Developing an Actuarial Risk Assessment to Inform the Decisions Made by Adult Protective Service Workers

In 2008, the New Hampshire Department of Health and Human Services Bureau of Elderly and Adult Services (BEAS) and the National Council on Crime and Delinquency (NCCD), with funding provided by the National Institute of Justice (NIJ), collaborated to construct an actuarial risk assessment to classify BEAS clients by their likelihood of elder maltreatment and/or self-neglect in the future. Studies in adult and juvenile corrections and child welfare have demonstrated that active service intervention with high risk clients can reduce criminal recidivism and the recurrence of child maltreatment (Wagner, Hull, & Luttrell, 1995; Eisenberg & Markley, 1987; Baird, Heinz, & Bemus, 1981). The purpose of this research was to examine a large set of individual and referral characteristics, determine their relationship to subsequent elder self-neglect and/or maltreatment, and develop an actuarial risk assessment for BEAS workers to complete at the end of an investigation to inform their case decisions.BEAS and NCCD pursued development of an actuarial risk assessment with the goal of reducing subsequent maltreatment of elderly and vulnerable adults who have been involved in an incident of self-neglect or maltreatment by another person (i.e., abuse, exploitation, or neglect). The actuarial risk assessment described in this report provides BEAS workers with a method to more accurately identify high risk clients and therefore more effectively target service interventions in an effort to protect their most vulnerable clients

Spatial-temporal data mining procedure: LASR

This paper is concerned with the statistical development of our spatial-temporal data mining procedure, LASR (pronounced ``laser''). LASR is the abbreviation for Longitudinal Analysis with Self-Registration of large-$p$-small-$n$ data. It was motivated by a study of ``Neuromuscular Electrical Stimulation'' experiments, where the data are noisy and heterogeneous, might not align from one session to another, and involve a large number of multiple comparisons. The three main components of LASR are: (1) data segmentation for separating heterogeneous data and for distinguishing outliers, (2) automatic approaches for spatial and temporal data registration, and (3) statistical smoothing mapping for identifying ``activated'' regions based on false-discovery-rate controlled $p$-maps and movies. Each of the components is of interest in its own right. As a statistical ensemble, the idea of LASR is applicable to other types of spatial-temporal data sets beyond those from the NMES experiments.Comment: Published at http://dx.doi.org/10.1214/074921706000000707 in the IMS Lecture Notes--Monograph Series (http://www.imstat.org/publications/lecnotes.htm) by the Institute of Mathematical Statistics (http://www.imstat.org

Structuring Decisions in Adult Protective Services

A new NCCD Focus article, "Structuring Decisions in Adult Protective Services," describes the value of structured decision frameworks in the growing field of adult protective services (APS). The article highlights findings on risk factors for future adult maltreatment from research literature as well as NCCD's efforts to develop an actuarial-based risk assessment for APS in partnership with the New Hampshire Bureau of Elderly and Adult Services under a grant from the National Institute of Justice

Professional guideline versus product label selection for treatment with IV thrombolysis: an analysis from SITS registry

Introduction: Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods: We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1–3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3–5), medium efficiency (6–8) or higher efficiency (9–11). Sites were also grouped by adherence with European product label and ESO guideline: ‘label adherent’ (>95% on-label), ‘guideline adherent’ (≥5% off-label, ≥95% on-guideline) or ‘guideline non-adherent’ (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0–1. Results: A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were ‘label adherent’, 204 ‘guideline adherent’ and 337 ‘guideline non-adherent’. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all ‘label adherent’ sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion: Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion: Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years

Budget Gimmicks Increase Federal Spending and Mask True Costs of Legislation

The power of the purse is one of the fundamental responsibilities delegated to Congress by the Constitution. Congress exercises this authority through its budget resolutions, annual appropriations legislation, and a wide variety of other legislation containing authorizations of activities and programs that it considers in a given year. The American people have the right to know the full costs of the activities in which Congress engages. Instead, Congress utilizes a wide variety of gimmicks and accounting tricks to hide those costs. This allows Congress to spend more and more -- evading fiscal discipline and adding billions of dollars to the federal debt each year. Congress must take immediate steps to close budget loopholes that have allowed for the continued use of budget gimmicks. Without reforms, debt and deficit levels are likely to continue to rise, pushing the nation closer to the brink of fiscal disaster

The Fabric of Time Myth

Back in the days of Ice and fog, on a cold and bitter morning, when the snow fell so high it blotted out the low rising sun, Time came down from the heavens as a naked lamb. “I am cold,” she said. “Who amongst you will weave me a garment strong enough to see me through these bitter days?

Debris cover and surface melt at a temperate maritime alpine glacier: Franz Josef Glacier, New Zealand

Melt rates on glaciers are strongly influenced by the presence of supraglacial debris, which can either enhance or reduce ablation relative to bare ice. Most recently, Franz Josef Glacier has entered into a phase of strong retreat and downwasting, with the increasing emergence of debris on the surface in the ablation zone. Previously at Franz Josef Glacier, melt has only been measured on bare ice. During February 2012, a network of 11 ablation stakes was drilled into locations of varying supraglacial debris thickness on the lower glacier. Mean ablation rates over 9 days varied over the range 1.2–10.1 cm d−1, and were closely related to debris thickness. Concomitant observations of air temperature allowed the application of a degree-day approach to the calculation of melt rates, with air temperature providing a strong indicator of melt. Degree-day factors (d f) varied over the range 1.1–8.1 mm d−1 °C−1 (mean of 4.4 mm d−1 °C−1), comparable with rates reported in other studies. Mapping of the current debris cover revealed 0.7 km2 of the 4.9 km2 ablation zone surface was debris-covered, with thicknesses ranging 1–50 cm. Based on measured debris thicknesses and d f, ablation on debris-covered areas of the glacier is reduced by a total of 41% which equates to a 6% reduction in melt overall across the entire ablation zone. This study highlights the usefulness of a short-term survey to gather representative ablation data, consistent with numerous overseas ablation studies on debris-covered glaciers

Enlightenment

Photograph

KEKERASAN SERTA PENCEGAHAN DAN PENANGANAN PELECEHAN SEKSUAL PADA ANAK

Maraknya pemberitaan di media massa mengenai kekerasan seksual terhadap anak cukup membuat masyarakat terkejut. Kasus kekerasan seksual terhadap anak masih menjadi fenomena gunung es. Hal inidisebabkan kebanyakan anak yang menjadi korban kekerasan seksual enggan melapor. Karena itu, sebagai orang tua harus dapat mengenali tanda-tanda anak yang mengalami kekerasan seksual. Kekerasan seksua lterhadap anak akan berdampak panjang, di samping berdampak pada masalah kesehatan di kemudian hari, juga berkaitan dengan trauma yang berkepanjangan, bahkan hingga dewasa. Dampak trauma akibat kekerasan seksual yang dialami oleh anak-anak, antara lain: pengkhianatan atau hilangnya kepercayaan anak terhadap orang dewasa (betrayal); trauma secara seksual (traumatic sexualization); merasa tidak berdaya (powerlessness); dan stigma (stigmatization). Secara fisik memang mungkin tidak ada hal yang harus dipermasalahkan pada anak yang menjadi korban kekerasan seksual, tapi secara psikis bisa menimbulkan ketagihan, trauma, bahkan pelampiasan dendam. Bila tidak ditangani serius, kekerasan seksual terhadap anak dapat menimbulkan dampak sosial yang luas di masyarakat. Penanganan dan penyembuhan trauma psikis akibat kekerasan seksual haruslah mendapat perhatian besar dari semua pihak yang terkait, sepertikeluarga, masyarakat maupun negara. Oleh karena itu, didalam memberikan perlindungan terhadap anak perlu adanya pendekatan sistem, yang meliputi sistem kesejahteraan sosial bagi anak-anak dan keluarga,sistem peradilan yang sesuai dengan standar internasional, dan mekanisme untuk mendorong perilaku yang tepat dalam masyarakat