An evaluation of the trimmed mean approach in clinical trials with dropout

The trimmed mean is a method of dealing with patient dropout in clinical trials that considers early discontinuation of treatment a bad outcome rather than leading to missing data. The present investigation is the first comprehensive assessment of the approach across a broad set of simulated clinical trial scenarios. In the trimmed mean approach, all patients who discontinue treatment prior to the primary endpoint are excluded from analysis by trimming an equal percentage of bad outcomes from each treatment arm. The untrimmed values are used to calculated means or mean changes. An explicit intent of trimming is to favor the group with lower dropout because having more completers is a beneficial effect of the drug, or conversely, higher dropout is a bad effect. In the simulation study, difference between treatments estimated from trimmed means was greater than the corresponding effects estimated from untrimmed means when dropout favored the experimental group, and vice versa. The trimmed mean estimates a unique estimand. Therefore, comparisons with other methods are difficult to interpret and the utility of the trimmed mean hinges on the reasonableness of its assumptions: dropout is an equally bad outcome in all patients, and adherence decisions in the trial are sufficiently similar to clinical practice in order to generalize the results. Trimming might be applicable to other inter‐current events such as switching to or adding rescue medicine. Given the well‐known biases in some methods that estimate effectiveness, such as baseline observation carried forward and non‐responder imputation, the trimmed mean may be a useful alternative when its assumptions are justifiable.     

The retirement system in transition: the 2007 Retirement Confidence Survey

WORKERS SLOW TO SEE OR ADAPT TO A CHANGING U.S. RETIREMENT SYSTEM: The 17th annual wave of the Retirement Confidence Survey (RCS) suggests that American workers may be slow to recognize how the U.S. retirement system is changing, and those who are aware of these changes may not be adapting to them in ways that are likely to secure them a comfortable retirement. HALF OF WORKERS LESS CONFIDENT ABOUT PENSION BENEFITS: The RCS finds pension-plan changes by employers have left nearly half of workers less confident about the benefits they will receive from a traditional pension plan, but that those experiencing a decline in retirement benefits often fail to react constructively. Moreover, although Americans will rely increasingly on 401(k) retirement savings plans and other personal savings and investments to fund their retirement security, data suggest that many may not follow professional investment advice when it is offered to them. MANY WORKERS COUNTING ON BENEFITS THAT WON'T BE THERE: Many workers are counting on employer-provided benefits in retirement that are increasingly unavailable. Only 41 percent of workers indicate they or their spouse currently have a defined benefit pension plan, yet 62 percent say they are expecting to receive income from such a plan in retirement. Likewise, workers are as likely to expect as retirees are to receive retiree health insurance through an employer, even though the number of employers offering this benefit to future retirees is declining. MANY WORKERS UNLIKELY TO HEED INVESTMENT ADVICE EVEN IF THEY GET IT: More than half of workers indicate they would be likely to take advantage of professional investment advice offered by companies that manage employer-sponsored retirement plans. However, two-thirds of these workers say they would probably implement only some of the recommendations they receive and 1 in 10 think they would implement none of them. AMERICANS OVERESTIMATE LONG-TERM CARE COVERAGE: One-quarter of workers and more than one-third of retirees report they have long-term care insurance (separate from health insurance, Medicare, and Medicaid) to help pay for care they might need in a nursing home, assisted living facility, or at home. But only 10 percent of Americans age 65 and older are estimated to have had private long-term care insurance in 2002, suggesting that many are counting on coverage they do not actually have. MOST SAVINGS LEVELS ARE MODEST: Almost half of workers saving for retirement report total savings and investments (not including the value of their primary residence or any defined benefit plans) of less than $25,000. The majority of workers who have not put money aside for retirement have little in savings at all: Seven in 10 of these workers say their assets total less than $10,000. CONTINUED IGNORANCE ABOUT SOCIAL SECURITY COVERAGE: Despite the longstanding increase in the eligibility age for Social Security, only a small minority of workers are aware of the age at which they can receive full retirement benefits from Social Security without a reduction for early retirement.     

Poverty and macroeconomic performance across space,race, and family structure

We examined the effects of macroeconomic performance and social policy on the extent and depth of poverty in America using state-level panel data from the 1981-2000 waves of the Current Population Survey. We found that a strong macroeconomy at both the state and national levels reduced both the number of families who were living in poverty and the severity of poverty. The magnitude and source of these antipoverty effects, however, were not uniform across family structures and racial groups or necessarily over time. While gains in the eradication of poverty, in general, were tempered by rising wage inequality, simulations indicated that female-headed families and families that were headed by black persons experienced substantial reductions in poverty in the 1990s largely because of the growth in median wages. An auxiliary time-series analysis suggests that the expansions in the federal Earned Income Tax Credit of the 1990s accounted for upward of 50% of the reduction in after-tax income deprivation.     

Disability Considerations for Measuring Poverty in Canada Using the Market Basket Measure

Social Indicators Research - Persons with disability (PWD) in Canada experience disproportionately high poverty rates. Poverty measures are often used to benchmark income assistance levels and...     

Poverty, Social Work and Social Justice

Correspondence to: Gary Craig, Professor of Social Justice, University of Hull, Hull, HU6 7RX, UK. E-mail: G.Craig{at}hull.ac.uk Summary The concept of social justice has become a common part of thepolitical lexicon in recent years, with New Labour identifyingit as a key goal of its social strategy. In this article, Iset out my understanding of what the elements of a social justiceprogramme should look like and apply it to the performance ofthe New Labour government in the policy area which has traditionallypresented a major challenge to social workers, the issue ofpoverty. Finally, I raise some questions about what this analysismeans for the future role of social work shaped by values ofsocial justice.     

The determinants of living wage rates

Several cities have recently adopted living wage ordinances which mandate that firms contracting with the city pay their workers an hourly wage at or above the legislated “living wage rate” set by the city. Following the literature on minimum wage rate determination, I explore factors influencing living wage rates. Using a sample of 39 cities, the results show that living wage rates are particularly sensitive to per capita income, fair-market rent, the minimum wage rate, the proximity of the city to other living wage cities, and the year that the city adopted the living wage ordinance.     

Identifying Gaps in Health Research among Refugees Resettled in Canada

While the global number of resettled refugees rises annually, the summaries of research on refugee health needs in countries of asylum remain sparse. We conducted a systematic review of published research on refugee health in Canada in order to: (i) identify studies addressing health outcomes among refugees recently resettled in Canada; (ii) identify general trends in health research conducted in Canada among refugee populations; (iii) identify significant gaps in current knowledge of health‐related issues among refugees recently resettled in Canada; (iv) evaluate the quality and consistency of available information; (v) develop a summary of available research results; and (vi) identify priorities for future research. A search of several major citation indices resulted in the analysis of 196 research reports after reviewing more than 5,000 articles. This review is timely, systematic and inclusive; furthermore, potential biases in methodology are clearly assessed. The results indicate an immediate need to address specific gaps in health knowledge for refugee populations and lead us to draw five primary conclusions. First, mental health outcomes dominate the research landscape. Second, cross‐sectional studies are most commonly the study design of choice. Third, studies examining some aspect of health among refugees from Asia dominate the literature. Fourth, there is a notable lack of information on cardiovascular diseases and its antecedents. Fifth, indications show that screenings for pre‐existing conditions are biased towards communicable diseases. These findings have implications for health monitoring, evaluation and policy affecting the health of refugees resettled in Canada and elsewhere.     

FIELD EXPERIMENTS ON THE ANCHORING OF ECONOMIC VALUATIONS

A pillar of behavioral research is that preferences are constructed during the process of choice. A prominent finding is that uninformative numerical “anchors” influence judgment and valuation. It remains unclear whether such processes influence market equilibria. We conduct two experiments that extend the study of anchoring to field settings. The first experiment produces evidence that some consumers' valuations can be anchored in novel situations; there is no evidence that experienced agents are influenced by anchors. The second experiment finds that anchors have only transient effects on market outcomes that converge to equilibrium predictions after a few market periods. (JEL C93, D11)