The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review

Objective: to investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age.Design: systematic review of studies examining use of or referral to SPC services in adult cancer patients.Search strategy and selection criteria: six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria.Main outcome measures: use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records).Results: 14 studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15-0.72) to 0.82 (0.80-0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC.Conclusions: there is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient's need for SPC

DYNAMIC PROGRAMMING: HAS ITS DAY ARRIVED?

Research Methods/ Statistical Methods,

A comparison of green space indicators for epidemiological research

<p><b>Background</b> The potential for natural environments to be salutogenic has received growing interest from epidemiologists, but there has been no critical examination of the extent to which associations between green space and health might vary according to the indicator of green space coverage used.</p> <p><b>Methods</b> Three different indicators of green space coverage were derived for a set of 268 small areas in four cities within Britain. The indicators had different origins and provided a spectrum of sensitivity from larger spaces only, through to ambient greenery. Two indicators reproducible for anywhere in Europe were included. Agreement between the indicators on the quantity of green space in a small area, and their independent association with measures of mortality and self-reported morbidity, were compared.</p> <p><b>Results</b> Overall, the indicators showed relatively close overall agreement (all r2>0.89, p<0.001). However, agreement varied by level of area socioeconomic deprivation (p<0.001). The indicator that detected larger spaces only found less green space in areas of socioeconomic deprivation than the other two. Despite this difference, all indicators showed similar protective associations with the risk of mortality and self-reported morbidity suggesting that larger green spaces may be more important for health effects than smaller spaces.</p> <p><b>Conclusions</b> Associations between green space indicator and health were not sensitive to indicator origin and type. This raises the possibility of trans-European epidemiological studies. Larger green spaces may be the most important for health effects, but may also be less prevalent in more deprived areas.</p&gt

Ductile mandrel and parting compound facilitate tube drawing

Refractory tubing is warm drawn over a solid ductile mandrel with a powder parting compound packed between mandrel and the tubes inner surface. This method applies also to the coextrusion of a billet and a ductile mandrel

REDUCTION OF STATE VARIABLE DIMENSION IN STOCHASTIC DYNAMIC OPTIMIZATION MODELS WHICH USE TIME-SERIES DATA

Statistical procedures are developed for reducing the number of autonomous state variables in stochastic dynamic optimization models when these variables follow a stationary process over time. These methods essentially delete part of the information upon which decisions are based while maintaining a logically consistent model. The relatively simple linear autoregressive process as well as the general case is analyzed and the necessary formulae for practical application are derived. Several applications in agricultural economics are discussed and results presented which quantify the relative amount of information sacrificed with the reduction in number of state variables.Research Methods/ Statistical Methods,

Measurement of point velocities in turbulent liquid flow

Turbulent water flow velocity distribution using hot-wire anemometer and photographic technique

Recommendations to the Social Security Administration on the Design of the Mental Health Treatment Study

Many beneficiaries with mental illness who have a strong desire to work nevertheless continue to seek the protection and security of disability benefits, not only because of the income such benefits provide but also for the health care coverage that comes with it. Further complicating matters is that few jobs available to people with mental illnesses have mental health care coverage, forcing individuals to choose between employment and access to care. These barriers, coupled with the limited treatment options and negative employer attitudes and even discrimination when it comes to employing people with serious metal illness, help "explain" the very rates of low labor force participation among people with psychiatric disabilities

A MODIFIED PARTIAL ADJUSTMENT MODEL OF AGGREGATE U.S. AGRICULTURAL SUPPLY

Aggregate U.S. agricultural supply response is modeled through a modified partial adjustment model, where the effects of weather and other temporal stochastic effects are structured to be purely static, while the effects of price and technology, or trend, are dynamic. The model is applied to a time series of aggregate U.S. farm output, aggregate U.S. crop production, and aggregate U.S. livestock and livestock products production for several sample periods within the period 1911-1958. The three aggregate output indexes are tested for irreversibilities in supply response, and no evidence of a definitive irreversible supply function is found for any of the dynamic supply models. The use of a nonstochastic difference equation to model the aggregate farm output and crop production equations results in short-run elasticity estimates that are somewhat smaller than previous studied suggest while the long-run elasticities are somewhat larger.Demand and Price Analysis, Production Economics,

WHEAT ACREAGE SUPPLY RESPONSE IN THE UNITED STATES

The dynamic structure of wheat acreage supply response is considerably more complex than previous studies have recognized. The distributed lag response is saw-toothed in its pattern, which is believed to eminate from the influence of summer fallow in crop rotations in the Great Plains. The acreage response elasticity estimate for the Great Plains at mean price was 1.3, and for the aggregate U.S. it was 1.5. For the Unites States, the proportion of long-run response experienced over the first five years from an increment to price was .24, .44, .70, .95, and. 99.Crop Production/Industries,

U.S. WHEAT STORAGE CONTROL UNDER JOINT CRITERIA OF MEAN BENEFITS AND PRICE VARIATION

A method based on stochastic dynamic programming is developed to derive efficiency frontiers for the trade-off between the long-run average social benefits and price variation. The method is used to quantify the importance of price variation per se as a criterion in U.S. wheat storage policy. The results suggest that a single criterion of maximum expected social benefits, calculated by the traditional surplus measures, is satisfactory because price variation is incidentally reduced enough that further reductions can be attained only a considerable opportunity cost.Crop Production/Industries,