The Need for Culturally-Based Palliative Care Programs for African American Patients at End-of-life

Patients facing life-threatening illness often experience unnecessary and preventable suffering including extreme and prolonged pain, psychological distress, as well as unsatisfactory communication with doctors, all of which result in enormous strain on patients and caregivers (Chochinov et al., 2009; Kamal et al., 2011; Morrison & Meier, 2011). It is common for needs in the physical, psychosocial and spiritual domains to be unmet (Zhukovsky, 2000). As a result, the last few weeks and months of life, and that of their loved ones, may be additionally burdened with physical, emotional and spiritual suffering. Palliative care programs, interdisciplinary care focused on relief of pain and other symptoms in support of best possible quality of life for patients with serious illness and their families, or consultations with palliative care experts where such team programs are not available, have been shown to reduce symptoms, alleviate suffering, improve doctor-patient communication and satisfaction with care, improve family satisfaction, and enhance the efficiency and effectiveness of hospital services (Bakitas et al., 2009a; Bakitas et al., 2009b; Casarett et al., 2008; Lagman, Rivera, Walsh, LeGrand, & Davis, 2007; Morrison & Meier, 2011; O’Hara et al., 2010), as well as to be associated with hospital cost savings (Morrison et al., 2008; Morrison et al., 2011; Penrod et al., 2010). Palliative care consultations for inpatients have successfully identified unrecognized symptoms and unmet problems (Abrahm, Callahan, Rossetti, & Pierre, 1996; Bailey et al., 2005; Bascom, 1997; Kuin et al., 2004; Manfredi et al., 2000), and have been associated with lower use of ICUs (Elsayem et al., 2006; Norton et al., 2007), lower likelihood of dying in ICU (Elsayem et al., 2006), lower costs of care (Penrod et al., 2006; Smith et al., 2003), and improvement in care processes, including medication prescribing and documenting patient goals for care(Bailey et al., 2005; Higginson et al., 2002; Higginson et al., 2003)

Opportunistic competition law enforcement

We analyse the interplay between investigation policies, deterrence and desistance in a model where a competition authority monitors multiple sectors and faces a budget constraint that prevents it from deterring cartels in all sectors simultaneously. Most studies of competition law enforcement treat competition authorities as all-knowing, unwavering and benevolent. They do not behave opportunistically, do not face asymmetric information and choose their actions to optimize social welfare. In this paper, we drop one of these assumptions, and study a competition authority that can not commit to a particular investigation strategy. As a consequence, a competition authority’s decisions to investigate will be driven by the (ex-post) desistance effect instead of the (ex ante) deterrence effect of an investigation policy. The resulting opportunistic behaviour may lead to a suboptimal investigation strategy. We find that, in the absence of commitment, developing a sector specific reward scheme based on the number of captured cartels can improve welfare.

Discretion to Follow the Law: The Collision of Ohio\u27s Nursing Home Bill of Rights with Ohio\u27s Political Subdivision Tort Liability Act

The Ohio Political Subdivision Tort Liability Act confers general immunity on political subdivisions. Therefore, government owned homes seek to avoid liability by raising the defenses provided by the Ohio Political Subdivision Tort Liability Act, despite the resident\u27s rights under the Nursing Home Bill of Rights. The result is that residents of government owned nursing homes have inferior remedies for the tortious acts of a county home\u27s employees. The disparate treatment meted out to residents of county owned homes opens the Political Subdivision Act to another challenge: equal protection. The law formerly recognized that government actors taking part in the marketplace like any other participant were liable in the same manner, and to the same extent as any other participant. Under Cramer, while residents of non-county owned homes can sue for ordinary negligence, county owned homes can be found immune for the same conduct. There is no justification for this disparate treatment

Discretion to Follow the Law: The Collision of Ohio\u27s Nursing Home Bill of Rights with Ohio\u27s Political Subdivision Tort Liability Act

The Ohio Political Subdivision Tort Liability Act confers general immunity on political subdivisions. Therefore, government owned homes seek to avoid liability by raising the defenses provided by the Ohio Political Subdivision Tort Liability Act, despite the resident\u27s rights under the Nursing Home Bill of Rights. The result is that residents of government owned nursing homes have inferior remedies for the tortious acts of a county home\u27s employees. The disparate treatment meted out to residents of county owned homes opens the Political Subdivision Act to another challenge: equal protection. The law formerly recognized that government actors taking part in the marketplace like any other participant were liable in the same manner, and to the same extent as any other participant. Under Cramer, while residents of non-county owned homes can sue for ordinary negligence, county owned homes can be found immune for the same conduct. There is no justification for this disparate treatment

The likelihood of admission of elderly persons to a psychiatric hospital : a comparative study of elderly persons admitted for the first time to a psychiatric hospital and of elderly persons in the community, with special reference to the composition, organisation, and structural integration of their families

The helping professions in many parts of the world, experience concern over the increased number of admissions of elderly patients to psychiatric hospitals. This study has been prompted by similar concern in Cape Town. Although old people have always suffered from psychiatric illnesses, the problem becomes more acute as the numbers of elderly rise, especially in industrialised countries. A noticeable and alarming trend, particularly in the last three decades, has been the rise in first admissions of old people to psychiatric hospitals. Over the period 1978 to 1980, a multidisciplinary project in which the writer was appointed as a research worker, was conducted by the Department of Psychiatry in the University of Cape Town. This project was conducted in both the Psychogeriatric Unit of Valkenberg Hospital and in suburbs of Cape Town from the same catchment area that the hospital serves. The aim of the project was, to examine the possible contributory reasons for psychiatric illness that led to consequent hospitalisation of the elderly. It covered a multitude of psychiatric, physical, and psychosocial variables. Over the same period, the author conducted a separate but associated research, focusing on one specific psychosocial variable - that of the family of the old person. This variable was selected as the nucleus of the study for two major reasons

Modelling health care expenditures; overview of the literature and evidence from a panel time series model

The first purpose of this paper is to give an up to date overview of the literature on health care expenditures. Secondly, this paper contributes to the existing literature by investigating the impact of several factors on health care expenditures in an empirical analysis using an error-correction model. Health care expenditures in industrial countries have been growing rapidly over the past forty years. This rapid growth jeopardizes the sustainability of public budgets and causes an increasing interest in the determinants of health care expenditures. Additional to the 'usual suspects' for rising health care expenditures, we pay attention to a somewhat neglected driving factor, which is the increase in the relative price of health care compared to other goods and services. We find that the increasing price of health care helps to explain the increase in real health care expenditures. However, the use of health care in volume terms is negatively affected by the increasing price. This effect seems to be stronger in periods of cost containment policy. Consistent with most recent findings in the literature, we find that income and ageing are important drivers of health care expenditures.

Embodied Language Comprehension Requires an Enactivist Paradigm of Cognition

Two recurrent concerns in discussions on an embodied view of cognition are the “necessity question” (i.e., is activation in modality-specific brain areas necessary for language comprehension?) and the “simulation constraint” (i.e., how do we understand language for which we lack the relevant experiences?). In the present paper we argue that the criticisms encountered by the embodied approach hinge on a cognitivist interpretation of embodiment. We argue that the data relating sensorimotor activation to language comprehension can best be interpreted as supporting a non-representationalist, enactivist model of language comprehension, according to which language comprehension can be described as procedural knowledge – knowledge how, not knowledge that – that enables us to interact with others in a shared physical world. The enactivist view implies that the activation of modality-specific brain areas during language processing reflects the employment of sensorimotor skills and that language comprehension is a context-bound phenomenon. Importantly, an enactivist view provides an embodied approach of language, while avoiding the problems encountered by a cognitivist interpretation of embodiment

True Fire, Noble Flame: Friendship Poetry by Katharina Lescailje, Cornelia van der Veer, and Katherine Philips

This essay examines early modern friendship poetry by women writers from England and the Dutch Republic, including Katherine Philips, Cornelia van der Veer, Catharina Questiers, and Katharina Lescailje. It argues that women used this genre to comment on the shifting definitions of public and private and especially to how these shifts affected them as women

'Before she ends up in a brothel': Public Femininity and the First Actresses in England and the Low Countries

This essay explores the first appearance of actresses on the public stage in England and the Dutch Republic. It considers the cultural climate, the theaters, and the plays selected for these early performances, particularly from the perspective of public femininity. In both countries antitheatricalists denounced female acting as a form of prostitution and evidence of inner corruption. In England, theaters were commercial institutions with intimate spaces that capitalized on the staging of privacy as theatrical. By contrast, the Schouwburg, the only public playhouse in Amsterdam, was an institution with a more civic character, in which the actress could be treated as unequivocally a public figure. I explain these differences in the light of changing conceptions of public and private and suggest that the treatment of the actress shows a stronger public- private division in the Dutch Republic than in England

The effect of the supplementary grant on parental contribution in the Netherlands

Recently, there has been considerable debate about a reform of the Dutch system of student support, in which grants will be (partly) replaced by loans. The discussion focuses on the effects on student enrollment decisions. Surprisingly, no study has yet analysed the effect of receiving a grant on parental contribution. Parents may decrease their contribution when their child receives a grant, in which case subsidies meant for the students unintentionally end up with the parents. Understanding the corresponding parental behaviour will contribute to a more in-depth discussion on the financial aid system. This paper focuses on the effect of the supplementary grant on the parental contribution in the Netherlands. The supplementary grant is meant to support students from disadvantaged families. Parents from students with the supplementary grant have less disposable income, which probably implies a lower contribution. Our identification strategy separates this income effect from the effect due to the payments of the supplementary grant. The results suggest substantial substitution. Each additional euro spent on supplementary grant reduces the parental contribution with approximately 20-60 cents. A broad range of sensitivity analyses support our main estimation results. Nevertheless, some caution in interpreting the results is needed because of data limitations.