Evaluation of the south carolina comr/cunity long-term care medicaid waiver for the elderly and disabled

Medicaid waivers play an important role in the health policy process. Various health care policy initiatives have encouraged states to experiment ith their Medicaid programs by expanding coverage to populations not traditionally covered by Medicaid, or by delivering Medicaid services in non traditional ways. Lessons learned by individual states' Medicaid waivers could be an important part of the health care reform debate. This paper presents an evaluation of a Medicaid waiver operating in South I Carolina. The South Carolina Community Long-term Care Waiver for the Elderly and Disabled is evaluated for cost effectiveness, quality of care, and client satisfaction. This evaluation shows that the waiver is highly effective in offering individuals who are medically and financially eligible for Medicaid supported nursing home care a viable, cost effective, high quality alternate to institutionalization.     

Fatal non-accidental pediatric cranial fracture risk and three-layered cranial architecture development

This study examines the influence of three-layered cranial architecture development upon blunt force trauma (BFT) cranial outcomes associated with pediatric non-accidental injury (NAI). Macroscopic and microscopic metric and morphological comparisons of subadult crania ranging from perinatal to 17 years of age chronicle the ontogenetic development and spatial and temporal variability in the emergence of a mature cranial architecture. Cranial vault thickness increases with subadult age, accelerating in the first 2 years of life due to rapid brain growth during this period. Three-layer differentiation of the cranial tables and diploë initiates by 3–6 months but is not consistently observed until 18 months to 2 years; diploë formation is not well developed until after age 4 and does not manifest a mature appearance until after age 8. These results allow topographic documentation of cortical and diploic development and temporal and spatial variability across the growing cranium. The lateral cranial vault is identified as expressing delayed development and reduced expression of the three-layer architecture, a pattern that continues into adulthood. Comparison of fracture locations from known BFT pediatric cases with identified cranial fracture high-risk impact regions shows a concordance and suggests the presence of a higher fracture risk associated with non-accidental BFT in the lateral vault region in subadults below the age of 2. The absence or lesser development of a three-layered architecture in subadults leaves their cranial bones, particularly in the lateral vault, thin and vulnerable to the effects of BFT.     

Deer stand fatalities in Kentucky: two cases of reverse suspension and blunt force trauma

Hunting many types of wild game is an avidly pursued outdoor activity that attracts all ages and both genders at various times of the year. Deer hunting is a popular sport in many regions of North America. A variety of weapons are used in the hunting, trapping, and killing of game. As a variety of different modalities are used, myriad types of injuries unique to the type of hunting can occur. Most deer hunting-related fatalities identified at the Office of the Chief Medical Examiner in Kentucky are accidental firearm injuries. Less commonly encountered are fatalities resulting from elevation of the hunter in a tree stand, often associated with poor design or construction of the perch. We present 2 tree stand-related deaths. One victim died of positional asphyxia due to reverse suspension from a hunting tree stand. The second victim died of multiple blunt force injuries sustained in a 20-foot fall from a tree stand. We summarize the features of morbidity and mortality related to deer hunting based on investigations by the Office of the Chief Medical Examiner.     

Theory and the scientific basis for forensic anthropology

Forensic anthropology has long been criticized for its lack of a strong theoretical and scientific foundation. This paper addresses this problem by examining the role of theory in forensic anthropology at different hierarchical levels (high-level, middle-range, and low-level) and the relevance of various theoretical concepts (taphonomic, agency, behavioral archaeology, nonlinear systems, and methodological theories) to the interpretation of forensic contexts. Application of these theories to a case study involving the search for the WWII Goettge Patrol illustrates the explanatory power these theories offer to the interpretation of forensic events as the end product of an often complex set of environmental constraints and behavioral interactions and choices. It also emphasizes the importance of case studies in theory building and hypothesis testing. A theoretical foundation does indeed currently exist in forensic anthropology; however, a recognition and broader implementation of anthropological (archaeological) theory is warranted and will further define forensic anthropology as a scientific endeavor.     

Parental warmth amplifies the negative effect of parental hostility on dating violence

Past research has documented the positive association between parental hostility and offspring involvement in intimate partner violence. Researchers, practitioners, and parents typically adopt the standpoint that parental warmth may counter these negative lessons. However, Straus and colleagues argue that parents foster IPV to the extent that they teach their child that verbal and physical aggression are a normal and legitimate component of loving relationships. A strict interpretation of social learning theory would suggest that these lessons are more, not less, likely to occur when parental hostility is interspersed with displays of affection. The present study tests this idea using data from 2,088 undergraduate students from a large university in the Southeast. Consistent with Straus' arguments, findings suggest that, rather than attenuating the negative effects of hostility, supportive interactions seem to amplify the probability that offspring will emulate aggressive behaviors in their own romantic relationships. The same is true for the effects of harsh parenting for women. It seems that the best way parents can avoid contributing to their child's chances of being in a violent dating relationship is to eschew family interaction involving verbal and physical aggression.     

Reconceptualizing elder abuse: treating the disease of senior community exclusion

This article focuses on the phenomenon of elder abuse, which is one of the paramount symptoms of the larger community's failure to address the social, medical, and legal needs of the senior populace. Although there have been multidisciplinary efforts to address this problem, they are not responsive to the needs of the senior population itself In response, the authors propose a model that takes into account the specific concerns of local senior communities and provides seniors and their stakeholder providers a stable infrastructure to ensure open, consistent, and effective participation and delivery of services.