Allelic heterogeneity of Crooked Tail Syndrome: result of balancing selection?

We report the identification of a second loss-of-function mutation (c.1906T>C) in the bovine MRC2 gene causing the Crooked Tail Syndrome in Belgian Blue Cattle. We demonstrate that the ensuing substitution of the highly conserved Cysteine 636 with Arginine causes illegitimate receptor oligomerization, which is predicted to impair function of the MRC2 encoded protein, Endo180. We propose that this second MRC2 mutation was selected by breeders as a result of its favourable effect on muscularity in heterozygotes.

The home care satisfaction measure: a client-centered approach to assessing the satisfaction of frail older adults with home care services.

OBJECTIVES: The Home Care Satisfaction Measure (HCSM) is an easy to administer, psychometrically sound instrument based on consumer-defined notions of satisfaction, including perspectives of ethnic minorities. The HCSM provides an overall home care satisfaction score and subscale scores for 5 common services, all on a 0-100 scale. METHODS: Focus groups with African American, Hispanic, and non-Hispanic White older adults were audiotaped. Tapes were transcribed and analyzed with grounded theory methods. Correlational and common factor analyses were conducted to select items, and the instrument was field tested with 228 frail, low-income, older home care recipients. RESULTS: Test-retest reliabilities ranged from .68 to .88, with high internal consistency reliabilities. Substantial concurrent validity was achieved for subscale and overall HCSM scores. Home care satisfaction was not related to gender, age or race but was negatively associated with physical disability. Significant social desirability effects were found. DISCUSSION: In the increasingly important area of home care, the HCSM is the first measure developed on the basis of the views of older consumers that also meets standard psychometric criteria. The HCSM provides a consumer-based indicator of quality and can be used to examine changes in satisfaction over time and differences among providers or within a single agency.

Advancing the state of the art: establishing guidelines for long-term care case management.

This article describes the results of a 15-month project, supported by a grant from The Robert Wood Johnson Foundation, to develop case management practice guidelines for long-term care. Connecticut Community Care, Inc. (CCCI), a nationally recognized case management agency, was the primary contractor for the grant. CCCI established and convened the National Advisory Committee on Long-Term Care Case Management, a group of case management experts from academia, provider organizations, and state and federal government. CCCI facilitated the work of the committee and had overall responsibility for financial management, data processing, and staff support. The committee's work culminated in a definition of long-term care case management, a set of principles underlying its practice, and the formulation of guidelines. Results and recommendations from the National Advisory Committee will be disseminated to government officials, policymakers, administrators, academicians, geriatricians, care providers, and long-term care community-based case managers.

The quest for uniform guidelines for long-term care case management.

This article presents proceedings and preliminary findings from the National Advisory Committee on Long-Term Care Case Management, a group of nationally recognized case management experts from academia, provider organizations, and state and federal governments. The National Advisory Committee, supported by a grant from The Robert Wood Johnson Foundation, was created to achieve consensus about case management and explore the feasibility of developing case management practice guidelines for long-term care. Preliminary findings include endorsement of the need for guidelines, identification of core and ancillary functions of case management, and agreement to limit the scope of guidelines to the long-term care populations of frail elders and adults with chronic functional limitations. Final results and recommendations from the National Advisory Committee will be disseminated to government officials, policymakers, administrators, academicians, geriatricians, care providers, and long-term care community-based case managers.

Assessment of needs of adults with developmental disabilities in skilled nursing and intermediate care facilities in Illinois.

Findings are reported from a statewide assessment of the habilitation, medical, and behavioral training needs of adults with developmental disabilities in Illinois general nursing homes. Only 10% were determined to be appropriately placed in medical settings, and only 27% were enrolled in developmental training programs. A large proportion of those recommended for alternative residential settings had significantly more intense medical, adaptive behavior, self-care, and self-preservation needs than did residents who typically reside in residential facilities for persons with developmental disabilities. Historical barriers to addressing the residential and active treatment needs of the assessed residents were discussed as were recent program developments in Illinois and implications of this study for other states.

Regulating the behavior of nursing homes through positive incentives: an analysis of Illinois' Quality Incentive Program (QUIP).

The Illinois Quality Incentive Program (QUIP) offers nursing homes a separate bonus payment per Medicaid day for achievement of each of 6 quality standards. Using data from 809 participating nursing homes between 1985-1988, this study found that over 90% of eligible facilities chose to participate annually. Success in achieving bonus payments in multiple standards increased over time, with 27% qualifying for 5 or 6 components by 1988. But the validity of the individual measures and the relationship between achievement of QUIP standards and resident quality was not firmly established. The resident satisfaction standard proved insensitive, with 92% of participating facilities qualifying on this standard.