Rethinking homicide: violence, race, and the politics of gender

Although homicide is the fourth leading cause of premature mortality in the United States and the leading cause of death for young blacks, the health professions have been largely oblivious to violence. Prevailing explanations contribute to this neglect by emphasizing biological or psychiatric factors that make homicide unpredictable and cultural and environmental factors such as the emergence of a new "underclass" that link violence to race. Focusing on instances where no other crime is involved, this article proposes that "primary" homicide be reconceptualized as a by-product of interpersonal violence, a broad category of social entrapment rooted in the politics of gender inequality and including wife abuse, child abuse, and assaults by friends and acquaintances. The data show that blacks are no more violent than whites, though they are arrested and die more often as the consequence of violence. In addition, a majority of homicides are between social partners or involve gender stereotypes, are preceded by a series of assaults that are known to service providers, and grow out of "intense social engagement" about issues of male control and independence. Professional failure to respond appropriately is a major reason why assaults become fatal, particularly among blacks. An international strategy that combines sanctions against interpersonal assault, gun control, and the empowerment of survivors might prevent half of all homicides.     

Corneal complications of intraocular surgery

Advances in intraocular surgery have decreased the incidence of corneal complications that result in corneal failure requiring transplantation. Interest continues in further refining surgery to minimize endothelial cell damage. New irrigating solutions, viscoelastic substances, and even new techniques have been introduced. Debate continues over certain issues, such as intraocular lens choice in the absence of capsular support. Improved design has prompted many early critics to regain confidence in the anterior chamber lens. Literature of recent years also reflects a shift in focus toward hastening recovery time and maximizing uncorrected visual acuity through the advantageous control of corneal astigmatism. Several reports this year may herald the next wave of interest, that surrounding intraocular surgery after refractive corneal surgery.     

Utilization of services for mentally ill chemically abusing patients discharged from residential treatment

Little is known about outcomes of treatment for individuals with mental illness and chemical dependencies. This article compares services utilization preadmission and postdischarge in 534 patients discharged from a residential treatment program in Washington State. A number of services, including chemical dependency detoxification, mental health crisis, inpatient psychiatric, medical emergency, and general medical inpatient hospitalization, were used less frequently in the period after discharge. The total reimbursement for all Medicaid services decreased by 44% from $5 million in the year prior to discharge to $2.8 million in the year after discharge. Also, individuals (32%) who completed the program were less likely to use costly, acute care services. This study was limited by the absence of a control group and posttreatment alcohol and drug use data. In addition, other unmeasured factors could have explained the association between program completion and better outcomes.     

Effects of adenosine on electrical activity of isolated guinea pig hearts

Summary Negative chronotropic and dromotropic effects of adenosine seem to be responsible for its antiarrhythmic action on supraventricular tachyarrhythmias. To further characterize the effects of adenosine on supraventricular arrhythmias heart rate, conduction, refractoriness, the time to steady-state of AV-nodal conduction slowing and of sinus rate reduction were evaluated.Changes of heart rate, conduction intervals and effective refractory periods were determined by the use of a high-resolution ECG recording technique in isolated guinea pig hearts perfused by the method of Langendorff.Adenosine in concentrations of 3 and 10 M reduced sinus rate and prolonged AV-nodal conduction significantly, while intraventricular and His bundle conduction were not altered. The maximal effect of adenosine on the sinus node and AV nodal conduction occurred after 636±109 and 111±35 (mean±SE) beats, respectively.During programmed stimulation at a cycle length of 250 ms, adenosine reduced atrial ERP in a dose-dependent manner. At cycle lengths of 170 and 200 ms, adenosine increased the atrial ERP at 3 M, and then progressively shortened the ERP at higher doses. At all adenosine concentrations used, the usual rate-dependent adaption in ERP was suppressed.These observations explain the efficacy of adenosine against supraventricular tachyarrhythmias where the AV-node forms a part of a reentrant circuit. Adenosine shortened the atrial ERP, but at high pacing rates also led to a relative prolongation of the atrial ERP as the rate-dependent adaption was suppressed. These opposite effects of adenosine may explain earlier contradictory findings of its action on atrial arrhythmias.     

Sixth Graders Can Take Blood Pressures

A curriculum guide entitled "Heart Health Curriculum Guide" was developed with and by teachers in Peabody Public Schools under a Massachusetts Public Health grant to the American Heart Association. The 67-page manual describes the format of the 12-hour teacher workshop, background physiology of heart/circulatory system, hypertension risk factors, a set of 20 lessons, and evaluating procedures. (Copies may be obtained for $3.00 by writing the corresponding author.) As a result of teaching this unit, sixth grade students in each school ran a Blood Pressure Screening Clinic for their parents and school staff.     

Extended multiplicative signal correction and spectral interference subtraction: new preprocessing methods for near infrared spectroscopy.

Near infrared (NIR) spectroscopy spectra can be converted mathematically to precise quantitative information of chemical and physical nature by multivariate calibration. This makes NIR analysis useful for a variety of "difficult" sample types (powders, slurries), more or less without any sample preparation. The paper emphasizes the importance of using prior knowledge for spectral preprocessing of spectral data prior to the linear multivariate calibration modelling. Two new preprocessing methods are presented: extended multiplicative signal correction (EMSC) for elimination of uncontrollable path length or scattering effects, and spectral interference subtraction (SIS) for elimination of known spectral interferences. Determination of toluene in mixtures with benzene and xylene from NIR spectra with gross simulated light scattering effects is used for illustration.     

Reliability of level of care decisions in a Long-Term Care program

This paper addresses the question of the degree of agreement between experienced assessors making level-of-care placement decisions for the same client, given a comparable opportunity to obtain and record client information in a community-based Long-Term Care program.A systematic sample of 246 cases was selected, consisting of 47 preadmission assessments and 199 reviews. The resulting data were subjected to analysis using the statistic Kappa and the degree of agreement categories suggested by Fleiss.¹ It was found that at the level-of-care extremes— Extended Care and Personal Care—the agreement between two nurse assessors for reviews could be considered excellent. In the Intermediate Care range, however, the reliability of the level-of-care decision can only be considered fair. Agreement for initial assessments was less, withK=0.469 indicating, overall, only fair agreement. While there was most often only a one-care-level difference between assessors, the program assessor tended to recommend a higher level than the study or check assessor. This has implications for funding agencies and/or facility planners who must assess the likely care requirements of an increasing number of disabled elderly. From a program management perspective, the preceding analyses allow an objective judgement of the extent of the placement decision problem, if any, and further provide a definition of areas most in need of revision. The value of collaboration between practitioner and researcher is evident in these analyses.Dr. Stark is Director, Division of Health Services Research and Development and Assistant Professor, Department of Health Care and Epidemiology, The University of British Columbia. Dr. Gutman is Director, Gerontology Centre and Associate Professor, Faculty of Interdisciplinary Studies, Simon Fraser University. Dr. Brothers is Research Associate, Division of Health Systems, The University of British Columbia. Address enquiries to Dr. A. Stark, Director, Division of Health Services Research and Development, Office of the Coordinator of Health Sciences, The John F. McCreary Health Sciences Centre, 2194 Health Sciences Mall, The University of British Columbia, Vancouver, B.C., V6T 1Z6.The research described in this paper, as well as the larger study of which it is a part, is supported by a grant from the B.C. Health Care Research Foundation. In addition, the cooperation and support of the Ministry of Health, Province of British Columbia is gratefully acknowledged.     

Pharmacy in the health care center: a model for health care delivery

Health care consumers use a plethora of services which are accessible on an ambulatory basis. These include the services of pharmacists, optometrists, nurses, dentists, audiologists, orthotics, and so forth. Since many of these services are provided in physically and financially separate facilities and often are not located in close proximity to one another, consumers may spend a large amount of time traveling between locations. Economic inefficiencies due to the size and dispersion of separate and independent facilities may produce an increase in the cost of ambulatory health care services. Thus, the concept of a health care center, an ambulatory health care analog to the multispecialty shopping center, is proposed as a potential alternative and improvement in the delivery of these services. Space, location, personnel, and initial capital requirements for a model health care center are projected based on existing data for the establishment of each separate auxiliary health care facility. Projections are made to determine the appropriate and necessary site for the health care center's trade area. Potential revenues are calculated by examining some pharmacy operations which are beginning to pioneer these areas and utilizing revenue figures for the various individual services. The results indicate that the pharmacy, as a frequently visited health care facility, may be an excellent choice around which to develop the health care center concept in metropolitan areas.