure surgical patients receive sufficient information before providing consent for pelvic floor surgery. In addition, we shall provide a wealth of information for future study in other areas of surgery and clinical management, and provide suggestions for changes to health policy.</p

Decision aid on radioactive iodine treatment for early stage papillary thyroid cancer - a randomized controlled trial

Abstract Background Patients with early stage papillary thyroid carcinoma (PTC), are faced with the decision to either to accept or reject adjuvant radioactive iodine (RAI) treatment after thryroidectomy. This decision is often difficult because of conflicting reports of RAI treatment benefit and medical evidence uncertainty due to the lack of long-term randomized controlled trials. Methods We report the protocol for a parallel, 2-arm, randomized trial comparing an intervention group exposed to a computerized decision aid (DA) relative to a control group receiving usual care. The DA explains the options of adjuvant radioactive iodine or no adjuvant radioactive iodine, as well as associated potential benefits, risks, and follow-up implications. Potentially eligible adult PTC patient participants will include: English-speaking individuals who have had recent thyroidectomy, and whose primary tumor was 1 to 4 cm in diameter, with no known metastases to lymph nodes or distant sites, with no other worrisome features, and who have not received RAI treatment for thyroid cancer. We will measure the effect of the DA on the following patient outcomes: a) knowledge about PTC and RAI treatment, b) decisional conflict, c) decisional regret, d) client satisfaction with information received about RAI treatment, and e) the final decision to accept or reject adjuvant RAI treatment and rationale. Discussion This trial will provide evidence of feasibility and efficacy of the use of a computerized DA in explaining complex issues relating to decision making about adjuvant RAI treatment in early stage PTC. Trial registration Clinical Trials.gov Identifier: NCT0108355

Distributed Consensus, Revisited

We provide a novel model to formalize a well-known algorithm, by Chandra and Toueg, that solves Consensus among asynchronous distributed processes in the presence of a particular class of failure detectors (Diamond S or, equivalently, Omega), under the hypothesis that only a minority of processes may crash. The model is defined as a global transition system that is unambigously generated by local transition rules. The model is syntax-free in that it does not refer to any form of programming language or pseudo code. We use our model to formally prove that the algorithm is correct