Resource effects on access to long-term care for frail older people

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Improbability of Igneous Intrusion Promoting a Critical Event in Spent Nuclear Fuel Disposed in Unsaturated Tuff

In their regulations, the U.S. Environmental Protection Agency and the U.S. Nuclear Regulatory Commission permit the omission of features, events, or processes with probabilities of <10(-4) in 10(4) yr (e.g., a constant frequency of <10(-8) per yr) in assessments of the performance of radioactive waste disposal systems. Igneous intrusion (or "volcanism") of a geologic repository at Yucca Mountain for radioactive waste is one disruptive event that has a probability with a range of uncertainty that straddles this regulatory criterion and is considered directly in performance assessment calculations. A self-sustained nuclear chain reaction (or "criticality") is another potentially disruptive event to consider, although it was never found to be important when evaluating the efficacy of radioactive waste disposal since the early 1970s. The thesis of this article is that the consideration of the joint event--volcanism and criticality--occurring in any 10,000-year period following closure can be eliminated from performance calculations at Yucca Mountain. The probability of the joint event must be less than the fairly well-accepted but low probability of volcanism. Furthermore, volcanism does not "remove" or "fail" existing hydrologic or geochemical constraints at Yucca Mountain that tend to prevent concentration of fissile material. Prior to general corrosion failure of waste packages, the mean release of fissile mass caused by a low-probability, igneous intrusive event is so small that the probability of a critical event is remote, even for highly enriched spent nuclear fuel owned by the U.S. Department of Energy. After widespread failure of packages occurs, the probability of the joint event is less than the probability of criticality because of the very small influence of volcanism on the mean fissile mass release. Hence, volcanism plays an insignificant role in inducing criticality over any 10(4)-yr period. We also argue that the Oklo reactors serve as a natural analogue and provide a rough bound on probability of criticality given favorable hydrologic or geochemical conditions on the scale of the repository that is less than 0.10. Because the product of this bound with the probability of volcanism represents the probability of the joint event and the product is less than 10(-4) in 10(4) yr, consideration of the joint event can be eliminated from performance calculations.     

The Social Dynamics of Technical Innovation in the Computing World*

The “computing world,” all those people and groups that collectively produce computers and computer-based services is an especially complex, dynamic and diffuse social world. Technical innovation is a dominant feature of the world. It is organized to provide a continuous flow of innovations from participants who specialize in innovation through many other participants to the final consumers of computer-based services. Technical innovations often flow across a large number of “markets” which are composed of only a few classes of participants such as “innovators” and “vendors” or of “users” and “consumers.” This paper identifies the major orientations taken on by participants in the computing world and examines some of the markets across which innovations are negotiated. The computing world is organized so that each market is biased in favor of innovations moving from suppliers to their customers. From this viewpoint, “innovation” is a dominant structural interest in computing around which participants organize their activities and to which they must continually adjust.     

Differences in Pharmacokinetics Between Children and Adults—II. Children''s Variability in Drug Elimination Half-Lives and in Some Parameters Needed for Physiologically-Based Pharmacokinetic Modeling

In earlier work we assembled a database of classical pharmacokinetic parameters (e.g., elimination half-lives; volumes of distribution) in children and adults. These data were then analyzed to define mean differences between adults and children of various age groups. In this article, we first analyze the variability in half-life observations where individual data exist. The major findings are as follows. The age groups defined in the earlier analysis of arithmetic mean data (0-1 week premature; 0-1 week full term; 1 week to 2 months; 2-6 months; 6 months to 2 years; 2-12 years; and 12-18 years) are reasonable for depicting child/adult pharmacokinetic differences, but data for some of the earliest age groups are highly variable. The fraction of individual children's half-lives observed to exceed the adult mean half-life by more than the 3.2-fold uncertainty factor commonly attributed to interindividual pharmacokinetic variability is 27% (16/59) for the 0-1 week age group, and 19% (5/26) in the 1 week to 2 month age group, compared to 0/87 for all the other age groups combined between 2 months and 18 years. Children within specific age groups appear to differ from adults with respect to the amount of variability and the form of the distribution of half-lives across the population. The data indicate departure from simple unimodal distributions, particularly in the 1 week to 2 month age group, suggesting that key developmental steps affecting drug removal tend to occur in that period. Finally, in preparation for age-dependent physiologically-based pharmacokinetic modeling, nationally representative NHANES III data are analyzed for distributions of body size and fat content. The data from about age 3 to age 10 reveal important departures from simple unimodal distributional forms-in the direction suggesting a subpopulation of children that are markedly heavier than those in the major mode. For risk assessment modeling, this means that analysts will need to consider "mixed" distributions (e.g., two or more normal or log-normal modes) in which the proportions of children falling within the major versus highweight/fat modes in the mixture changes as a function of age. Biologically, the most natural interpretation of this is that these subpopulations represent children who have or have not yet received particular signals for change in growth pattern. These apparently distinct subpopulations would be expected to exhibit different disposition of xenobiotics, particularly those that are highly lipophilic and poorly metabolized.     

Equal Opportunities Policies,Employment and Patriarchy

This paper, based on research in the North of England, seeks to examine the interconnections between equal opportunities policies, women's employment and patriarchy in a local labour market. It is argued that organizations develop a selection of public patriarchal strategies, most notable of which are the denial of inequality and the use of ‘time’ to segregate and disadvantage women within the labour market and labour process. It is masculine culture which has determined the shape and operation of equal opportunities policies where time commitment, individualism and priority to employment are necessary in order to achieve. Equal opportunities policies fail to address not only structural inequalities but also the role that organizations themselves play in maintaining gender segregation. By individualizing women the policies may also undermine women's own employment coping strategies which depend on assistance from other women both inside and outside the employment setting.     

Rate Capping and Local Government

This paper argues that rate-capping was an inevitable product of the government's determination to control both the aggregate expenditure of local government and that of all individual authorities. We set out the background to these developments before going on look in more detail at the mechanics of rate-capping and its likely effects on the services provided by "capped" authorities. We challenge the rationale underlying rate-capping, arguing that its motivation is largely political and that to be effective all (or most) authorities will have to be rate-capped. Finally we examine the resistance being offered by "capped" authorities, their chance of success and the implications for central-local relations.     

Innovation and Improvement in the Delivery of Public Services: The Use of Quality Management Within Local Government in Canada

Local government in Canada has been subject to considerable change in the 1990s. In response, a number of mechanisms have been adopted to improve performance and respond to citizen and customer demands. One particular mechanism quality management, has received considerable continuing support. This article documents the level of use of quality management within local government in Canada, discusses some of the key challenges of introducing this type of program, and, outlines some elements of success of those programs in public management.     

Use of Environmental Tobacco Smoke Constituents as Markers for Exposure

The 16-City Study analyzed for gas-phase environmental tobacco smoke (ETS) constituents (nicotine, 3-ethenyl pyridine [3-EP], and myosmine) and for particulate-phase constituents (respirable particulate matter [RSP], ultraviolet-absorbing particulate matter [UVPM], fluorescing particulate matter [FPM], scopoletin, and solanesol). In this second of three articles, we discuss the merits of each constituent as a marker for ETS and report pair-wise comparisons of the markers. Neither nicotine nor UVPM were good predictors for RSP. However, nicotine and UVPM were good qualitative predictors of each other. Nicotine was correlated with other gas-phase constituents. Comparisons between UVPM and other particulate-phase constituents were performed. Its relation with FPM was excellent, with UVPM approximately 1 1/2 times FPM. The correlation between UVPM and solanesol was good, but the relationship between the two was not linear. The relation between UVPM and scopoletin was not good, largely because of noise in the scopoletin measures around its limit of detection. We considered the relation between nicotine and saliva cotinine, a metabolite of nicotine. The two were highly correlated on the group level. That is, for each cell (smoking home and work, smoking home but nonsmoking work, and so forth), there was high correlation between average cotinine and 24-hour time-weighted average (TWA) nicotine concentrations. However, on the individual level, the correlations, although significant, were not biologically meaningful. A consideration of cotinine and nicotine or 3-EP on a subset of the study whose only exposure to ETS was exclusively at work or exclusively at home showed that home exposure was a more important source of ETS than work exposure.