Assessing uncertainty in the American Indian Trust Fund

Fiscal year-end balances of the Individual Indian Money System (a part of the Indian Trust) were constructed from data related to money collected in the system and disbursed by the system from 1887 to 2007. The data set of fiscal year accounting information had a high proportion of missing values, and much of the available data did not satisfy basic accounting relationships. Instead of just calculating a single estimate and arguing to the Court that the assumptions needed for the computation were reasonable, a distribution of calculated balances was developed using multiple imputation and time series models. These provided information to assess the uncertainty of the estimate due to missing and questionable data.Comment: Published in at http://dx.doi.org/10.1214/09-AOAS274 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Evidence based management of hypertension: Using cardiovascular risk profiles to individualise hypertensive treatment

This is the fourth in a series of five articles Individual risks must be assessed in order to for the best decision to be made as to which patients to treat and how. Assessment identifies important cardiovascular risk factors that may warrant treatment and helps to establish the absolute benefits that patients can expect from particular treatments. The benefits of treating hypertensive patients also vary, depending on each patient's competing risks of dying from other than cardiovascular causes. For example, patients with multiple serious conditions, such as end stage Alzheimer's disease, obstructive lung disease, frequent falls, gout, and urinary incontinence, have high competing risks that may minimise or negate the benefits of treating their hypertension. #### Summary points Several treatment options reduce risk of cardiovascular disease and improve outcomes in patients with hypertension Providers should consider the expected benefits and potential adverse effects of different treatment options and discuss them with patients The use of decision tools may help decision making about options for reducing cardiovascular risk Establishing treatment priorities for patients with multiple cardiovascular risk factors and multiple conditions is difficult. Factors such as those given in the box deserve consideration. Knowing and weighing up multiple risk factors, conditions, and treatments is difficult. Explaining them to patients is daunting and time consuming. Some patients prefer to be told what to do rather than to have to take in the diverse, complicated information necessary to make their