State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.     

Boundary-Crossing Competence: Theoretical Considerations and Educational Design

This article provides a conceptual account and empirical analyses of the development of boundary-crossing competence—the ability to function competently in multiple contexts—using representative cases from two after-school programs with immigrant and low-socioeconomic status students. Our findings suggest that organizational designs that create networks of related communities of practice can provide opportunities for nondominant students to develop boundary-crossing competences through participation in expanded, horizontal—rather than hierarchal—systems of what Moll and colleagues have called “networked expertise.” These new directions in understanding competence have important implications for improving learning designs for nondominant students.     

The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751–2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

Beyond Self‐Reports: Changes in Biomarkers as Predictors of Mortality

The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population‐based surveys. A crucial question is whether biomarkers offer incremental value beyond self‐reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (aged 54+ in 2000, examined in 2000 and 2006 with mortality follow‐up through 2011) to address that question with respect to predicting all‐cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self‐reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six‐year period yields a small improvement in mortality prediction compared with one‐time measurement. But, is the incremental value worth the costs?     

The Impact of the Within My Reach Relationship Training on Relationship Skills and Outcomes for Low‐Income Individuals

A federal grant was awarded to provide the Within My Reach healthy relationships curriculum to low‐income, at‐risk individuals involved with various social service agencies. The effectiveness of this curriculum was evaluated for 202 participants through measures of training and relationship outcomes pre‐, immediately post‐ and 6 months posttraining. Participants experienced high levels of training satisfaction; significant increases in knowledge, communication/conflict resolution skills, and relationship quality; as well as a trend in the reduction of relationship violence. An important implication of this research is that MFTs may broaden their service delivery to at‐risk individuals by collaborating with community agencies to adapt established relationship enhancement programs, evidence‐based tools, and principles that complement traditional couples therapy.     

Resource Dependency and Rural Poverty: Rural Areas in the United States and Japan*

Abstract Although rural residents often expect resource extraction to lead to local prosperity, much of the recent research finds that resource extraction is associated with poverty. This paper tests these results by examining whether the findings may be due to methodological factors such as the tendency to focus on extreme cases, particular extracting sectors, and certain periods of time. By comparing two localities that have followed very different developmental trajectories—the state of Wisconsin and Hokkaido Prefecture in Japan—during the period from 1970 to 1990, this paper addresses these issues. The results do not clearly support either the expectation that resource extraction will lead to poverty or that it will lead to economic prosperity. Instead, like a handful of studies on resource dependency, the results indicate that the relationship between extraction and poverty is unique to location. Despite the many differences between the United States and Japan, the strongest correlates of poverty in each country involve the proportion of land in an area that is forested. Particularly because these results mirror the findings from the one previous study that included this variable, future research must give greater attention to this explicitly environmental variable, as well as examining some of the possible reasons for the relationship.     

Reaching for Integrity: An Eriksonian Life-Cycle Perspective on the Experience of Adolescents Being Raised by Grandparents

Increasing numbers of children are being raised by their grandparents because their own parents are unable or unwilling to care for them. A case is presented illustrating how an Eriksonian life-cycle perspective clarifies the developmental demands on adolescents in these situations and provides a theoretical framework for organizing therapeutic work with them.     

Americans and Iraq,twelve years apart: Comparing support for the US wars in Iraq

Significant differences exist in Americans’ support for force between the 1991 Persian Gulf War and 2003 Iraq War, even when holding all demographic variables constant. Nearly every group decreased their support from 1991 to 2003, including men and women, Whites and racial minorities, people with high school degrees or higher, nearly all age categories, and Democrat and Independent affiliated individuals. When examining potential causes for decreased support in the 2003 Iraq War, the “nature of the conflict” presents the strongest argument and evidence. The Persian Gulf War aimed to force the Iraqi army from Kuwait, while the Iraq War was aimed at changing the governmental regime of Iraq. The latter conflict was less socially acceptable than the former to Americans. These differences between the conflicts are the best explanation for the change in support, while other explanations, including the changing composition of the population and a less pro-military populace, are insufficient.