Poorhouse to Warehouse: Institutional Long-Term Care in the United States

Nursing homes in the United States are a product of Americanfederalism and reflect the complexities and variabilities ofthat system. Over time, institutional long-term care for frailelders has shifted from local government funding and administrationto state-level oversight and support to a shared federal-stateconcern. The unsystematic American approach produces haphazardresults in terms of quality, equity, and efficiency. The grayingof the American population will increase the demand for long-termcare, resulting in pressure for a more coherent policy response.     

Work in the interstices: Woman in academe

Stress and anger are inevitable responses on the part of a woman entering the men's sanctuary of the University, and will be aggravated by her not recognizing that the University has been from its beginnings a patriarchal institution and is committed to remaining so. She fails to recognize the pollution sanctions that are levelled against her, interpreting them as personal, and thus struggles with imaginary foes. Hope lies not in confronting these mystifying primitive taboos directly, for she can never be admitted to the secret society and may not really want to be, but in drawing on the larger tradition of learning itself to renew the principles of education in general, and in particular her own work.     

Variation in the growth and incidence of medical malpractice claims

This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.     

Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities.

Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.     

Portrait of the North American runaway: A critical review

Runaway behavior has been viewed as a psychopathological problem by many. However, a review of the available research literature questions this perspective. An examination of the reported psychological profile of runaways suggests no clear relationship between personality and runaway behavior. Further, a multiplicity of factors can be noted which are potential causal agents for running away. These factors range from sociocultural values to school problems. Runaway research is shown to be methodologically limited by several factors, but the data are suggestive. Also, the authors conclude that future research on this growing social problem might utilize an “alternative values” or “deindivuation model” in generating testable hypotheses about runaway behavior.