Effect of wrist restraint on maximal exercise capacity in healthy volunteers

Each year, reports occur of deaths in individuals, while struggling against physical restraint. The mechanism of these deaths remains unclear. This study aimed to determine the effect of wrist restraint on cardiorespiratory function during maximal exercise. Twelve healthy volunteers underwent 3 incremental maximal exercise tests on a cycle ergometer. In a randomized order, they exercised while unrestrained, with the wrists tied in front of the body or wrists tied behind the back. The primary outcome measures were the number of minutes exercised in each position and heart rate and whole blood lactate level for each stage and on reaching maximum exercise capacity. The mean exercise duration was 19 minutes 6 seconds unrestrained (95% confidence interval [CI] 16 minutes 52 seconds to 20 minutes 57 seconds), 18 minutes 51 seconds (95% CI 17 minutes 51 seconds to 20 minutes 50 seconds) with arms restrained in front and 16 minutes 51 seconds (95% CI 14 minutes 6 seconds to 19 minutes 20 seconds) with the arms restrained behind the body (P = 0.16). There was no significant difference in heart rate or lactate measurements. It is probable that other factors make a more important contribution than wrist restraint behind the body to cardiorespiratory compromise in a struggling and fatigued individual.     

Investigation of elderly deaths in nursing homes by the medical examiner over a year

Despite death being one of the most common reasons for discharge from a nursing home, fewer than 1% of nursing home resident deaths are autopsied. To evaluate our role as medical examiner in nursing home deaths, we conducted a retrospective review of all decedents in Jefferson County, Alabama, for the year 2001. Death certificate data indicate that 995 deaths occurred in nursing homes in Jefferson County in 2001. Of those 995 deaths, 119 (12%) were reported to the Jefferson County Coroner/Medical Examiner Office. Jurisdiction was accepted in 5 cases in which the circumstances already made clear that the death was a nonnatural event. In the remaining 96% of nursing home deaths reported to the medical examiner, the statements of the reporting person were taken to be true concerning the expected nature of the death. An independent scene evaluation was provided by a police officer or paramedic in 82% of the cases reported to the medical examiner's office. Elderly individuals, as a group, are expected to die, but the death of a particular elder may or may not be expected. In our jurisdiction, only 12% of all nursing home deaths are reported to our office, and only 4% of reported deaths are actively investigated. Actively investigating each nursing home death would overwhelm the resources currently available to our office. We advocate the study and development of criteria to aid in determining whether the death of an individual elder is sudden and unexpected.     

Community‐Based Participatory Research as a Tool for Policy Change: A Case Study of the Southern California Environmental Justice Collaborative

In 2000, a regional rule governing maximum individual cancer risk from stationary facilities in Southern California was dramatically altered, reducing allowable risk levels by 75%. This article uses a case study approach to explore the role of a community‐based participatory research (CBPR) partnership, the Southern California Environmental Justice Collaborative, in producing research and helping spearhead policy advocacy leading to this policy change. It also highlights the role of the collaborative in helping to change the framing of the issue from individual to cumulative risk assessment, so that the regulatory agencies began to reflect this broader thinking in their policymaking. The collaborative's structure and methodology, regional focus, relationships with key decision makers, and its reputation as an important source of both credible science and “people power” were seen as contributing to its effectiveness. The role of contextual factors including a recovering and more regulation‐friendly economy also is highlighted, as are key barriers faced. Implications for other community–academic partnerships working to address regional and statewide public policy are discussed.     

Determinants of initial entry onto welfare by young women

Using data from the youngest cohorts of women in the National Longitudinal Survey of Youth, this study constructs Aid to Families with Dependent Children (AFDC) histories starting at age 15. Most young women go on AFDC for the first time between ages 18 and 25 and do so in the first few years after the birth of their first baby. These histories are used to estimate models of the determinants of initial use of AFDC. The models provide mixed evidence that the financial or other incentives of welfare policy affect the likelihood and timing of AFDC use. Benefit levels do not seem to affect participation, but the presence of a program for medically needy families who are not on welfare appears to decrease entrance to welfare for some groups. Parental poverty, family structure, academic achievement, attitudes toward school, and race are significantly related to the likelihood of participating in AFDC, and the rate of entry. © 2000 by the Association for Public Policy Analysis and Management.     

The Rate of Cyber Dating Abuse Among Teens and How It Relates to Other Forms of Teen Dating Violence

To date, little research has documented how teens might misuse technology to harass, control, and abuse their dating partners. This study examined the extent of cyber dating abuse—abuse via technology and new media—in youth relationships and how it relates to other forms of teen dating violence. A total of 5,647 youth from ten schools in three northeastern states participated in the survey, of which 3,745 reported currently being in a dating relationship or having been in one during the prior year (52 % were female; 74 % White). Just over a quarter of youth in a current or recent relationship said that they experienced some form of cyber dating abuse victimization in the prior year, with females reporting more cyber dating abuse victimization than males (particularly sexual cyber dating abuse). One out of ten youth said that they had perpetrated cyber dating abuse, with females reporting greater levels of non-sexual cyber dating abuse perpetration than males; by contrast, male youth were significantly more likely to report perpetrating sexual cyber dating abuse. Victims of sexual cyber dating abuse were seven times more likely to have also experienced sexual coercion (55 vs. 8 %) than were non-victims, and perpetrators of sexual cyber dating abuse were 17 times more likely to have also perpetrated sexual coercion (34 vs. 2 %) than were non-perpetrators. Implications for practice and future research are discussed.     

A Knowledge‐Based Approach to Public Value Management: A Case Study of Change Implementation in Disability Services in Western Australia

This paper provides a knowledge‐based perspective to understanding public value management (PVM). As distinct from other approaches to public administration, PVM focuses on collaborative capacity building for the creation of public value. To develop the notion of PVM further, we explore the role of a knowledge‐based strategy in a case study of change implementation in 18 disability service organisations in Western Australia. Our findings show important inter‐relationships between knowledge management strategy, adopting a person‐centred approach to service provision, and sustainability of change implementation. We discuss the implications of the study for disability sector change management and for the further exploration of the strategic role of knowledge management capabilities in the study and practice of PVM in public sector administration. The paper explores the relationship between an organisation's knowledge capture and sharing systems and processes and its ability to implement change in a way that generates long‐term benefits for both public sector employees (e.g., engaging with key stakeholders to generate innovative solutions for serving client needs) and clients (i.e., increased well‐being through better service design and support).