Clinical case management: a strategy to coordinate detection, reporting, and prosecution of elder abuse

Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime.     

Reforming residency: modernizing resident education and training to promote quality and safety in healthcare

The goal of medical residency is to provide the best clinical education for future practice, while increasing quality and safety in current and future healthcare. This goal is not being met. Traditional residency programs often continue to utilize individually oriented, shame-and-blame approaches that do not recognize the systems nature of outcomes, care, and patient safety. Appropriate substantive methods, content, and training tools are also lacking, while residents continue to labor in a poor working environment. All these factors create a system that serves no one-not the resident, the patient, or the system in which both interact. Residency reforms are proposed to address these imperative concerns.     

Balancing police budgets and decision making: an experiment in disentanglement

Abstract: In examining the relationship between municipal and provincial government authority over policing in Ontario, this article explores a specific project which has generated a substantial amount of interest, and controversy, around the issue of control of municipal police budgets. It will further scrutinize the process undertaken by the Expert Panel on Municipal Police Services Budgets in developing and advancing its recommendations as an interesting and instructive innovation in government decision making. The article will summarize and elaborate on the work of the Expert Panel, formed in March 1992, as the first enterprise in the disentanglement process embarked on by the Ontario provincial government, in partnership with the Association of Municipalities of Ontario, to review and rationalize a wide spectrum of provincial/local relationships with an aim to achieve greater efficiency, effectiveness, and client service. The issue of financial control over municipal police services is one of considerable importance in Ontario to both the municipal sector and the policing community. By considering the work of the Expert Panel as an exercise in disentanglement, within the context of the “vigilant problem-solving approach” formulated by Irving Jnnis, this article attempts to provide specific insight and guidance to other practitioners in the realm of public policy making, as well as to capture the processes and proceedings of this particular undertaking. Sommaire: Cet article examine le rapport entre les autorités provinciales et municipales qui exercent le contrôle de la police en Ontario; il s'intéresse à un projet particulier qui a suscité discussion et controverse en ce qui concerne le contrôle des budgets municipaux de police. Il examine par ailleurs le processus entrepris par le groupe d'experts en matière de budgets municipaux de services policiers pour formuler ses recommandations, processus qui constitue une innovation intéressante et instructive pour la prise de décisions gouvernementales. L'article résume et analyse le travail du groupe d'experts mis sur pied en mars 1992, première étape du processus de démêlement des rôles entrepris par le gouvernement de l'Ontario, en partenariat avec l'Association des municipalités de l'Ontario, afin d'examiner et de rationaliser une vaste gamme de relations provinciales-locales pour augmenter l'efficacité et améliorer le service à la clientèle. La question du contrôle financier des services policiers municipaux revêt beaucoup d'importance en Ontario, tant pour le secteur municipal que pour la collectivité policière. En considérant le travail du groupe d'experts comme étant un exercice de démêlement des rôles, dans le contexte de “ l'approche vigilante de résolution de problèmes ” formulée par Irving Janis, cet article essaie d'offrir aux autres praticiens de la prise de décisions publiques à la fois des explications et des façons de faire, tout en cernant les processus et méthodes de cet effort particulier.     

How do voters form positive economic beliefs? Evidence from the Survey of Americans and Economists on the Economy

Beliefs about normative economics appear to be primarily determined by sociotropic rather than egocentric variables. (Sears & Funk, 1990; Citrin & Green, 1990) Using the Survey of Americans and Economists on the Economy, the current paper finds that the same holds for positiveeconomic beliefs in most – but not all – cases. This hinges on whether a question is “causal” or “non-causal”: Causal beliefs depend on sociotropic variables, especially education and ideology; non-causal beliefs, in contrast, depend on egocentric variables, with income growth playing the leading role. This is consistent with a cognitive model where actors answer easier questions using personal experience, and harder ones with ``off-the-shelf" theories.     

Forensic handwriting examiners' expertise for signature comparison

This paper reports on the performance of forensic document examiners (FDEs) in a signature comparison task that was designed to address the issue of expertise. The opinions of FDEs regarding 150 genuine and simulated questioned signatures were compared with a control group of non-examiners' opinions. On the question of expertise, results showed that FDEs were statistically better than the control group at accurately determining the genuineness or non-genuineness of questioned signatures. The FDE group made errors (by calling a genuine signature simulated or by calling a simulated signature genuine) in 3.4% of their opinions while 19.3% of the control group's opinions were erroneous. The FDE group gave significantly more inconclusive opinions than the control group. Analysis of FDEs' responses showed that more correct opinions were expressed regarding simulated signatures and more inconclusive opinions were made on genuine signatures. Further, when the complexity of a signature was taken into account, FDEs made more correct opinions on high complexity signatures than on signatures of lower complexity. There was a wide range of skill amongst FDEs and no significant relationship was found between the number of years FDEs had been practicing and their correct, inconclusive and error rates.     

The Contentious American Debate: The First Amendment and Internet-based Hate Speech

This essay reviews the debate over what constitutes hate speech and whether or not such speech is protected by the American First Amendment. First, the concept of white racialism and white supremacy is defined and illustrated. Then after a brief discussion of the legal debate, the nature and problematic definition(s) of hate speech is presented. The unique speech environment of the internet is reviewed alongside attempts to limit and censor topics available on the internet. The arguments for and against restricting first amendment protection are discussed, with a focus on Michael Israel's five criteria for withdrawing first amendment protections. The work concludes with a discussion of the difficulty in constraining discourse on the internet.