More than "petty squabbles" - Developing a contextual understanding of conflict and aggression among older women in low-income assisted living

Dominant approaches to relational aggression among older adults tend to conceptualize the problem as a behavioral or interpersonal issue, and can inadvertently infantilize the phenomenon as 'bullying.' In this article we use a narrative approach and the conceptual lens of precarity to develop an in-depth, theoretically informed analysis of relational aggression between older women in low-income assisted living. The analysis of the narratives of tenants (and a manager) indicated that past life experiences and intersecting threats to power and identity shaped and could intensify tenants' interpretations of and reactions to others' actions and comments. Conflicts over a) unequal distributions of caring labor, b) control of social activities, and c) access to appreciation are complex and rational responses to precarious contextual conditions. Findings contribute empirically to the body of research on relational aggression among older adults, expanding this field through connecting it to critical gerontological conceptualizations of precarity. Preventing relational aggression requires increased public investment in formal social supports for older adults, challenging dominant discourses that privilege independence, and recognizing how the legacies of past disadvantage and contextual precarity (as opposed to mental illness or dementia) shape social interactions with and responses to others.

A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration

In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care

Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked “consoling refrains” to manage grief, including “such is life,” “they are better off,” and “they had a full life.” To manage guilt and moral distress, RCAs reminded themselves “I did my best” and “I experience rewards.” Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.

Quantifying the distribution of inhalation exposure in human populations: 2. Distributions of time spent by adults, adolescents, and children at home, at work, and at school

Using distributions of time spent at various ventilation levels, ranges of inhalation exposure in the population can be established. Distributions of exposure time were determined using results of a study by the California Air Resources Board (CARB) which focused on time spent by humans participating in various activities and the locations where the activities occurred. The daily at-home activities from the CARB study were assigned to one of three ventilation levels, generating aggregate time periods. Distinct age and gender populations were identified, and distributions for aggregate time were established for these populations at each of the ventilation levels. In addition to aggregate time spent at home, distributions for various ages and genders were established for aggregate time spent at school and work. By combining distributions of aggregate time with corresponding ventilation rates, the distribution of inhalation rates can be established for at home, at work, and at school exposures.

Distribution of residence duration in owner occupied housing

Residence duration was determined in owner occupied household by employing tax records that identify changes in ownership. Residence duration was estimated by selecting a random sample of households from Multnomah County, Oregon and using the interval between the two most recent changes in ownership. Residence duration was observed to be consistent with an exponential distribution with a mean of 13.6 years. While mean residence duration in this study was consistent with the results of other studies, the distribution of residence duration in this study was not consistent with the results of another study. The distribution of residence duration is important in establishing the distribution of exposure in a population using probabilistic risk assessment methods.

Quantifying the distribution of inhalation exposure in human populations: distribution of minute volumes in adults and children

Assessments of inhalation exposure to environmental agents necessitate quantitative estimates of pulmonary ventilation rates. Estimating a range of exposures in a given population requires an understanding of the variability of ventilation rates in the population. Distributions of ventilation rates (Ve) were described based on the results of a large study where Ve were measured while subjects performed a variety of physical tasks. Three distinct ventilation levels were identified using cluster analyses of the mean Ve and then various activities were assigned to the three levels using a k-means procedure. Separate distributions were identified for the three Ve levels for adult males, adult females, and children. The variability of Ve was consistent with a lognormal distribution for all groups. An aggregate daily inhalation rate can be estimated based on the distributions of Ve.