Clinical Pathways to Disability

This paper examines the pathways by which individuals transition from healthy to disabled. Because of the high prevalence and costs associated with disability, understanding these pathways is critical to developing interventions to prevent or minimize disability. We compare two estimates of disabling conditions: those observed in medical claims and conditions indicated by the disabled individual. A small number of conditions explain about half of incident disability: arthritis, infectious disease, dementia, heart failure, diabetes, and stroke. These conditions show up in medical claims and self reports. A large number of elderly also attribute disability to old age and various symptoms. Because so many of the most disabling conditions do not have clear medical treatments, the outlook for major reductions in disability might be limited.

How Do the Better Educated Do It? Socioeconomic Status and the Ability to Cope with Underlying Impairment

There is a pronounced gradient in disability across socioeconomic groups, with better educated and higher income groups reporting substantially less disability. In this paper, we consider why that is the case, focusing on impairments in basic physical and cognitive aspects of living for the elderly. Our empirical work has two parts. First, we consider how much of this gradient in disability is a result of underlying differences in functioning versus the ability to cope with impairments. We show differences in functioning are the major part of the difference in disability, but both are important. Second, we consider how the better educated elderly cope with disability. Better educated people use substantially more assistive technology than the less educated and are more likely to use paid help. But use of these services is not the primary reason that the better educated are better able to cope. We conclude with thoughts about other potential factors that may explain differential coping.

Intensive Medical Care and Cardiovascular Disease Disability Reductions

There is little empirical evidence to explain why disability declined among the elderly over the past 20 years. In this paper, we explore the role of improved medical care for cardiovascular disease on health status improvements over time. We show that the incidence of cardiovascular disease hospitalizations remained relatively constant between 1984 and 1999 at the same time that post-event survival improved and disability declined. We find that use of appropriate therapies, including pharmaceuticals such as beta-blockers, aspirin, and ace-inhibitors, and invasive procedures, explains up to 50% and 70% of the reductions in disability and death over time, respectively. Elderly patients living in regions with high use of appropriate medical therapies had better health outcomes than patients living in low-use areas. Finally, we estimate that preventing disability after an acute event can add as much as 3.7 years of quality-adjusted life expectancy, or $316,000 of value.

A Proposed Method for Monitoring U.S. Population Health: Linking Symptoms, Impairments, and Health Ratings

We propose a method of quantifying non-fatal health on a 0-1 QALY scale that details the impact of specific symptoms and impairments and is not based on ratings of counterfactual scenarios. Measures of general health status are regressed on health impairments and symptoms in different domains, using ordered probit and ordinary least squares regression. This yields estimates of their effects analogous to disutility weights, and accounts for complex non-additive relationships. Health measures used include self-rated health status on a 5-point scale, EuroQol 5D (EQ-5D) scores, and ratings of current health using a 0-100 rating scale and a time-tradeoff. Data are from the nationally representative Medical Expenditure Panel Survey (MEPS) year 2002 (N=34,615), with validation in an independent sample from MEPS 2000 (N=21,067) and among 1420 adults age 45-89 in the Beaver Dam Health Outcomes Study. Decrement weights for symptoms and impairments are used to derive estimates of overall health-related quality of life, laying the groundwork for a detailed national summary measure of health. To purchase a copy of the earlier version of this paper, please contact the Working Papers department directly at (617) 588 1405.

Running-mass models of inflation, and their observational constraints

If the inflaton sector is described by softly broken supersymmetry, and the inflaton has unsuppressed couplings, the inflaton mass will run strongly with scale. Four types of model are possible. The prediction for the spectral index involves two parameters, while the COBE normalization involves a third, all of them calculable functions of the relevant masses and couplings. A crude estimate is made of the region of parameter space allowed by present observation.Comment: Latex file, 20 pages, 11 figures, uses epsf.sty. Comment on the observation of the spectral index scale dependence added; Fig. 3-6 improve

High visibility two photon interference of frequency time entangled photons generated in a quasi phase matched AlGaAs waveguide

We demonstrate experimentally the frequency time entanglement of photon pairs produced in a CW pumped quasi phased matched AlGaAs superlattice waveguide. A visibility of 96.0+-0.7% without background subtraction has been achieved, which corresponds the violation of Bell inequality by 52 standard deviations

Is This the End of the Tory Dynasty? The Wildrose Alliance in Alberta Politics

The Alberta Tory dynasty begun by Peter Lougheed is now 40 years old. With only four leaders across four decades, the party has managed to maintain its hold on the political imagination of Albertans. It has weathered a number of storms, from minor party assaults during the tumultuous 1980s to the Liberal threat of 1993 and the stresses associated with the global financial crisis. Now it confronts a new challenge in the form of the Wildrose Alliance led by Danielle Smith.Just as the Tories stole the centre ground from beneath Social Credit in the 1970s, the Wildrose leadership team hopes to take what was a fringe right wing party and turn it into a broad coalition capable of appealing to a large number of Albertans. What challenges do they face in repositioning the party? And how will the Tories protect their home turf?In brief, the Wildrose Alliance must modify its policies and present them in such a manner as to be able to plausibly claim that it now reflects the core values of Albertans better than the current government.For its part, the government must select a new leader capable of successfully painting Wildrose as outsiders who cannot be trusted to cleave to the values that Albertans hold dear. What are these values? Strong support for individualism, a populist view of government – including wariness of the federal government – combined with a deep commitment to a role for government in providing core programs in areas such as health care, the environment, and social welfare