Physician Perspectives on Medical Care Delivery in Assisted Living

OBJECTIVES—To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings. DESIGN—Cross-sectional descriptive study. SETTING—AL communities in 27 states. PARTICIPANTS—One hundred sixty-five physicians and administrators of 125 AL settings in which they had patients. MEASUREMENTS—Interviews and questionnaires containing open- and close-ended questions regarding demographics, care arrangements, attitudes, and behaviors in managing medical problems. RESULTS—Most respondents were certified in internal medicine (46%) or family medicine (47%); 32% were certified in geriatrics and 30% in medical directorship. In this select sample, 48% visited the AL setting once a year or less, and 19% visited once a week or more. Mean physician confidence in AL staff was 3.3 (somewhat confident), with greater confidence associated with smaller AL community size, nursing presence, and the physician being the medical director. Qualitative analyses identified differences between settings including lack of vital sign assessment in the home setting, concern about the ability of AL staff to assess and monitor problems, and greater administrative and regulatory requirements in AL than in the other settings. CONCLUSION—Providing medical care for AL residents presents unique challenges and opportunities for physicians. Nursing presence and physician oversight and familiarity and communicating with AL staff who are highly familiar with a given resident and can monitor care may facilitate care

Licensed Nurse Staffing and Health Service Availability in Residential Care and Assisted Living

To create data driven typologies of licensed nurse staffing and health services in residential care/assisted living (RC/AL)

Archeological Investigations at the Santa Maria Creek Site (41CW104) Caldwell County, Texas

The excavations by Atkins at the Santa Maria Creek site (41CW104) described in the following report have succeeded in bringing together a myriad of information regarding aboriginal occupations in eastern Central Texas at the dawn of the Historic period. The analysis of the materials recovered from National Register of Historic Places testing and data recovery has demonstrated that even a site buried in sandy, bioturbated sediments can still significantly add to the archeological record. This becomes even more important for areas such as Caldwell County, Texas, which have witnessed few such investigations. The report utilized a wide array of analytical techniques to unravel the site, including extensive ethnohistorical research, artifact analysis, special studies, and experimental archeology

Archeological Investigations at the Santa Maria Creek Site (41CW104) Caldwell County, Texas

Report on the excavations at the Santa Maria creek site in Caldwell County, Texas during 2006 and 2007. The report includes a discussion of research methods, analysis of the findings, and history of the area

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead