New York Breaks Gideon’s Promise

In 1963, the Supreme Court of the United States held that criminal defendants have the constitutional right to counsel, regardless of whether they can afford one, in the famous case of Gideon v. Wainwright. However, statistics, as well as public defense attorneys, reveal that the Supreme Court’s decision has yet to be fulfilled. Part of the problem is due to the system of mass incarceration in the United States. In 2013, the Brennan Center for Justice reported that the prison population reached 2.3 million individuals, compared to the 217,000 inmates imprisoned when Gideon was decided. The American Bar Association estimates that between 60 to 90 percent of criminal defendants cannot afford a lawyer, and must rely on public criminal defense services. Even though there has been an exceptional rate of criminalization and growth in the prison system population, funding for public defenders remains inadequate and meager compared to prosecution offices. In 2007, the U.S. Bureau of Justice Statistics (BJS), determined that state and local public defender offices’ budgets were merely $2.3 billion, compared to prosecutor offices’ budgets that were approximately$5.8 billion. BJS further concluded that only 27 percent of county-based public defender offices have an adequate number of attorneys to effectively manage their caseloads. This has real consequences for defendants. “Numerous studies that stretch from the 1980s to recent years show that public defenders meet with clients less quickly, file fewer motions, plea-bargain more often, and get charges dismissed less often than private attorneys.” However, since politicians receive little incentive from voters to reform the public defense system and increase public defender offices’ funding, these deficits continue to persist in jurisdictions. The absence of a political upside for lawmakers to increase funding may be the reason why Governor Cuomo of New York vetoed Bill S.8114/A.10706, a criminal justice reform bill that would have required New York State, rather than the individual counties, to provide funding for public defender office

Industry Implications of Value Creation and Appropriation Investment Decisions

As managers weigh their resource investment decisions, we argue that these investments have a direct impact on the growth and volatility of the firm’s industry. With data covering 377 industries across 16 years, we investigate relationships for aggregate firm investments on the growth and volatility of industry profit and sales. Results reveal important, complex relationships between investment in value creation and appropriation and different elements of the industry environment

Performance Implications of Firm Resource Interactions in the Acquisition of R&D-Intensive Firms

We explore the role of resource interactions in explaining firm performance in the context of acquisitions. Although we confirm that acquisitions do not lead to higher performance on average, we do find that complementary resource profiles in target and acquiring firms are associated with abnormal returns. Specifically, we find that acquiring firm marketing resources and target firm technology resources positively reinforce (complement) each other; meanwhile, acquiring and target firm technology resources negatively reinforce (substitute) one another. Implications for management theory and practice are identified

Opioid Tolerant: A Survey of Certified Registered Nurse Anesthetist Self-Perceptions of Pain Management in the Care of Opioid Tolerant Patients

The overall aim of this systems change project is to identify the specific barriers to optimal care faced by Certified Registered Nurse Anesthetists (CRNAs) who are managing the pain of opioid tolerant patients, so as to eliminate those barriers. The postoperative pain of opioid tolerant patients is substantially undertreated, implicitly requiring changes in their treatment for both ethical and economic reasons. These changes will require growth in CRNA skills and thinking. Benner’s conceptual framework has been used to describe this growth in opioid tolerant pain management from novice to expert. A literature review informed the formulation of a descriptive survey instrument to gather data on the self-perceived barriers to optimal practice. The questionnaire was distributed via the American Association of Nurse Anesthetists (AANA) to 2500 practicing CRNAs, achieving a question response rate of 25.6% (640) to 28.9% (717), yielding a very large sample size for each question. The survey data were summarized and analyzed to distinguish the several actual from the numerous possible barriers. The analyses of the survey results revealed three barriers above all others: (a) a lack of specific guidelines for opioid tolerant patients, (b) a general failure to use an opioid calculator to ensure proper dosing, and (c) the very broadly-perceived need for CEUs specifically for managing the pain of the opioid tolerant patient. To initiate the change process, this study was presented to members of the Minnesota Association of Nurse Anesthetists. The data and analysis will serve as a font from which future researchers will draw

Multiracial

Abstract included in text

Evaluating the Effectiveness of Incorporating Nutrition Education and Counseling Services into a Diverse, Low-Income Community Health Center

Suboptimal nutrition has been identified as the leading behavioral risk factor of morbidity and mortality from chronic diseases in the United States, yet approximately ten percent of all primary care visits included nutrition counseling by physicians in 2014 (Marczak, O’Rourke, & Shepard, 2016; GBD 2013 Risk Factor Collaborators, 2015; Rui, Hing, & Okeyode, 2015). The integration of registered dietitians into the primary care setting may serve as a potential solution to increasing the rates of delivery for nutrition counseling and improve patient outcomes. The objective of this study was to examine the incorporation and impact of a three-month nutrition education and counseling pilot program at a Community Health Center (CHC) in serving urban and rural populations in South Carolina. A retrospective chart review of the paper outpatient nutrition chart and electronic medical record (EMR) were conducted to assess the overall success of the 3- month pilot program and determine areas of improvement. Additionally, the medical providers at the CHC were surveyed to examine perceptions and satisfaction regarding the current practices related to nutrition counseling, perceived barriers to nutrition counseling, and the program and its delivery was conducted. A total of 93 patients were referred to the program with 53.8% (n=50) utilizing the services. Although there were no statistically significant changes for weight, body mass index (BMI), or hemoglobin A1c, downward trends were observed. Fisher’s exact tests indicated a significant association between number of visits and dyslipidemia/hyperlipidemia referrals (P=0.002) and between number of visits and age (P=0.0012). Patients without a referral for dyslipidemia were more likely to attend a single visit. In contrast, patients with a referral for ii dyslipidemia were more likely to attend multiple visits. Patients below the age of fifty years old were more likely to attend a single visit compared to adults above fifty years old (91.3% vs. 59.3%, respectively) (P=0.0012). Despite accounting for financial barriers to nutrition services, 46.2% of referred patients were never seen during the pilot program. Communication was the primary reasons these patients were never seen. Medical providers reported high satisfaction with the incorporation of nutrition services into their clinic. Future research is needed to determine intervention strategies that address both financial and nonfinancial barriers (e.g. cost, transportation, and communication) to integrating nutrition counseling and education into CHC and determine the influence of increased access to services on health outcomes

Racialization, Recognition, and Rights: Lumping and Splitting Multiracial Asian Americans in the 2000 Census

THE 2000 CENSUS WILL MARK a dramatic change in the way that “race” is officially enumerated in the United States to allow people to check more than one race. This is a significant change for the way people do and understand the concept of race, and will have potentially far-reaching effects for multiracial Asian Americans, Pacific Islanders, and Asian Pacific Islander communities. The Census, as a representation of the state, is an ideal place to see how race is changing both practically and conceptually as people lobby the Census Bureau to change racial categories to accurately reflect their multiracial understanding.1 In this article, I examine the impact of changing the Census to allow people to check more than one race box on Asian Pacific Americans (APAs). Race is now widely recognized as being a contested and changing, socially constructed category.3 As historical proof of this, APAs have long been unable to fit the racial labels used by the U.S. government to classify them. For example, the plaintiffs in the infamous cases of Ozawa v. United States, 260 U.S. 178 (1922) and United States v. Thind, 261 U.S. 204 (1923) failed in their attempts to be considered “not Asian, Caucasian/white” in order to become naturalized citizens of the U.S. Those cases foreshadowed a legal framework that would continue throughout the 1900s to remind APAs that they were racially different, not white, and therefore ineligible for American citizenship.4 There has never been a comfortable fit historically for Asian Americans with racial categories used by the U.S

Occupational Engagement in Adults under age 65 living in Skilled Nursing Facilities (OEA-SNF)

Background: Adults under age 65 living in skilled nursing facilities is a growing population and lack of occupational engagement in skilled nursing facilities is well documented. There is also a documented lack of training programs for skilled nursing facility staff to appropriately care for this population’s occupational needs. Occupational Therapists are uniquely qualified to educate and train skilled nursing facility staff in the occupational engagement needs of this group. Purpose: There is a lack of documented research regarding adults under age 65 living in skilled nursing facility and training programs for staff that care for this group. To address this gap in knowledge, the purpose of this study is to examine the relationship between staff training and the knowledge and perceived competence of staff related to promotion of occupational engagement in adults under age 65 living in skilled nursing facilities. Theoretical Framework: This research project is guided by four theories: the social ecological model for the overall research project, cognitive constructivism for the design of the educational program, self-determination theory for development of outcome measure related to perceived confidence of participants, and occupational justice theory for guidance related to the issues of occupational justice and deprivation related to this topic. Methods: This pre-experimental one group pretest and posttest research design explored the effects of an occupation-based training program for skilled nursing facility activities professionals on the participant’s knowledge and perceived competence. The primary locations for this study were two skilled nursing facilities in Cincinnati, Ohio. Eight participants total were recruited from both locations. Inclusion criteria included: able to speak English, able to read and write, currently work with adults under age 65 in their work setting, have worked at the research study site for at least 3 months, and able to give their own informed consent. This research study incorporated quantitative research methods with training content delivered in a webinar format and data collected via two written outcome measures. Results: Eight activities professionals participated in this study. Statistical analysis of pre and post test data indicated a statistically significant improvement in knowledge and perceived competence of participants following participation in an occupation-based training program. Conclusions: Skilled nursing facility staff could benefit from occupation-based training in order to meet the occupation needs of adults under age 65 living in skilled nursing facilities. Occupational therapists have the necessary skills to act as a consultant and educator to the staff in skilled nursing facilities in order to improve occupational engagement and quality of life for all residents

Estimating ancestry in South Africa: a comparison of geometric morphometrics and traditional craniometrics

In ancestry estimation of South African individuals, non-metric morphological trait assessment has not proven useful and previous results in FORDISC 3.0 leave room for improvement. The accuracy rates of software programs FORDISC 3.1 and 3D-ID were compared for ancestry estimation based on cranial data of black and white South Africans using discriminant function analysis. Cranial landmarks were digitized using a Microscribe G2 for geometric morphometric analysis in 3D-ID, and traditional craniometric measurements for use in FORDISC were calculated using the data collection software 3Skull. Data was collected from a total of 385 individuals (186 black and 199 white crania) from the Pretoria Bone Collection. Overall accuracy rates of 75.6% using FORDISC 3.1 and 63.1% using 3D-ID were obtained for black and white South Africans. Incorrect estimates were more often due to misclassifications of sex rather than ancestry, reflecting the decreased amount of sexual dimorphism in South African populations when compared against American populations, discussed previously. Black South Africans were more often classified correctly in FORDISC 3.1, and white South Africans were more often classified correctly in 3D-ID. Low sample size in comparative databases and broad ancestral differences between South Africans and the proxy populations used (American, European, and African) likely explain the low accuracy rates. The use of FORDISC and 3D-ID in conjunction can help South African anthropologists in estimating ancestry and ensuring correct classifications