Psychometric Properties of The Five-Item Victimization of Exploitation (FIVE) Scale: A Measure of Financial Abuse of Older Adults.

BACKGROUND AND OBJECTIVES: Elder mistreatment affects at least 1 in 10 older adults. Financial abuse, or exploitation, of older adults is among the most commonly reported forms of abuse. Few validated measures exist to measure this construct. We aim to present a new psychometrically validated measure of financial abuse of older adults. RESEARCH DESIGN AND METHODS: Classical test theory and item response theory (IRT) methodologies were used to examine a five-item measure of financial abuse of older adults, administered as part of the New York State Elder Mistreatment Survey. RESULTS: Factor analysis revealed a single factor best fits the data, which we labeled as financial abuse. Moreover, IRT analyses revealed that these items discriminated well between abused and nonabused persons and provided information at high levels of the latent trait θ, as is expected in cases of abuse. DISCUSSION AND IMPLICATIONS: The Five-Item Victimization of Exploitation Scale has acceptable psychometric properties and has been used successfully in large-scale survey research. We recommend this measure as an indicator of financial abuse in elder abuse, or mistreatment prevalence research studies.

Financial exploitation of older adults: a population-based prevalence study.

BACKGROUND: Financial exploitation is the most common and least studied form of elder abuse. Previous research estimating the prevalence of financial exploitation of older adults (FEOA) is limited by a broader emphasis on traditional forms of elder mistreatment (e.g., physical, sexual, emotional abuse/neglect). OBJECTIVES: 1) estimate the one-year period prevalence and lifetime prevalence of FEOA; 2) describe major FEOA types; and 3) identify factors associated with FEOA. DESIGN: Prevalence study with a random, stratified probability sample. PARTICIPANTS: Four thousand, one hundred and fifty-six community-dwelling, cognitively intact adults age ≥ 60 years. SETTING: New York State. MAIN MEASURES: Comprehensive tool developed for this study measured five FEOA domains: 1) stolen or misappropriated money/property; 2) coercion resulting in surrendering rights/property; 3) impersonation to obtain property/services; 4) inadequate contributions toward household expenses, but respondent still had enough money for necessities and 5) respondent was destitute and did not receive necessary assistance from family/friends. KEY RESULTS: One-year period FEOA prevalence was 2.7% (95% CI, 2.29-3.29) and lifetime prevalence was 4.7% (95% CI, 4.05-5.34). Greater relative risk (RR) of one-year period prevalence was associated with African American/black race (RR, 3.80; 95 % CI, 1.11-13.04), poverty (RR, 1.72; 95 % CI, 1.09-2.71), increasing number of non-spousal household members (RR, 1.16; 95 % CI, 1.06-1.27), and ≥ 1 instrumental activity of daily living (IADL) impairments (RR, 1.69; 95 % CI, 1.12-2.53). Greater RR of lifetime prevalence was associated with African American/black race (RR, 2.61; 95 % CI, 1.37-4.98), poverty (RR, 1.47; 95 % CI, 1.04-2.09), increasing number of non-spousal household members (RR, 1.16; 95 % CI, 1.12-1.21), and having ≥1 IADL (RR, 1.45; 95 % CI, 1.11-1.90) or ≥1 ADL (RR, 1.52; 95 % CI, 1.06-2.18) impairment. Living with a spouse/partner was associated with a significantly lower RR of lifetime prevalence (RR, 0.39; 95 % CI, 0.26-0.59) CONCLUSIONS: Financial exploitation of older adults is a common and serious problem. Elders from groups traditionally considered to be economically, medically, and sociodemographically vulnerable are more likely to self-report financial exploitation.

Elder Abuse and Neglect Risk Alleviation in Protective Services.

Little is known about conditions associated with favorable elder mistreatment (EM) case outcomes. The fundamental goal of EM protective service programs is to alleviate risk associated with substantiated cases of elder abuse and neglect. Using the EM socio-cultural model, this study examined victim, perpetrator, victim-perpetrator relationship, social embeddedness, and socio-cultural factors predicting risk alleviation of EM cases. Data from a random sample of EM protective social service cases (n = 250) at a large community agency in New York City were collected and coded by multiple, independent raters. Multinomial and binary logistic regression were used to examine undifferentiated risk alleviation for the entire sample of EM cases as well as differentiated financial, emotional, and physical abuse sub-types. Undifferentiated EM risk alleviation was associated with male victim gender, older victim age, previous community help-seeking, and victim-perpetrator dyads characterized by a separate living arrangement and shorter term abuse longevity. Financial abuse cases with younger perpetrators were less likely to have risk reduction. Physical abuse risk reduction was less likely when the perpetrator was male and the victim-perpetrator dyad included different genders. Distinct findings across EM sub-types suggest a need to develop targeted practice strategies with clients experiencing different forms of EM. Findings highlight a need to develop EM protective service infrastructure around perpetrator rehabilitation.

Broadening the etiological discourse on Alzheimer's disease to include trauma and posttraumatic stress disorder as psychosocial risk factors.

Biomedical perspectives have long dominated research on the etiology and progression of Alzheimer's disease (AD); yet these approaches do not solely explain observed variations in individual AD trajectories. More robust biopsychosocial models regard the course of AD as a dialectical interplay of neuropathological and psychosocial influences. Drawing on this broader conceptualization, we conducted an extensive review of empirical and theoretical literature on the associations of trauma, posttraumatic stress disorder (PTSD) and AD to develop a working model that conceptualizes the role of psychosocial stressors and physiological mechanisms in the onset and course of AD. The proposed model suggests two pathways. In the first, previous life trauma acts as a risk factor for later-life onset of AD, either directly or mediated by PTSD or PTSD correlates. In the second, de novo AD experiential trauma is associated with accelerated cognitive decline, either directly or mediated through PTSD or PTSD correlates. Evidence synthesized in this paper indicates that previous life trauma and PTSD are strong candidates as psychosocial risk factors for AD and warrant further empirical scrutiny. Psychosocial and neurological-based intervention implications are discussed. A biopsychosocial approach has the capacity to enhance understanding of individual AD trajectories, moving the field toward 'person-centered' models of care.

Vitamin E and neurological function.

The clinical, neuropathological and electrophysiological evidence that vitamin E (alpha-tocopherol) is essential for normal neurological function will be reviewed. The possible reasons why neural tissues should be particularly affected by a deficiency of this fat-soluble vitamin and the mechanism(s) involved will be considered.

Heteroepitaxial growth of vertical GaAs nanowires on Si(111) substrates by metal-organic chemical vapor deposition.

Epitaxial growth of vertical GaAs nanowires on Si(111) substrates is demonstrated by metal-organic chemical vapor deposition via a vapor-liquid-solid growth mechanism. Systematic experiments indicate that substrate pretreatment, pregrowth alloying temperature, and growth temperature are all crucial to vertical epitaxial growth. Nanowire growth rate and morphology can be well controlled by the growth temperature, the metal-organic precursor molar fraction, and the molar V/III ratio. The as-grown GaAs nanowires have a predominantly zinc-blende crystal structure along a <111> direction. Crystallographic {111} stacking faults found perpendicular to the growth axis could be almost eliminated via growth at high V/III ratio and low temperature. Single nanowire field effect transistors based on unintentionally doped GaAs nanowires were fabricated and found to display a strong effect of surface states on their transport properties.

Mothers raising children with sickle cell disease at the intersection of race, gender, and illness stigma.

This qualitative study used the long interview method with Canadian mothers of African and Caribbean descent to understand the underresearched experience of raising a child with sickle cell disease (SCD). Mothers' realities were explored through three levels of social organization: daily caregiver coping (micro level); community views of SCD, such as stigma (meso level); and systemic SCD health care provision (macro level). Through the use of population health and structural social work perspectives, mothers' experiences were examined in the context of perceived gender and racial oppression. Saturation was achieved after initial interviews with 10 participants and a four-month postinterview with half of the participants. Mothers commonly reported several daily coping challenges: fear of their children's death, separation anxiety, loss of control over life, helplessness, and loneliness/isolation. SCD stigma interacted with racism, contributed to social isolation, and prevented families from organizing as a group. All mothers perceived racism as a salient factor behind inadequate mainstream SCD health care. Recommendations to improve SCD health care and implications for social work practice and research are discussed. This is the first known Canadian psychosocial study of SCD and investigation into SCD stigma outside of rural Nigeria.

Supplementation with antioxidants and folinic acid for children with Down's syndrome: randomised controlled trial.

OBJECTIVES: To assess whether supplementation with antioxidants, folinic acid, or both improves the psychomotor and language development of children with Down's syndrome. DESIGN: Randomised controlled trial with two by two factorial design. SETTING: Children living in the Midlands, Greater London, and the south west of England. PARTICIPANTS: 156 infants aged under 7 months with trisomy 21. INTERVENTION: Daily oral supplementation with antioxidants (selenium 10 mug, zinc 5 mg, vitamin A 0.9 mg, vitamin E 100 mg, and vitamin C 50 mg), folinic acid (0.1 mg), antioxidants and folinic acid combined, or placebo. MAIN OUTCOME MEASURES: Griffiths developmental quotient and an adapted MacArthur communicative development inventory 18 months after starting supplementation; biochemical markers in blood and urine at age 12 months. RESULTS: Children randomised to antioxidant supplements attained similar developmental outcomes to those without antioxidants (mean Griffiths developmental quotient 57.3 v 56.1; adjusted mean difference 1.2 points, 95% confidence interval -2.2 to 4.6). Comparison of children randomised to folinic acid supplements or no folinic acid also showed no significant differences in Griffiths developmental quotient (mean 57.6 v 55.9; adjusted mean difference 1.7, -1.7 to 5.1). No between group differences were seen in the mean numbers of words said or signed: for antioxidants versus none the ratio of means was 0.85 (95% confidence interval 0.6 to 1.2), and for folinic acid versus none it was 1.24 (0.87 to 1.77). No significant differences were found between any of the groups in the biochemical outcomes measured. Adjustment for potential confounders did not appreciably change the results. CONCLUSIONS: This study provides no evidence to support the use of antioxidant or folinic acid supplements in children with Down's syndrome. TRIAL REGISTRATION: Clinical trials NCT00378456.

A systematic study on the growth of gaas nanowires by metal-organic chemical vapor deposition.

The epitaxial growth of GaAs nanowires (NWs) on GaAs(111)B substrates by metal-organic chemical vapor deposition has been systematically investigated as a function of relevant growth parameters, namely, temperature, arsine (AsH3) and trimethyl-gallium (TMGa) flow rates, growth time, and gold nanoparticle catalyst size. When growing in excess As conditions (V/III molar ratios greater than four), the NW growth rate is independent of AsH3 concentration, while it is linearly dependent on TMGa concentration, and it is thermally activated. The NW morphology is primarily affected by the growth temperature, with very uniform NWs growing at around 400 degrees C and severely tapered NWs growing above 500 degrees C. A simple phenomenological expression that allows prediction of the NW growth rate over a wide range of growth parameters has been derived. The growth rate dependence on the seed nanoparticle size has also been investigated, which reveals valuable information on the role of catalyst supersaturation and Ga surface diffusion in the growth mechanism. The NW growth rate is found to be almost independent of Au nanoparticle size down to diameters of approximately 20 nm over a wide range of temperatures and TMGa and AsH3 molar flows. For smaller NW radii, the growth rate becomes size-dependent and is strongly affected by the V/III molar ratio; at relatively low V/III ratios, smaller NWs grow more slowly due to the Gibbs-Thompson effect, while at higher V/III ratios (V/III >50), Ga adatom diffusion becomes the dominant mass-transport mechanism, and smaller NWs grow faster than larger ones. The growth-limiting mechanisms in the above growth regimes are finally discussed, and important quantities such as pyrolysis efficiency of the precursors, supersaturation, and surface diffusion length are deduced by comparing the experimental results with the NW growth rates predicted from first principles.

Rational synthesis of p-type zinc oxide nanowire arrays using simple chemical vapor deposition.

We report, for the first time, the synthesis of the high-quality p-type ZnO NWs using a simple chemical vapor deposition method, where phosphorus pentoxide has been used as the dopant source. Single-crystal phosphorus doped ZnO NWs have their growth axis along the 001 direction and form perfect vertical arrays on a-sapphire. P-type doping was confirmed by photoluminescence measurements at various temperatures and by studying the electrical transport in single NWs field-effect transistors. Comparisons of the low-temperature PL of unintentionally doped ZnO (n-type), as-grown phosphorus-doped ZnO, and annealed phosphorus-doped ZnO NWs show clear differences related to the presence of intragap donor and acceptor states. The electrical transport measurements of phosphorus-doped NW FETs indicate a transition from n-type to p-type conduction upon annealing at high temperature, in good agreement with the PL results. The synthesis of p-type ZnO NWs enables novel complementary ZnO NW devices and opens up enormous opportunities for nanoscale electronics, optoelectronics, and medicines.

High electron mobility InAs nanowire field-effect transistors.

Single-crystal InAs nanowires (NWs) are synthesized using metal-organic chemical vapor deposition (MOCVD) and fabricated into NW field-effect transistors (NWFETs) on a SiO(2)/n(+)-Si substrate with a global n(+)-Si back-gate and sputtered SiO(x)/Au underlap top-gate. For top-gate NWFETs, we have developed a model that allows accurate estimation of characteristic NW parameters, including carrier field-effect mobility and carrier concentration by taking into account series and leakage resistances, interface state capacitance, and top-gate geometry. Both the back-gate and the top-gate NWFETs exhibit room-temperature field-effect mobility as high as 6580 cm(2) V(-1) s(-1), which is the lower-bound value without interface-capacitance correction, and is the highest mobility reported to date in any semiconductor NW.

Effects on neural function of repleting vitamin E-deficient rats with alpha-tocopherol.

A severe and chronic deficiency of vitamin E (alpha-tocopherol) is associated with a characteristic neurological syndrome with typical "clinical," neuropathological, and electrophysiological abnormalities in both humans and experimental animals. Repletion of vitamin E-deficient human subjects with alpha-tocopherol typically halts the progression of the neural signs and symptoms, and in some cases, can result in objective improvement. Electrophysiological parameters provide an objective measure of neural and visual function and improvement of some of these measures has been reported after repletion with vitamin E in humans. In this longitudinal study, the effects of repleting rats with a diet containing 36 mg/kg all-rac-alpha-tocopheryl acetate for 20 wk after they had been receiving a vitamin E-deficient diet for 38 wk was studied. We report significant improvements in growth and a number of electrophysiological parameters of both neural and visual function after repletion. These results confirm the validity of the vitamin E-deficient rat as a model of vitamin E deficiency in humans.

Dietary lipids and vascular function: UK Food Standards Agency workshop report.

The UK Food Standards Agency convened a group of expert scientists to review current research investigating the effect of dietary lipids on vascular function. The workshop highlighted the need for intervention studies to be sufficiently powered for these measures and that they should be corroborated with other, more validated, risk factors for CVD. Work presented at the workshop suggested a beneficial effect of long-chain n-3 PUFA and a detrimental effect of trans fatty acids. The workshop also considered the importance of the choice of study population in dietary intervention studies and that "at risk" subgroups within the general population may be more appropriate than subjects that are unrepresentatively healthy.

Synthesis and analysis of conjugates of the major vitamin E metabolite, alpha-CEHC.

Glucuronide and sulphate conjugates of 2,5,7,8-tetramethyl-2-(2'-carboxyethyl)-6-hydroxychroman (alpha-CEHC), the major metabolite of alpha-tocopherol (vitamin E), have been synthesized and used for the first direct analysis of conjugated urinary vitamin E metabolites. The metabolites of vitamin E (alpha-tocopherol) could be useful as markers of the function(s) of vitamin E in vivo. A number of methods have been described for the analysis of urinary vitamin E metabolites but these have relied on either acid or enzymatic deconjugation of the metabolites prior to analysis by high performance liquid chromatography or gas chromatography/mass spectrometry. These methods have provided useful information about the amount and types of metabolites excreted in the urine but suffer from a number of disadvantages. Deconjugation has been shown to produce artifacts as a result of the conversion of alpha-CEHC to alpha-tocopheronolactone and the efficiency of deconjugation is also difficult to assess. Methods that allow the direct measurement of the conjugated metabolites would overcome these problems and would also substantially reduce the preparation and analysis time. Here we describe the use of conjugated standards to characterize alpha-CEHC conjugates in human urine by tandem mass spectrometry (MS-MS). The future use of MS-MS to measure urinary vitamin E metabolites is also discussed.

Architecture of RNA polymerase II and implications for the transcription mechanism.

A backbone model of a 10-subunit yeast RNA polymerase II has been derived from x-ray diffraction data extending to 3 angstroms resolution. All 10 subunits exhibit a high degree of identity with the corresponding human proteins, and 9 of the 10 subunits are conserved among the three eukaryotic RNA polymerases I, II, and III. Notable features of the model include a pair of jaws, formed by subunits Rpb1, Rpb5, and Rpb9, that appear to grip DNA downstream of the active center. A clamp on the DNA nearer the active center, formed by Rpb1, Rpb2, and Rpb6, may be locked in the closed position by RNA, accounting for the great stability of transcribing complexes. A pore in the protein complex beneath the active center may allow entry of substrates for polymerization and exit of the transcript during proofreading and passage through pause sites in the DNA.

Yeast RNA polymerase II at 5 A resolution.

Appropriate treatment of X-ray diffraction from an unoriented 18-heavy atom cluster derivative of a yeast RNA polymerase II crystal gave significant phase information to 5 A resolution. The validity of the phases was shown by close similarity of a 6 A electron density map to a 16 A molecular envelope of the polymerase from electron crystallography. Comparison of the 6 A X-ray map with results of electron crystallography of a paused transcription elongation complex suggests functional roles for two mobile protein domains: the tip of a flexible arm forms a downstream DNA clamp; and a hinged domain may serve as an RNA clamp, enclosing the transcript from about 8-18 residues upstream of the 3'-end in a tunnel.

Acute urinary retention due to ectopic pregnancy.

Two cases of ectopic pregnancy are presented in which acute urinary retention was a salient clinical feature. The emergency physician must consider ectopic pregnancy in the differential diagnosis in any woman of child-bearing age with abdominal, pelvic, or urinary complaints.

Repeated tertiary fold of RNA polymerase II and implications for DNA binding.

X-ray diffraction data from two forms of yeast RNA polymerase II crystals indicate that the two largest subunits of the polymerase, Rpb1 and Rpb2, may have similar folds, as is suggested by secondary structure predictions. DNA may bind between the two subunits with its 2-fold axis aligned to a pseudo 2-fold axis of the protein.

Low-resolution real-space envelopes: the application of the condensing-protocol approach to the ab initio macromolecular phase problem of a variety of examples.

A recently reported method - the improved condensing protocol [Subbiah (1991). Science, 252, 128-133; (1993). Acta Cryst. D49, 108-119] - for obtaining low-resolution macromolecular envelopes is applied to five varied test cases. These examples were chosen to illustrate the general applicability of the method to the wide range that typical macromolecular crystals adopt. The cases include small and large asymmetric unit volumes (4.7 x 10(4) to 1.17 x 10(6) A(3)), low and high symmetry (2 to 12 symmetry elements), small and large proteins (1570 to 12 216 non-H atoms), orthogonal and non-orthogonal unit cells, a wide variety of space groups (P2(1) to P6(3)22), small and large solvent contents (33-80%), and a case of non-crystallographic symmetry (threefold). In all five cases the inherent ambiguity of the condensing protocol in differentiating between bulk matter and bulk solvent is then resolved by use of the recently reported sign-fixing method (Subbiah, 1993).

[8 years outcome of 243 trials of coronary angiography performed in the Montreal Institute of Cardiology]. / Evolution à 8 ans des 243 premières tentatives d'angioplastie coronaire réalisées à l'Institut de cardiologie de Montréal.

This study reports the long-term outcome of the first 243 patients who underwent coronary angioplasty at the Montreal Heart Institute between February 1980 and March 1983. The average age of the patients was 50 +/- 9 years; one quarter of cases were unstable angina; three quarters of the patients were men. Single vessel coronary disease was present in 83% of patients; the mean ejection fraction was 62%. One segment was dilated in 216 patients and 2 segments in 27 patients. The LAD was dilated in 179 patients, the right coronary in 63 and the left circumflex artery in 20 patients. The average severity of stenosis was 83 +/- 9.5%. Angioplasty was successful in 68.7% of patients. There were no fatalities: 25.5% of patients underwent coronary bypass surgery; 6.2% of patients suffered myocardial infarction. Restenosis was observed in 28% of patients. The average follow-up period was 99 +/- 10 months (average 8 years) and ranged from 7 to 10 years. The survival rate was 98.4% and 90.5% at 5 and 10 years respectively. Survival rates without infarction were 91.8% and 81.3% at 5 and 10 years, and survival without infarction or revascularisation was 73.2% and 60.3% at 5 and 10 years, respectively. During follow-up, 80% of patients were asymptomatic. Nearly a half of patients required antianginal therapy (monotherapy in 65.7% of them). Factors associated with absence of mortality infarction or revascularisation were: female sex, absence of restenosis and less severe stenosis before angioplasty. Using a multivariate analysis, only the degree of stenosis was correlated to the absence of these complications.(ABSTRACT TRUNCATED AT 250 WORDS)