scholarly journals Inequities in Palliative and Dementia Care and Health in Long-Term Supportive Services Settings

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 329-329
Author(s):  
Abraham Brody
Keyword(s):  
Palliative Care ◽  
The United States ◽  
Routine Care ◽  
Data Sets ◽  
Supportive Services ◽  
Adult Day Centers ◽  
Systemic Factors ◽  
Diverse Society ◽  
The Individual

Abstract Most older adults with serious illness, including Alzheimer’s Disease and Related Dementias (ADRD) reside in community-based settings. These individuals and their care partners rely on Long Term Supportive Services (LTSS) including nursing home, home health, hospice, and adult day centers to provide support. LTSS are often under-resourced and reimbursed however, with significant regulatory restrictions on the care they can provide. These issues combined with other systemic factors in our healthcare system and society, including racism and poverty, lead to substantial inequities. Even preceding the use of LTSS, ADRD is diagnosed later in non-white individuals and access to high-quality services, including palliative care is severely limited. Moreover, few palliative care interventions address ADRD and even fewer have been specifically tailored to address the needs of our multi-cultural, racially and ethnically diverse society. This symposium will therefore utilize data from several nationwide data sets collected as part of routine care for clinical, billing, and/or regulatory purposes to assess inequities that exist across LTSS sites related to ADRD and palliative care. The individual abstracts show a clear pattern of inequities that stem from endemic systems failures towards people of color in the United States that must be addressed through a multipronged approach. This research shows that policies must be changed to require adequate collection of social determinants of health, to target policies that allow sub-standard or limited access to care, and research and clinical reform to produce a more culturally sensitive approach to care for those with ADRD and other serious illnesses.

Asian Americans and Pacific Islanders: Employment Issues in the United States

2011 ◽  
Vol 9 (1-2) ◽  
pp. 58-69
Author(s):  
Marlene Kim
Keyword(s):  
United States ◽  
Asian Americans ◽  
The United States ◽  
Current Data ◽  
Pacific Islanders ◽  
Native Hawaiians ◽  
Data Sets ◽  
High Poverty ◽  
Unemployment Rates

Asian Americans and Pacific Islanders (AAPIs) in the United States face problems of discrimination, the glass ceiling, and very high long-term unemployment rates. As a diverse population, although some Asian Americans are more successful than average, others, like those from Southeast Asia and Native Hawaiians and Pacific Islanders (NHPIs), work in low-paying jobs and suffer from high poverty rates, high unemployment rates, and low earnings. Collecting more detailed and additional data from employers, oversampling AAPIs in current data sets, making administrative data available to researchers, providing more resources for research on AAPIs, and enforcing nondiscrimination laws and affirmative action mandates would assist this population.

scholarly journals Internal consistency of the Regional Brewer Calibration Centre for Europe triad during the period 2005–2016

2018 ◽  
Vol 11 (7) ◽  
pp. 4059-4072 ◽  
Author(s):  
Sergio Fabián León-Luis ◽  
Alberto Redondas ◽  
Virgilio Carreño ◽  
Javier López-Solano ◽  
Alberto Berjón ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Relative Standard Deviation ◽  
Data Sets ◽  
Individual Values ◽  
Relative Standard ◽  
The World ◽  
The Mean ◽  
The Individual ◽  
Ozone Column

Abstract. Total ozone column measurements can be made using Brewer spectrophotometers, which are calibrated periodically in intercomparison campaigns with respect to a reference instrument. In 2003, the Regional Brewer Calibration Centre for Europe (RBCC-E) was established at the Izaña Atmospheric Research Center (Canary Islands, Spain), and since 2011 the RBCC-E has transferred its calibration based on the Langley method using travelling standard(s) that are wholly and independently calibrated at Izaña. This work is focused on reporting the consistency of the measurements of the RBCC-E triad (Brewer instruments #157, #183 and #185) made at the Izaña Atmospheric Observatory during the period 2005–2016. In order to study the long-term precision of the RBCC-E triad, it must be taken into account that each Brewer takes a large number of measurements every day and, hence, it becomes necessary to calculate a representative value of all of them. This value was calculated from two different methods previously used to study the long-term behaviour of the world reference triad (Toronto triad) and Arosa triad. Applying their procedures to the data from the RBCC-E triad allows the comparison of the three instruments. In daily averages, applying the procedure used for the world reference triad, the RBCC-E triad presents a relative standard deviation equal to σ = 0.41 %, which is calculated as the mean of the individual values for each Brewer (σ157 = 0.362 %, σ183 = 0.453 % and σ185 = 0.428 %). Alternatively, using the procedure used to analyse the Arosa triad, the RBCC-E presents a relative standard deviation of about σ = 0.5 %. In monthly averages, the method used for the data from the world reference triad gives a relative standard deviation mean equal to σ = 0.3 % (σ157 = 0.33 %, σ183 = 0.34 % and σ185 = 0.23 %). However, the procedure of the Arosa triad gives monthly values of σ = 0.5 %. In this work, two ozone data sets are analysed: the first includes all the ozone measurements available, while the second only includes the simultaneous measurements of all three instruments. Furthermore, this paper also describes the Langley method used to determine the extraterrestrial constant (ETC) for the RBCC-E triad, the necessary first step toward accurate ozone calculation. Finally, the short-term or intraday consistency is also studied to identify the effect of the solar zenith angle on the precision of the RBCC-E triad.

scholarly journals Violent Extremist Disengagement and Reintegration: Lessons from Over 30 Years of DDR

2021 ◽  
Author(s):  
Mary Beth Altier
Keyword(s):  
United States ◽  
The United States ◽  
Islamic State ◽  
Review Of The Literature ◽  
Conflict Zones ◽  
Individual Level ◽  
Systemic Factors ◽  
Societal Level ◽  
The Individual

Recent questions surrounding the repatriation, rehabilitation, and reintegration of those who traveled to join the Islamic State in Iraq and Syria (ISIS), the reintegration of violent extremists in conflict zones including Somalia, Nigeria, Libya, and Mali, and the impending release of scores of homegrown violent extremists from prisons in the United States and Europe have heightened policymaker and practitioner interest in violent extremist disengagement and reintegration (VEDR). Although a number of programs to reintegrate violent extremists have emerged both within and outside of conflict zones, significant questions remain regarding their design, implementation, and effectiveness. To advance our understanding of VEDR, this report draws insights from a review of the literature on ex-combatant disarmament, demobilization, and reintegration (DDR). The literature on DDR typically adopts a “whole of society” approach, which helps us to understand how systemic factors may influence VEDR at the individual level and outcomes at the societal level. Despite the important differences that will be reviewed, the international community’s thirty-year experience with DDR—which includes working with violent extremists—offers important insights for our understanding of VEDR.

scholarly journals Multianalyzer Spectroscopic Data Fusion for Soil Characterization

2020 ◽  
Vol 10 (23) ◽  
pp. 8723
Author(s):  
Richard R. Hark ◽  
Chandra S. Throckmorton ◽  
Russell S. Harmon ◽  
John R. Plumer ◽  
Karen A. Harmon ◽  
...  
Keyword(s):  
Data Fusion ◽  
Classification Accuracy ◽  
Traditional Approach ◽  
Hierarchical Classification ◽  
Principal Component ◽  
The United States ◽  
Relative Advantage ◽  
Data Sets ◽  
Breakdown Spectroscopy ◽  
The Individual

The ability to rapidly conduct in-situ chemical analysis of multiple samples of soil and other geological materials in the field offers many advantages over a traditional approach that involves collecting samples for subsequent examination in the laboratory. This study explores the application of complementary spectroscopic analyzers and a data fusion methodology for the classification/discrimination of >100 soil samples from sites across the United States. Commercially available, handheld analyzers for X-ray fluorescence spectroscopy (XRFS), Raman spectroscopy (RS), and laser-induced breakdown spectroscopy (LIBS) were used to collect data both in the laboratory and in the field. Following a common data pre-processing protocol, principal component analysis (PCA) and partial least squares discriminant analysis (PLSDA) were used to build classification models. The features generated by PLSDA were then used in a hierarchical classification approach to assess the relative advantage of information fusion, which increased classification accuracy over any of the individual sensors from 80-91% to 94% and 64-93% to 98% for the two largest sample suites. The results show that additional testing with data sets for which classification with individual analyzers is modest might provide greater insight into the limits of data fusion for improving classification accuracy.

Personalized Dynamic Pricing with Machine Learning: High-Dimensional Features and Heterogeneous Elasticity

2021 ◽  
Author(s):  
Gah-Yi Ban ◽  
N. Bora Keskin
Keyword(s):  
Dynamic Pricing ◽  
Simulated Data ◽  
The United States ◽  
Model Parameters ◽  
Data Sets ◽  
Demand Model ◽  
Pricing Policy ◽  
Data Set ◽  
Customized Pricing ◽  
The Individual

We consider a seller who can dynamically adjust the price of a product at the individual customer level, by utilizing information about customers’ characteristics encoded as a d-dimensional feature vector. We assume a personalized demand model, parameters of which depend on s out of the d features. The seller initially does not know the relationship between the customer features and the product demand but learns this through sales observations over a selling horizon of T periods. We prove that the seller’s expected regret, that is, the revenue loss against a clairvoyant who knows the underlying demand relationship, is at least of order [Formula: see text] under any admissible policy. We then design a near-optimal pricing policy for a semiclairvoyant seller (who knows which s of the d features are in the demand model) who achieves an expected regret of order [Formula: see text]. We extend this policy to a more realistic setting, where the seller does not know the true demand predictors, and show that this policy has an expected regret of order [Formula: see text], which is also near-optimal. Finally, we test our theory on simulated data and on a data set from an online auto loan company in the United States. On both data sets, our experimentation-based pricing policy is superior to intuitive and/or widely-practiced customized pricing methods, such as myopic pricing and segment-then-optimize policies. Furthermore, our policy improves upon the loan company’s historical pricing decisions by 47% in expected revenue over a six-month period. This paper was accepted by Noah Gans, stochastic models and simulation.

Untangling the Racialization of Disabilities

2013 ◽  
Vol 10 (2) ◽  
pp. 329-347 ◽  
Author(s):  
Alfredo J. Artiles
Keyword(s):  
Special Education ◽  
The United States ◽  
Future Research ◽  
Educational Trajectories ◽  
Individual Structure ◽  
Historical Processes ◽  
Disability Categories ◽  
The Individual ◽  
Sizable Number

AbstractThis article advances an intersectional perspective in the analysis of racial inequities in special education so that theoretical refinement of this problem will strengthen educational equity research and theory. Racial disproportionality in some disability categories continues to affect a sizable number of students in the United States, with dire long-term consequences for the educational trajectories of these learners. After more than four decades, the problem continues to be debated in research, practice, and policy circles. There is consensus among researchers that the racialization of disability embodies complexities that defy linear explanations. But this debate has overlooked the potential of intersectionality to document complexity and to transcend the individual-structure binary that tends to permeate previous scholarship. Indeed, intersectionality's explicit attention to how the complexity of people's everyday experiences is connected to larger historical processes could offer key insights. I analyze how disproportionality research has addressed the intersections of race and disability (along with other markers of oppression) through a contrapuntal reading of works framed with medical, social, and cultural disability models. I conclude with reflections for future research on racial disparities in special education that is mindful of intersectional complexity.

“Nothing More to Be Done”: Palliative Care Versus Exerimental Therapy in Advanced Cancer

1995 ◽  
Vol 8 (1) ◽  
pp. 209-229 ◽  
Author(s):  
Ilana Löwy
Keyword(s):  
United States ◽  
Palliative Care ◽  
United Kingdom ◽  
The United States ◽  
Experimental Therapy ◽  
Incurable Cancer ◽  
The United Kingdom ◽  
Experimental Therapies ◽  
The Difference ◽  
The Individual

The ArgumentPatients suffering from advanced, incurable cancer often receive from their doctors proposals to enroll in a clinical trial of an experimental therapy. Experimental therapies are increasingly perceived not as a highly problematic approach but as a near-standard way to deal with incurable cancer. There are, however, important differences in the diffusion of these therapies in Western countries. The large diffusion of experimental therapies for malignant disease in the United States contrasts with the much more restricted diffusion of these therapies in the United Kingdom. The difference between the two reflects differences in the organization of health care in these countries and distinct patterns of the professionalization of medical oncology in America and in Britain. The high density and great autonomy of medical oncologists in the United States encourages there the diffusion of experimental therapies (regarded by some as expensive and inefficient); the lower density of these specialists in the United Kingdom and their task as consultants and not primary caregivers, favors the choice of more conservative (for some, too conservative) treatments. Theoretically, the decision as to whether patients suffering from advanced, incurable cancer will be steered toward an experimental therapy or toward palliative care depends on the values and beliefs of these patients and their physicians. In practice, however, such choice does not depend exclusively on the individual' cultural background and ethical values, but is also strongly affected by the — culturally conditioned — Professional and institutional structure of medicine

scholarly journals When the going gets tougher: the importance of long-term supportive psychotherapy in psychosis

2008 ◽  
Vol 14 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Alan Meaden ◽  
Susie Van Marle
Keyword(s):  
Clinical Practice ◽  
Psychosocial Interventions ◽  
Individual Case ◽  
Routine Care ◽  
Routine Clinical Practice ◽  
Psychotic Symptoms ◽  
Treatment Team ◽  
Supportive Psychotherapy ◽  
The Individual

There has been considerable progress in recent years in developing psychosocial interventions for people who experience persistent psychotic symptoms. However, it is sometimes difficult to generalise these findings into routine clinical practice. Long-term, psychodynamically informed, supportive psychotherapy is a valuable approach for working with individuals for whom current psychosocial interventions are ineffective or where unhelpful team reactions are obstacles to care. Its principles are used to inform a multiaxial formulation, which is shared with the treatment team and guides treatment, promoting good-quality comprehensive routine care. The benefits of this approach can best be seen at the individual case level using a subsequent multiaxial reformulation.

scholarly journals Long-Term Trends in Regional Wet Mercury Deposition and Lacustrine Mercury Concentrations in Four Lakes in Voyageurs National Park

2021 ◽  
Vol 11 (4) ◽  
pp. 1879
Author(s):  
Mark E. Brigham ◽  
David D. VanderMeulen ◽  
Collin A. Eagles-Smith ◽  
David P. Krabbenhoft ◽  
Ryan P. Maki ◽  
...  
Keyword(s):  
Atmospheric Deposition ◽  
National Park ◽  
Total Mercury ◽  
The United States ◽  
Multimedia Data ◽  
Data Sets ◽  
Mercury Deposition ◽  
Continental Scale ◽  
Voyageurs National Park

Although anthropogenic mercury (Hg) releases to the environment have been substantially lowered in the United States and Canada since 1990, concerns remain for contamination in fish from remote lakes and rivers where atmospheric deposition is the predominant source of mercury. How have aquatic ecosystems responded? We report on one of the longest known multimedia data sets for mercury in atmospheric deposition: aqueous total mercury (THgaq), methylmercury (MeHgaq), and sulfate from epilimnetic lake-water samples from four lakes in Voyageurs National Park (VNP) in northern Minnesota; and total mercury (THg) in aquatic biota from the same lakes from 2001–2018. Wet Hg deposition at two regional Mercury Deposition Network sites (Fernberg and Marcell, Minnesota) decreased by an average of 22 percent from 1998–2018; much of the decreases occurred prior to 2009, with relatively flat trends since 2009. In the four VNP lakes, epilimnetic MeHgaq concentrations declined by an average of 44 percent and THgaq by an average of 27 percent. For the three lakes with long-term biomonitoring, temporal patterns in biotic THg concentrations were similar to patterns in MeHgaq concentrations; however, biotic THg concentrations declined significantly in only one lake. Epilimnetic MeHgaq may be responding both to a decline in atmospheric Hg deposition as well as a decline in sulfate deposition, which is an important driver of mercury methylation in the environment. Results from this case study suggest that regional- to continental-scale decreases in both mercury and sulfate emissions have benefitted aquatic resources, even in the face of global increases in mercury emissions.

Palliative Care in Long-Term Care Settings

2018 ◽  
Author(s):  
Sriram Yennurajalingam
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Long Term Care ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Nursing Home Residents ◽  
Supportive Services ◽  
Term Care ◽  
Home Placement

Long-term care is a setting of provision of health and supportive services to patients unable to practice self-care, usually over months or years. For older frail patients, nursing homes have increasingly become a common setting for long-term care. Approximately 65% of nursing home residents die within 12 months of nursing home placement. A vast majority of these patients experience significant symptom distress, and frequent hospital admissions. Palliative care in these at risk patients is essential to improve symptom management, aligning care with patient care, and reduce hospital readmissions. This chapter outlines the important aspects involved in provision of palliative care in long-term settings.

Sign in / Sign up

Export Citation Format

Share Document