Palliative medicine in Britain

In Britain, Palliative Medicine was recognized as a subspecialty of Internal Medicine exactly 20 years after Cicely Saunders founded St Christopher's, at exactly the same time that government was at last recognizing the worth and the needs of general practice. Both had far-reaching effects and implications for patients, doctors, and the future of medicine. For Palliative Medicine it meant units wishing to train specialists going through a rigorous selection process; the development of an equally rigorous training program for the doctors who had already gained a higher qualification before starting Palliative Medicine, demonstrating the need for and benefits of palliative medicine to the sceptics in the profession and, now, continuing to recruit the staff for the steadily increasing number of new services. Today there are more Palliative Medicine consultants/specialists than there are oncologists and neurologists combined, with Hospital Palliative Care Teams in every major hospital and cancer center. With nine Chairs in Palliative Medicine, there is now a drive for research and professional education. The specialty faces major challenges, however, ranging from training to care for patients with non-malignant disease to enabling patients to die in the place of their choice-something that rarely happens today; from defining what is distinctive or unique about palliative medicine to clarifying the respective place of general practice and the specialty. Most would agree that the biggest challenge for the young, thriving specialty is how to share its principles with other doctors wherever they work.     

Important Yet Ignored: Problems of 'Expertise' in Emergency Duty Social Work

Summary This paper deals with the important role that emergency dutyworkers play in respect of the variety of situations that arereferred to them outside of the normal working hours of socialservices departments. The first section presents some interimoutcomes of ongoing research suggesting that the variabilityof priorities and assessments made by such workers is even greaterthan might be intuitively expected. The paper questions whetherconventional expectations of social work assessment are applicablein circumstances that are radically different from day-timework. In the second section, the paper explores the evidentmoral dilemmas contained in these circumstances, highlightingthe need for workers to have internalized as ‘expert’as broad a grasp as possible of the diversity of values andmethods of social assessment, decision-making and intervention.The paper continues by considering the nature of expert methodssuitable for the demands of emergency duty work, the need forguidelines for professional judgement, and an appropriate genericframework.     

A comparison of several adaptive forecasting procedures

There is a considerable amount of published research relevant to the selection of automatic, online, single exponential smoothing models, applicable primarily to following a stationary process of data. Research into adaptive, double exponential smoothing models which are applicable to following a linear trend in the data has not been so profuse, however, particularly under strict online design specifications. Five feasible methods from the double exponential family were selected for comparison in this study, which consisted of four separate simulation experiments. The online design specifications are interpreted quite strictly to include adaptiveness, recursiveness, fading memory, computational economy, robustness, self-initialisation and comprehensibility to management.     

German Reunification: Welfare Gains and Losses East and West

A framework of welfare accounts (Juster and Stafford, 1985; Headey, 1993; see also Goodin et al., 1999) is used to assess gains and losses to East and West Germans in the post-reunification period, 1990–1997. The welfare accounts have three segments: a capital/stocks account, an income/flows account and a subjective welfare/psychic income account. This framework differs from conventional welfare economic accounts in explicitly defining and measuring welfare in psychological terms ... as perceived utility/satisfaction. It has recently been argued that this approach is required, if one accepts that individual utilities are not exogenous but are affected by changing comparisons with others (Duesenberry, 1949; Easterlin, 1974, 1995; Hollaender, 2001). Our hypotheses are that in the post-reunification period West German welfare was sacrificed – in all three segments of the accounts – in order to permit resources to flow to East Germans and to boost their stocks, flows and utilities. The hypotheses are supported in the case of West Germans, but results are mixed for East Germans. Our data source is the German Socio-Economic Panel (GSOEP) which began in 1984 in West Germany and has involved reinterviewing a very large representative national sample every year since. The panel was extended to East Germany in June 1990, before formal reunification occurred, and so provides a picture of stocks, flows and utilities before the effects of integration into the Federal Republic were felt.     

Multiple Rhythmically Varying Prices,the Timing of Factor Demands and Induced Technological Change

ABSTRACT: This Paper the existing literature on optimal capital utilisation and shiftwork patterns by arguing that labour is not the only input to exhibit a price which varies over the time of day week or year Indeed in certain situations as in the w e of capital intensive industries which are heavy consumers of electricity labour costs may not even be the most important consideration The introduction of a second varying input price can completely alter the optimal operating times of production units Once this extension has been adopted it is a fairly easy final step to demonstrate that some firms face a strong inducement to develop technologies which allow them to use their capital and labour independently This type of technological change has become commonplace in recent years but largely unexplained by the existing literature These developments have important implications for the organisation of work patterns and the flexible use of the labour input