Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1–10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.     

Minority government and marginal members: new issues for political and policy legitimacy in Australia

A steady decline in major party support in Commonwealth nations has resulted in changing parliamentary compositions, including the growing prevalence of minority government. Such situations pose new questions for notions of government legitimacy within Westminster systems. For instance, is negotiation with cross-benchers an example of government illegitimacy? What is the legitimate role of non-ministerial members when the composition of parliament gives them the final say on the enabling legislation for public policy? What is the legitimate response of the public sector regarding policy-making in the context of minority government? In this paper, we reflect on how a ‘marginal member’ concept can provide new insights into such issues and their implications.     

‘I’m not really sure but I hope it’s better’: early thoughts of parents and carers in a regional trial site for the Australian National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) is one of the most significant initiatives in Australian social policy history. Its complexity has been compounded by a fast-paced introduction and ongoing refinement throughout the initial trial phase. Parents and carers of very young disabled children face particular challenges accessing and navigating NDIS systems. This article presents findings from a mixed-method pilot study examining the perspectives of parents and carers of disabled children in one NDIS trial site – the Hunter Region of New South Wales. The research highlights a number of policy assumptions potentially impacting on NDIS take up for young disabled children and their families in regional contexts. Based on research findings a number of policy suggestions and improvements for disabled children and their families entering the NDIS and other individualised funding schemes are outlined.     

An online copy number variant detection method for short sequencing reads

The availability of the next generation sequencing (NGS) technology in today's biomedical research has provided new opportunities in scientific discovery of genetic information. The high-throughput NGS technology, especially DNA-seq, is particularly useful in profiling a genome for the analysis of DNA copy number variants (CNVs). The read count (RC) data resulting from NGS technology are massive and information rich. How to exploit the RC data for accurate CNV detection has become a computational and statistical challenge. We provide a statistical online change point method to help detect CNVs in the sequencing RC data in this paper. This method uses the idea of online searching for change point (or breakpoint) with a Markov chain assumption on the breakpoints loci and an iterative computing process via a Bayesian framework. We illustrate that an online change-point detection method is particularly suitable for identifying CNVs in the RC data. The algorithm is applied to the publicly available NCI-H2347 lung cancer cell line sequencing reads data for locating the breakpoints. Extensive simulation studies have been carried out and results show the good behavior of the proposed algorithm. The algorithm is implemented in R and the codes are available upon request.     

Movers as early adopters of linguistic innovation

Long‐distance migration is a primary source of language contact. Those who voluntarily migrate, though, may not resemble the broader population: psychological research suggests some factors that predispose people to become migrants also tend to lead to more openness to trying new things, potentially including linguistic features. This implies differential reactions to language contact, so inferences drawn from migrants may not generalize to the language‐contact process more generally. To test this hypothesis, this article examines lexical patterns in the 1940 United States census, focusing on who used the title mortician or funeral director rather than the traditional undertaker. Individuals who had moved from their state of birth were particularly likely to use the newer terms, even when explicitly controlling for the distribution of titles among the states from which the movers relocated. The personal characteristics leading people to encounter new linguistic environments may also independently affect their choices within those environments.     

What if gender became an essential,standard element of Vulnerability Assessments?

Vulnerability Assessments (VAs) can be useful tools for providing key insights for non-government organisations and other development actors, including governments. Not only can they provide an extensive, ‘landscape-wide’ understanding of vulnerability and its underlying causes in a specific context, but this understanding can be jointly owned by all participants. They can thus be used for designing risk reduction and resilience-building measures, programmes, or projects that affect specific groups within a community or the landscape. Beyond that, VAs can provide a platform that promotes interaction among otherwise disconnected stakeholders, as well as the evidence and argumentation for community groups to engage in advocacy with local and municipal/district authorities. This article draws on our combined experience as development practitioners, and considers what we have learnt about the importance of integrating gender issues into VAs.     

Examining concepts of power and agency in research with young people

Concepts of power and agency have become increasingly prominent in the youth studies literatures and related research. A focus of the research to date has been an examination of how a better understanding of young people's lived experiences can reveal possibilities for young people's agency to emerge. Despite increased interest in the term agency, much less has been said about how the concept is defined and recognized in research with young people, including what the concept may entail but crucially, how the term is linked to and underpinned by the related concept of power. This paper seeks to contribute to our understanding of power and agency as utilized in research with young people. The discussion that follows identifies the possible ways in which different theoretical positions shape our understanding of how power and agency are investigated and how these understandings inform the ways we interpret young people's perspectives and actions as holding potential for ‘agency’. Drawing on recent empirical examples, we consider how varying interpretations of power and/or agency shape not only the ways in which young people's agentic experiences are theorized (and the related ontological and epistemological assumptions these positions imply) but also the presumed effects of that agency.     

Disability and climate change: A critical realist model of climate justice

Existing literature on climate change as an issue of environmental justice documents the heightened vulnerability of people with disabilities to the effects of climate change. Additionally, there are numerous studies showing that access to information is a prerequisite for perceiving risk and taking action. Building on this work, our review seeks to understand how physical disability relates to perceptions of climate-related risk and adaptations to climate-related events. We introduce a critical realist model of climate justice to understand the relationships between the environmental features that disable, risk perception and information seeking, and adaptive capacity and resilience to climate change. In understanding the vulnerability and adaptive capacity of people with disabilities to climate change, this review synthesizes research on one of the U.S.’s largest minority communities with the goals of better understanding how vulnerable populations cope with climate change and integrating them into climate action and policy.     

失地农民问题与制度变迁

文章在制度演进论的框架下分析了农民失地的制度变迁过程,重新分析了被我国学者忽视的失地农民和城市居民作为行为主体的参与博弈过程所起到的重要作用。同时提到了要关注制度执行的效率与结果,提出了失地农民得到补偿后会带来的一些社会问题,最后要求加强制度的执行监管,提出建立一种平衡机制,达到社会的和谐的目标。