Planning for a statewide network of dementia assessment services: A survey of geriatric assessment services in Michigan

All 38 geriatric assessment service units identified in Michigan were surveyed and responded as a component of planning a statewide network of diagnostic and assessment services for patients with dementia. Most units were outpatient (71 percent), urban (71 percent), and hospital-based (82 percent). Some provided primarily geropsychiatric services (21 percent), while the rest provided general geriatric services. The staff included physicians (95 percent), nurses (100 percent), social workers (95 percent) and other professionals (SO percent) such as nutritionists, neuro psychologists or clinical pharmacists. Assessments performed by most units included physical (92 percent), psychosocial (95 percent), functional (95 percent), neurological (71 percent) mental (95 percent), and financial (89 percent). Patient referral sources were most frequently self/family, followed by physician, community agencies, and community mental health. Reasons for referral were most often confusion! memory loss, followed by behavior change, caregiver stress, depression, and evaluation for placement. Most patients seen were between 65 and 84 years of age (72 percent), lived within 25 miles of the unit (87 percent), and had dementia (62 percent). Urban sites assessed significantly more persons per month (19 percent) than non-urban sites (4 percent). Community-based services spent significantly more time per month on geriatric assessments (68 hours) than did hospital-based services (26 hours). These survey results will aid the development of a statewide network of dementia diagnostic and assessment services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67004/2/10.1177_153331759200700606.pd

Guns and/or Butter: The Relationship between the Economy and the Military

SUMMARY The relationship between military expenditure and economic performance is a complex one, changing over time. At this historical juncture — especially for the UK and the USA — the evidence suggests that the net impact of military expenditure is negative. Although there are important technological spin?offs, these appear to be more than outweighed by their opportunity cost and the distortion of R & D. Military expenditure, because of its capital and import intensity and its use of scarce skills, also serves as a poor Keynesian pump primer. The prospects of ‘conversion’ are, however, constrained by the close political and economic meshing between military contractors, the defence establishment and political interest groups. SOMMAIRE Des fusils et/ou du beurre: Les rapports entre l'économie et le militaire Le rapport entre la dépense militaire et la performance économique est trés complexe, toujours changeant. A ce point de rencontre historique — surtout pour le Royaume Uni et les Etats Unis — l'évidence suggère que l'impact net de la dépense militaire est négatif. Quoiqu'il y ait d'importants dérivatifs technologiques, ceux?ci sont largement dépassés par leur coût et leur distortion. La dépense militaire, à cause du capital et de l'intensité de l'importation et de son pauvre usage de compétence, montre un bien pauvre exemple Keynesien. Les perspectives de ‘conservation’ sont, toutefois, restreintes par le filet serré politique et économique existant entre les entrepreneurs militaires, l'administration de la défence et les groupes d'intérêt politiques. RESUMEN Cañones y/o mantequilla: relación entre la economía y lo militar La relación entre gasto militar y comportamiento económico es muy compleja y cambia a través del tiempo. En la coyuntura histórica presente — especialmente para el Reino Unido y los EEUU — la evidencia indica que el impacto neto del gasto militar es negativo. Aun cuando tiene importantes ventajas tecnológicas éstas parecieran estar contrarrestadas por la pérdida de mejores oportunidades de inversión y por la distorción provocada en investigación y desarrollo. Debido a que requiere capitales e importaciones intensivos y destrezas especializadas escasas, el gasto militar es un pobre estímulo para la economía en el sentido keynesiano. Las posibilidades de ‘conversión’ están restringidas por la íntima interrelación política y económica entre los contratistas militares, el ‘sistema’ de defensa y los grupos de intereses políticos

Academic Assessment: Best Practices for Successful Outcomes with Accreditation Evaluation Teams

This chapter describes the role of faculty in conducting quality assessment and includes suggestions for preparing for successful meetings with reviewers on accreditation teams

Racial differences in influenza vaccination among older americans 1996–2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey

BACKGROUND: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. METHODS: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50–61 years of age (1992–2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70+ years (1993–2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. RESULTS: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10–20% higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55–0.72), AHEAD: OR = 0.55 (0.44–0.66)) CONCLUSIONS: There is much work left if the Healthy People 2010 goal of 90% of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Inherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests - microsatellite instability (MSI) and MMR immunohistochemistry (IHC) - are used in CRC patients to identify individuals at high risk of LS for genetic testing. MLH1 (MutL homologue 1) promoter methylation and BRAF V600E testing can be conducted on tumour material to rule out certain sporadic cancers. OBJECTIVES: To investigate whether testing for LS in CRC patients using MSI or IHC (with or without MLH1 promoter methylation testing and BRAF V600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources. REVIEW METHODS: Systematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors. RESULTS: Ten studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC, BRAF V600E and MLH1 promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective. LIMITATIONS: Most of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted. CONCLUSIONS: Systematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016033879. FUNDING: The National Institute for Health Research Health Technology Assessment programme.Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Researc

Biofuels and the role of space in sustainable innovation journeys

This paper aims to identify the lessons that should be learnt from how biofuels have been envisioned from the aftermath of the oil shocks of the 1970s to the present,and how these visions compare with biofuel production networks emerging in the 2000s. Working at the interface of sustainable innovation journey research and geographical theories on the spatial unevenness of sustainability transition projects,we show how the biofuels controversy is linked to characteristics of globalised industrial agricultural systems. The legitimacy problems of biofuels cannot be addressed by sustainability indicators or new technologies alone since they arise from the spatial ordering of biofuel production. In the 1970-80s, promoters of bioenergy anticipated current concerns about food security implications but envisioned bioenergy production to be territorially embedded at national or local scales where these issues would be managed. Where the territorial and scalar vision was breached, it was to imagine poorer countries exporting higher-value biofuel to the North rather than the raw material as in the controversial global biomass commodity chains of today. However, controversy now extends to the global impacts of national biofuel systems on food security and greenhouse gas emissions, and to their local impacts becoming more widely known. South/South and North/North trade conflicts are also emerging as are questions over biodegradable wastes and agricultural residues as global commodities. As assumptions of a food-versus-fuel conflict have come to be challenged, legitimacy questions over global agri-business and trade are spotlighted even further. In this context, visions of biofuel development that address these broader issues might be promising. These include large-scale biomass-for-fuel models in Europe that would transform global trade rules to allow small farmers in the global South to compete, and smallscale biofuel systems developed to address local energy needs in the South

A review of the polygraph: history, methodology and current status

The history of research into psychophysiological measurements as an aid to detecting lying, widely known as the ‘lie detector’ or polygraph is the focus of this review. The physiological measurements used are detailed and the debates that exist in regards to its role in the investigative process are introduced. Attention is given to the main polygraph testing methods, namely the Comparative Question Test and the Concealed Information Test. Discussion of these two central methods, their uses and problems forms the basis of the review. Recommendations for future research are made specifically in regards to improving current polygraph technology and exploring the role of the polygraph in combination with other deception detection techniques