Long Term Care Policy and Procedure Manual

This culminating project will focus on the changes that have occurred in the medical world and how those changes have, and will continue to impact the elderly, specifically in the long term care setting . Over the years the main consideration of health care has changed from direct patient impact to direct dollar impact . With these changes has come the ethical dilemma of providing care for the elderly in a dignified and individualized manner while maintaining a positive cash flow . No longer will society accept mediocre care for the elderly, gone are the days of few and poorly defined regulations that mandate nursing homes . State and federal regulations mandate how long term care facilities are managed. Indeed, the nursing home industry is one of the most heavily regulated, second only to nuclear waste. Nursing homes have long been viewed by society as a place elderly patients go to die. A place where there is no dignity, no life, no choices. The purpose of this manual is to assist a long term care facility in the accurate completion of the admission process, correct placement of the patient, identification rehabilitative needs and observance of patient rights while adhering to the mandated state and federal regulations in the most cost effective manner . As with many of the changes emanating from Washington, recently proposed legislation will dramatically change the delivery of health care in the United States . Coupled with the changes already in effect , health care facilities, particularly long term care facilities, are scrambling to stay competitive . The role of the long term care facility continues to change as hospitals release patients more quickly, and nursing homes see sicker, frailer patients at their door. The nursing home must balance identifying the needs of their patients while adhering to the regulations and observing patients rights, all the while on a very small reimbursement rate

The Political Roles of Presidential Children: Kennedy through Clinton

Many facets of the institution of the presidency warrant examination. Individual presidents, cabinets, staffs, and first ladies have all been studied in-depth, but one aspect of the presidency remains fundamentally unexplored: the political activities of presidential children. Role analysis using case studies was the method of examination used. Role analysis was the method used in early studies on first ladies and is replicated in this study on presidential children. The basic assumption is that all presidential children from Kennedy through Clinton have performed political roles. By examining the repeated political activities of the 24 presidential children, five political roles were designated. First is the role of symbol. Symbols serve to display the presidential candidate or president as a person that is a good family man, loving father, and someone with high moral integrity. Surrogates serve to stand in for the president when the president cannot be present. The bulk of a surrogate’s role takes place on the campaign trail. The increase in importance of primaries and the decrease in power of political parties have both made the need for campaign surrogates mandatory. Informal advisors/confidant(e)s provide opinions and advice to the president. Skeletons tend to embarrass the president. Finally, if an individual president child performs several of these roles equally, they are labeled as hybrids. Each of the 24 children from the Kennedy through Clinton is categorized in of the above roles and their actions and impacts are analyzed through expansive case studies. The findings display that all presidential children have performed at least one of these political roles. It is interesting to note that these roles vary by the age of the child. Those children younger than 18 years old were almost exclusively symbols because they really had no other choice. The study also highlights that the use of symbols has become more important since the beginning of the media age of American politics. In many cases, images have become more important than messages, and younger children of presidents are utilized as image-makers to help increase the popularity of the candidate or president. Roles also vary by the sex of the child. Female children are often called upon to fill in for the first lady as hostess at the White House while the male children are not. Though a historical overview of the political activities of presidential children have been important political actors even before the dawn of the media age. Finally, this study is significant to presidential studies for several reasons. First, it seems as if the presidential strategy of “going public” has been conceptualized too narrowly. Beyond presidents making personal appeals to the American people, “going public” may also include activities such as sending surrogates out to interact with the public. Second, presidential children can be seen as extensions of the presidents himself. This is extremely significant because it means that presidents with children, or more specifically, active children, may in fact have an advantage over presidents without children. If presidential power is personal, then having active children may increase the total sum of personal power. Third, having, children increase a president’s ability to manipulate or mold public perceptions of him through their symbolism. Finally, just as formal staff and advisor influence the decisions presidents make, so too do presidential children. Therefore, presidential children can perform multiple roles that do have an affect on the institution of the presidency. They can be physical surrogates, symbolic personifications, mouthpieces of Administrative policies, and protectors of the president, ambassadors overseas for the president, public defenders, or extensions of the president himself. Therefore, this study elucidates that although presidential children may not be formal players in the institution of the presidency, though their personal influence they impact the institution nonetheless

The Elastic Scattering of Protons by Lithium

The cross section for the reaction Li7(p, p) has been measured over the proton energy range 360-1400 kev. Measurements were made at scattering angles of 50, 70, 89.2, 110, 130, 143.4, and 160 degrees in the center-of-mass system. Anomalous scattering was observed near 441.5 kev, the resonance energy for the reaction Li7(p, γ), and near 1030 kev, the resonance energy for the reaction Li7(p, p′). Analysis of the results at 441.5 kev indicates a state in Be8 with J=1, even parity, formed by p wave protons. The relative stopping cross section for protons in lithium was also measured from 200-1300 kev

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Objective: To identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support. Methods: An audit was conducted of all community‐dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associCorrespondence A. Warters, PhD, Community Healthcare Organisation, Ballymun Healthcare Facility, Dublin, Ireland. Email: [email protected] ated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. Results: The audit comprised 1597 community‐dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8%and 9%, respectively, during the 12‐month period. Factors significantly associated with admission to LTC were “cognitive dysfunction” [OR 2.10 (1.41‐3.14), P < .001] and the intensity of home support [OR 1.05 (1.01‐1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). Conclusion: “Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive‐specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer

The immunological consequences of radiation-induced DNA damage.

Historically, our understanding of the cytotoxicity of radiation has centred on tumour cell-autonomous mechanisms of cell death. Here, tumour cell death occurs when a threshold number of radiation-induced non-reparable double-stranded DNA breaks is exceeded. However, in recent years, the importance of immune mechanisms of cell death has been increasingly recognised, as well as the impact of radiotherapy on non-malignant cellular components of the tumour microenvironment. Conserved antiviral pathways that detect foreign nucleic acid in the cytosol and drive downstream interferon (IFN) responses via the cyclic guanosine monophosphate-adenosine monophosphate synthase/stimulator of IFN genes (cGAS/STING) pathway are key components of the immune response to radiation-induced DNA damage. In preclinical models, acute induction of a type 1 IFN response is important for both direct and abscopal tumour responses to radiation. Inhibitors of the DNA damage response show promise in augmenting this inflammatory IFN response. However, a substantial proportion of tumours show chronic IFN signalling prior to radiotherapy, which paradoxically drives immunosuppression. This chronic IFN signalling leads to treatment resistance, and heterotypic interactions between stromal fibroblasts and tumour cells contribute to an aggressive tumour phenotype. The effect of radiotherapy on myeloid cell populations, particularly tumour-associated macrophages, has an additional impact on the immune tumour microenvironment. It is not yet clear how the above preclinical findings translate into a human context. Human tumours show greater intratumoural genomic heterogeneity and more variable levels of chromosomal instability than experimental murine models. High-quality translational studies of immunological changes occurring during radiotherapy that incorporate intrinsic tumour biology will enable a better understanding of the immunological consequences of radiation-induced DNA damage in patients. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd

A p53-independent role for the MDM2 antagonist Nutlin-3 in DNA damage response initiation.

BACKGROUND: The mammalian DNA-damage response (DDR) has evolved to protect genome stability and maximize cell survival following DNA-damage. One of the key regulators of the DDR is p53, itself tightly regulated by MDM2. Following double-strand DNA breaks (DSBs), mediators including ATM are recruited to the site of DNA-damage. Subsequent phosphorylation of p53 by ATM and ATM-induced CHK2 results in p53 stabilization, ultimately intensifying transcription of p53-responsive genes involved in DNA repair, cell-cycle checkpoint control and apoptosis. METHODS: In the current study, we investigated the stabilization and activation of p53 and associated DDR proteins in response to treatment of human colorectal cancer cells (HCT116p53+/+) with the MDM2 antagonist, Nutlin-3. RESULTS: Using immunoblotting, Nutlin-3 was observed to stabilize p53, and activate p53 target proteins. Unexpectedly, Nutlin-3 also mediated phosphorylation of p53 at key DNA-damage-specific serine residues (Ser15, 20 and 37). Furthermore, Nutlin-3 induced activation of CHK2 and ATM - proteins required for DNA-damage-dependent phosphorylation and activation of p53, and the phosphorylation of BRCA1 and H2AX - proteins known to be activated specifically in response to DNA damage. Indeed, using immunofluorescent labeling, Nutlin-3 was seen to induce formation of γH2AX foci, an early hallmark of the DDR. Moreover, Nutlin-3 induced phosphorylation of key DDR proteins, initiated cell cycle arrest and led to formation of γH2AX foci in cells lacking p53, whilst γH2AX foci were also noted in MDM2-deficient cells. CONCLUSION: To our knowledge, this is the first solid evidence showing a secondary role for Nutlin-3 as a DDR triggering agent, independent of p53 status, and unrelated to its role as an MDM2 antagonist

Affiliate Contributors to Primary Care for Children

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people

The effect of neuromuscular blockade on mask ventilation

Summary We wished to test the hypothesis that neuromuscular blockade facilitates mask ventilation. In order reliably and reproducibly to assess the efficiency of mask ventilation, we developed a novel grading scale (Warters scale), based on attempts to generate a standardised tidal volume. Following induction of general anaesthesia, a blinded anaesthesia provider assessed mask ventilation in 90 patients using our novel grading scale. The non-blinded anaesthesiologist then randomly administered rocuronium or normal saline. After 2 min, mask ventilation was reassessed by the blinded practitioner. Rocuronium significantly improved ventilation scores on the Warters scale (mean (SD) 2.3 (1.6) vs 1.2 (0.9), p &lt; 0.001). In a subgroup of patients with a baseline Warters scale value of &gt; 3 (i.e. difficult to mask ventilate; n = 14), the ventilation scores also showed significant improvement (4.2 (1.2) vs 1.9 (1.0), p = 0.0002). Saline administration had no effect on ventilation scores. Our data indicate that neuromuscular blockade facilitates mask ventilation. We discuss the implications of this finding for unexpected difficult airway management and for the practice of confirming adequate mask ventilation before the administration of neuromuscular blockade

"Cult of equity": actuaries and the transformation of pension fund investing, 1948–1960

This article examines the mid-twentieth-century transformation of U.K. pension fund investment policy known as the “cult of equity.” It focuses on the influence exercised by the Association of Superannuation and Pension Funds over actuarial and corporate governance standards, through actuaries who were members of its council. This intervention led to increasingly permissive actuarial valuations that reduced contributions for sponsors of pension funds investing in equities. Increased demand for equities required pension funds to adopt a more permissive approach to corporate governance than insurance companies and investment trusts, and contributed to declining standards of corporate governance