Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

Going to Pieces: Paul Monette and the Fragments of the Tribe

Author of the highly acclaimed Borrowed Time: An AIDS Memoir (1988) and winner of the 1992 National Book Award for his autobiography Becoming a Man: Half a Life Story, Paul Monette died of complications from AIDS in Los Angeles on February 12, 1995. His most recent work, Last Watch of the Night: Essays Too Personal and Otherwise (1994), is his third volume in a trilogy of autobiographical writing on growing up gay, coming-out, and living with AIDS. A graduate of Phillips Academy and Yale University, Monette received a number of awards for his writing and his work as an outspoken voice in the battle against AIDS, including the National Book Award, three Lambda Literary awards, the PEN Center West Freedom to Write Award, and three honorary doctorate degrees, from Wesleyan University, the City University of New York, and the State University of New York at Oswego. A memorial service was held for Monette on Sunday, February 19, 1995, at the Directors Guild of America on Sunset Boulevard in Los Angeles. Paul Monette was 49.     

Three faces of international inequality

Recent studies of international inequality have focused mostly on the trend in international income inequality. This article extends the analysis of international inequality to also include inequalities in education and health. Analyses of time-series data for more than 100 countries show that international income inequality declined from 1980 to 2003 as several large, poor Asian countries outpaced many Western countries in national income growth. By contrast, international health inequality followed a U-shaped trend, falling in the 1980s before rising in the 1990s. The turnaround in health inequality coincides with a trend of declining life expectancy in sub-Saharan Africa. International educational inequality experienced the sharpest recent decline, spurred by the global expansion of formal schooling. These findings confirm that there is more to international inequality than income inequality alone and suggest that patterns of inequality in the current era of globalization are likely more complex than many leading theories suggest.     

Bioaccessibility and Risk of Exposure to Metals and SVOCs in Artificial Turf Field Fill Materials and Fibers

To reduce maintenance costs, municipalities and schools are starting to replace natural grass fields with a new generation synthetic turf. Unlike Astro‐Turf, which was first introduced in the 1960s, synthetic field turf provides more cushioning to athletes. Part of this cushioning comes from materials like crumb rubber infill, which is manufactured from recycled tires and may contain a variety of chemicals. The goal of this study was to evaluate potential exposures from playing on artificial turf fields and associated risks to trace metals, semi‐volatile organic compounds (SVOCs), and polycyclic aromatic hydrocarbons (PAHs) by examining typical artificial turf fibers (n = 8), different types of infill (n = 8), and samples from actual fields (n = 7). Three artificial biofluids were prepared, which included: lung, sweat, and digestive fluids. Artificial biofluids were hypothesized to yield a more representative estimation of dose than the levels obtained from total extraction methods. PAHs were routinely below the limit of detection across all three biofluids, precluding completion of a meaningful risk assessment. No SVOCs were identified at quantifiable levels in any extracts based on a match of their mass spectrum to compounds that are regulated in soil. The metals were measurable but at concentrations for which human health risk was estimated to be low. The study demonstrated that for the products and fields we tested, exposure to infill and artificial turf was generally considered de minimus, with the possible exception of lead for some fields and materials.     

Predictive Inference for Big,Spatial, Non‐Gaussian Data: MODIS Cloud Data and its Change‐of‐Support

Remote sensing of the earth with satellites yields datasets that can be massive in size, nonstationary in space, and non‐Gaussian in distribution. To overcome computational challenges, we use the reduced‐rank spatial random effects (SRE) model in a statistical analysis of cloud‐mask data from NASA's Moderate Resolution Imaging Spectroradiometer (MODIS) instrument on board NASA's Terra satellite. Parameterisations of cloud processes are the biggest source of uncertainty and sensitivity in different climate models’ future projections of Earth's climate. An accurate quantification of the spatial distribution of clouds, as well as a rigorously estimated pixel‐scale clear‐sky‐probability process, is needed to establish reliable estimates of cloud‐distributional changes and trends caused by climate change. Here we give a hierarchical spatial‐statistical modelling approach for a very large spatial dataset of 2.75 million pixels, corresponding to a granule of MODIS cloud‐mask data, and we use spatial change‐of‐Support relationships to estimate cloud fraction at coarser resolutions. Our model is non‐Gaussian; it postulates a hidden process for the clear‐sky probability that makes use of the SRE model, EM‐estimation, and optimal (empirical Bayes) spatial prediction of the clear‐sky‐probability process. Measures of prediction uncertainty are also given.     

Male bisexuality and condom use at last sexual encounter: results from a national survey

Relatively little is known about condom use among bisexual men as separate and distinct from exclusively homosexual and heterosexual men. Most previous research on bisexual men has relied on non-probabilistic, high risk samples with limited generalizability. We examined the relationship between male behavioral bisexuality and condom use in the 2002 cycle of the National Survey of Family Growth (NSFG). Bisexually-active men positively differed from heterosexually- and homosexually-active men on every indicator of confounding risk. However, bisexually-active men did not report using condoms less often than other men during their last sexual encounters with males and females. Indeed, with female partners, bisexually-active men reported higher rates of condom use than other men. These relationships remained when all sociodemographic and confounding risk factors were held constant. Our results suggest that caution must be used when making assumptions about condom use in the general population of bisexual men from non-probabilistic samples.     

Hospital-to-community transitions. A bridge program for adolescent mental health patients

Making the transition from the hospital to a community setting can be extremely challenging for patients with acute mental health conditions. Transitional services have been created to help patients overcome difficulties associated with this transition. Nurses frequently play an integral role in the success of these services. By providing patients with individualized support during such transitions, nurses act as clinical liaisons and directly contribute to an increase in positive patient and system-level outcomes. This article describes a transitional service called the Bridge Program, designed to help adolescents make a successful transition from the hospital to the community. An overview of the Bridge Program is provided, and the results of an evaluation of this program are presented. Results suggest that the Bridge Program contributes to a decrease in the length of hospital stays and improves continuity of care for patients and their families.