Nursing Home Ownership Trends and Their Impacts on Quality of Care: A Study Using Detailed Ownership Data From Texas

The role of ownership in the provision of nursing home care has long been a challenging issue for policy makers and researchers. Although much of the focus historically has been on differences between for-profit and not-for-profit facilities, this simple distinction has become less useful in recent years as companies have employed more complicated ownership and management structures. Using detailed ownership data from the state of Texas, we describe the evolution of nursing home corporate structures from 2000 to 2007, analyze the effect of these structures on quality of care and staffing in nursing homes, and discuss the policy implications of these changes.     

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.     

The Family Interaction Test A Preliminary Study of a Method for Interpreting Narratives about the Family

The Family Interaction Test is a narrative projective method designed to elicit children's perceptions of family life and patterns of interaction by way of stories around particular themes and events. Drawing on a post-modern interpretive approach, the paper proposes that traditional psychometric research methodologies underpinned by the logico-empirical paradigm are inappropriate in the study of narrative meaning. It is argued that practitioners, rather than seeing themselves as separate from the story teller and thus objectifying the ‘true’ meaning of the narratives, can instead enter into a discourse with the story teller as a way of testing hypotheses and thus establish the verisimilitude of story meanings. The results of a preliminary clinical study using this methodology with the Family Interaction Test are presented and discussed.     

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.     

A Bayesian Approach to Integrated Ecological and Human Health Risk Assessment for the South River,Virginia Mercury‐Contaminated Site

We conducted a regional‐scale integrated ecological and human health risk assessment by applying the relative risk model with Bayesian networks (BN‐RRM) to a case study of the South River, Virginia mercury‐contaminated site. Risk to four ecological services of the South River (human health, water quality, recreation, and the recreational fishery) was evaluated using a multiple stressor–multiple endpoint approach. These four ecological services were selected as endpoints based on stakeholder feedback and prioritized management goals for the river. The BN‐RRM approach allowed for the calculation of relative risk to 14 biotic, human health, recreation, and water quality endpoints from chemical and ecological stressors in five risk regions of the South River. Results indicated that water quality and the recreational fishery were the ecological services at highest risk in the South River. Human health risk for users of the South River was low relative to the risk to other endpoints. Risk to recreation in the South River was moderate with little spatial variability among the five risk regions. Sensitivity and uncertainty analysis identified stressors and other parameters that influence risk for each endpoint in each risk region. This research demonstrates a probabilistic approach to integrated ecological and human health risk assessment that considers the effects of chemical and ecological stressors across the landscape.     

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.