Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Intentional Exposure Studies of Environmental Agents on Human Subjects: Assessing Benefits and Risks∗

In this article, I assess the benefits and risks of studies that intentionally expose research subjects to environmental agents. I describe these types of studies, identify their benefits and risks, compare them to other research methods that can be used to investigate the relationship between environmental exposures and disease, and discuss some issues related to research design and risk minimization. I argue that the benefits of intentional environmental exposure studies outweigh the risks when 1) the knowledge gained is likely to improve our understanding of the relationship between environmental exposure and disease, 2) this knowledge cannot be obtained by other methods, 3) the experiments are well designed, 4) the subjects will receive some benefits, such as medical evaluations, 5) risks are minimized, and 6) the risks to human subjects are less than those encountered in a typical Phase I drug study. Only in rare circumstances (i.e., when an intentional environmental exposure study is needed to implement an important environmental or public health intervention or regulation) may such studies expose research subjects to risks as high as those encountered in a typical Phase I drug trail.     

Gambling and Federal civil service employment law

Federal sector employment law concerning employee misconduct in which gambling is a factor has evolved significantly since the enactment of the Civil Service Reform Act of 1978, and is breaking new ground in this aspect of civil rights and employment law. Among other things, a debate is taking place in this sector as to whether compulsive gambling is a handicapping condition similar to alcoholism and drug addiction. Traditionally, disciplinary cases in the Federal Sector may be classified in two categories. The first involves misconduct related to compulsive gambling. The second concerns gambling on-the-job, either through promotion of gambling by, for example, running a numbers game, or by placing bets. While employees who promote gambling by running numbers games can be fired for just one instance of such misconduct, employees whose misconduct on or off the job is the result of compulsive or pathological gambling have a strong affirmative defense restricting the employer's attempts to fire for just cause. As defined by administrative agencies which have primary jurisdiction over Federal civil service law matters, compulsive gambling, generally, is not recognized as a handicapping condition. Developments in Federal sector, however, have required the federal manager to consider the existence of a condition of pathological gambling as a mitigating factor in deciding upon appropriate discipline. Other related developments indicate that compulsive gambling may, in fact, be reclassified as a handicapping condition.The author is an Assistant Professor (Adjunct) of Public Administration at John Jay College, C.U.N.Y., where he teaches Administrative Law and Regulation and Labor Relations in the Public Sector and Employment Discrimination Law in the Master of Public Administration Program. This article is adapted from remarks made at the Second Annual Conference on Gambling Behavior held at Philadelphia, PA, November 19–21 1986.     

Father Absence and Accelerated Reproductive Development in Non-Hispanic White Women in the United States

Girls who experience father absence in childhood also experience accelerated reproductive development in comparison with peers with present fathers. One hypothesis advanced to explain this empirical pattern is genetic confounding, wherein gene-environment correlation (rGE) causes a spurious relationship between father absence and reproductive timing. We test this hypothesis by constructing polygenic scores for age at menarche and first birth using recently available genome-wide association study results and molecular genetic data on a sample of non-Hispanic white females from the National Longitudinal Study of Adolescent to Adult Health. We find that young women’s accelerated menarche polygenic scores are unrelated to their exposure to father absence. In contrast, polygenic scores for earlier age at first birth tend to be higher in young women raised in homes with absent fathers. Nevertheless, father absence and the polygenic scores independently and additively predict reproductive timing. We find no evidence in support of the rGE hypothesis for accelerated menarche and only limited evidence in support of the rGE hypothesis for earlier age at first birth.     

Advance Medical Directives for College Students: It's Not Your Father's Living Will

Abstract

Educators and researchers strive to use terms that reflect a replicable measure of behavior. A term commonly used to describe drinking of a problematic nature is binge drinking. Binge drinking defines behavior by a number of drinks of an alcoholic beverage consumed in a space of time. The authors argue that the term does not describe drinking behavior that students believe is problematic. They claim that students define problem drinking not in terms of quantity, but rather by the outcome (and occasionally by frequency), and attribute different negative connotations to the term binge. They suggest using a term that has shared meaning with students, such as dangerous drinking, to describe the drinking behavior that results in undesirable or unintended consequences.     

Feasibility of Integrating Mental Health Screening and Services Into Routine Elder Abuse Practice to Improve Client Outcomes

This study examined law enforcement and prosecution involvement in 71 cases of elder abuse where pure financial exploitation (PFE), physical abuse (PA), neglect (Neglect), or hybrid financial exploitation (HFE) (financial exploitation co-occurring with physical abuse and/or neglect) occurred in a domestic setting. Victims of elder abuse and assigned Adult Protective Services (APS) caseworkers were systematically interviewed. Law enforcement officials were involved in 54% of the cases, and 18% of the cases were prosecuted. PA was significantly more likely to trigger a law enforcement response and to be prosecuted than Neglect or PFE. HFE involved prosecution for assault rather than financial exploitation. Generally, the victims of elder abuse were not receptive to criminal justice involvement, which appears to have a significant impact upon the level of this involvement. The reasons for this reluctance are discussed, as well as the challenges and limitations of criminal justice system involvement and related implications for policy and practice.     

Least Restrictive or Least Understood? Waist Restraints,Provider Practices,and Risk of Harm

Since implementation of The Omnibus Budget Reconciliation Act of 1987, restraint use in American nursing homes has reduced dramatically. The reduction in vest restraints has resulted in an increase in “least restrictive” devices such as waist restraints. Although this analysis of U.S. Food and Drug Administration Adverse Event Reporting Data Files found that waist devices pose the same potential risk for asphyxial death as vest restraints, few health professionals and consumers are aware of this outcome. Post-marketing device reporting needs better data quality and surveillance, which can certainly benefit the Centers for Medicare and Medicaid Services in their efforts to regulate and enforce standards of care that reduce deaths and injuries to vulnerable nursing home residents.     

Least Squares Programs-A Look at the Square Root Procedure

Various algorithms are in use on computers to solve least squares problems. Apparently very few programs use the square root procedure. In this paper, results from programs based on the square root procedure are compared with results based on some other algorithms. Remarkably good results are obtained using the square root procedure.