Administering the U.S. Family Violence Option: The role of stigma in waiver recommendations

The Family Violence Option (FVO) was designed to help survivors of domestic violence (DV) more easily secure income support in the United States (U.S.), without placing them at risk of further abuse. The objective of this study is to determine whether the decision-making of advocates responsible for determining waiver recommendations under the FVO is influenced by the relationship status of DV survivors. Recursive partitioning was used to analyse data from a sample of 237 survivor risk assessments from four New Jersey counties to determine which women receive waiver recommendations and which do not. Advocates completed risk assessments for the women and were instructed to make recommendations on waivers based on their assessment. Workers’ decision-making was examined using classification and regression trees (CART) to determine what case factors made it more or less likely for survivors to be recommended waivers. The CART results were supplemented with logistic regression analyses to ensure validity. For two of three waivers, survivors who reported currently residing with their abuser or who had ended the relationship recently were less likely to receive waiver recommendations than those who had been out of the relationship for a longer period of time (OR = 0.09–0.21), even when accounting for the type and severity of DV and the impacts of the violence on survivors’ mental health. The results indicate that DV advocates’ decision-making is complicated by factors independent of survivors’ case characteristics. This can affect the safety and well-being of women attempting to leave violent relationships by affecting their access to resources.     

A GPS logger and software for analysis of homing in pigeons and small mammals

A detailed analysis of homing in pigeons and small mammals has remained difficult because the paths of the animals could not be reconstructed precisely. Here, we describe a lightweight global position system (GPS) data logger (35 g including battery and casing; 40 x 68 x 18 mm) that records the flight of pigeons and the path of dogs with an accuracy of +/-12 m. With one battery, the logger runs in continuous mode (1 fix/s) for 3.5 h and in power-saving mode (1 fix/5 s) for about 16 h, and stores a maximum of 100,000 data points that are downloaded to a PC. A module of our public domain software WINTRACK permits a detailed numerical and graphical analysis of path geometry, phases of resting and moving, and path similarity. The device can be adapted to different species provided that satellite signals can be received reliably and that the loggers can be recovered. We expect it to be useful for testing hypotheses about pigeon homing, assessing natural spatial behavior and orientation of many species, and anticipate further miniaturization.     

Cardiac myxomas

Cardiac myxoma is the most common primary tumor of the heart. Between 1970 and 1998, 33 myxomas from patients operated at the Cardiosurgical Department were submitted for pathological examination. A review of age, sex and clinical symptoms of the patients as well as of gross and histological features of the tumors is presented. Immunohistochemical examination was performed on 10 selected myxomas-reactivity to vimentin, desmin, S-100 protein, cytokeratin and FVIIIR-Ag. The necessity of histological examination of the embolectomy material is stressed.     

Carcinoid heart disease

Demonstrated are eight cases of carcinoid heart disease (7 females, 1 male; average age 63.4 y.). The primary tumor was localized in the ileum in 5, and in the cecal area in 3 patients, with liver metastases in each case. The characteristic heart lesion appears as an endocardial plaque composed of loose intercellular matrix with scattered smooth muscle cells, covered by an endothelial layer. The plaques are apposed on an otherwise normal valvular, or mural endocardium of the right heart. The resulting combined valvular lesions show a predominance o tricuspid incompetence, or of pulmonary stenosis. In one case with a widely patent foramen ovale there was involvement of left-heart valves in addition. Local effect of serotonin appears to play the main role in pathogenesis of the endocardial plaques.     

Postpartum psychiatric disorders

The literature on postpartum psychiatric disorders (PPD) is reviewed with particular reference to recent advances in the field. Despite the prevailing tendency to consider PPD as a manifestation of other pre-existing psychiatric disorders (i.e. affective, schizophreniform, organic, neurotic, etc.) a growing number of studies point to the uniqueness and specificity of postpartum symptomatology. Theories of etiology, psychosocial as well as biological, are still wide-ranging and unconvicing. Attempts to predict PPD and/or to identify mothers-to-be at risk are based largely on retrospective studies or else are hindered by the use of nonspecific instruments. Society's implicit belief in the "joys of motherhood" may have further contributed to the obscurity surrounding these frequently occurring disorders. Interventions follow conventional methods of psycho- and pharmacotherapy but the multidisciplinary treatment approach especially for women with acute PPD who require hospital admission is gaining wider acceptance. The inpatient psychiatric mother-baby intensive care unit model is part of this approach.     

Appropriateness of acute medical care for the elderly: an analysis of the literature

Over the past 30 years, an explosion in health care expenditures has occurred. Prior to 1960, health care accounted for 4.4% of the U.S. Gross National Product; today it is 11%. Before rational solutions to controlling this rise can be proposed, we must determine whether the care that we are currently paying for is appropriate to the needs of the elderly. This paper analyzes the literature regarding appropriateness of acute care provided to the elderly. We identified 17 articles that explicitly cited appropriate or inappropriate care (including under-, over- and misuse) provided in hospital and ambulatory settings and for procedures, and 19 articles that presented data on the appropriateness of medication use in the elderly. Virtually every study included in this review found at least double-digit levels of inappropriate care. Perhaps as much as one-fifth to one-quarter of acute hospital services or procedures were felt to be used for equivocal or inappropriate reasons, and two-fifths to one-half of the medications studied were overused in outpatients. The few studies that examined underuse or misuse of services also documented the existence of these phenomena. This was especially true for the ambulatory care of chronic physical and mental conditions and concerned the use of low-cost technologies (visits, preventive services, some medications). Thus, we conclude that there appears to be a substantial problem in the matching of acute services to the needs of elderly patients. This mismatch occurs both in terms of overuse and underuse, at least for areas where research has been conducted.     

Zur Topographie des oberen Bicepssehnenabschnittes

Zusammenfassung Die polarisationsoptische and histologische Untersuchung des oberen Bicepssehnenabschnittes an 26 Schultern bestätigt, daß die Sehne ihren Ursprung nicht nur, wie allgemein angenommen, am Tuberculum supraglenoidale hat, sondern außerdem -förmig im Labrum glenoidale. Dieser Befund kann phylogenetisch erklärt werden. Im weiteren Verlauf der Sehne können neue Befunde im Bereich des Sulcus bicipitalis erhoben werden. Hier ist regelmäßig ein Mesotenonium nachweisbar, das durch einen bindegewebigen Ausläufer an Sulcusdach oder -grund befestigt ist. Darüberhinaus wird gezeigt, daß das Sulcusdach nicht als Ligament (Ligamentum transversum humeri) anzusprechen ist, es handelt sich vielmehr um Ausläufer der Kollagenfasern von Subscapularis- bzw. Kapselansatz am Tuberculum minus.

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Topography of the upper biceps tendon

Summary 26 shoulders are studied by polariscopic and histologic examination. It can be confirmed that the origin of the long biceps tendon is not only at the supraglenoid tubercle, but also -shaped in the glenoid labrum. This finding can be explained by phylogenetic means. Further details are found during the course of the tendon through the bicipital groove. A mesotenonium is seen regularly. This is fixed either to the roof or the ground of the sulcus by a band of connective tissue. It is shown also, that the roof of the groove is not a ligament (ligamentum transversum. humeri) but consists of collagen fibers continuing from the subscapularis and capsular attachment at the lesser tubercle.

     

Health policy. Managed care--just ask US

Managed care in the US reduces use of health services and hospital admissions. Concerns that cost control could jeopardize quality are widespread. But there is no significant evidence to suggest that this is the case. Managed care produces low patient satisfaction ratings. The US evidence on managed care has little direct relevance to the UK, but elements of it might be usefully tested here.