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The RAI may have improved the quality of care of nursing home residents by reducing overall rates of decline in important areas of resident function. However, this innovation may have generated trade-offs in that it may have reduced improvement rates in some areas of function. The system's implementation also seems to have focused staff's attention on the needs and strengths of specific subpopulations of residents. Revisions of the RAI must assist staff in generalizing their efforts to all residents and to increasing improvement rates, especially in areas related to mood and behavior.

Background: A case definition of Gulf War illness with 3 primary variants, previously developed by factor analysis of symptoms in a US Navy construction battalion and validated in clinic veterans, identified ill veterans with objective abnormalities of brain function. This study tests prestated hypotheses of its external validity. Methods: A stratified probability sample (n = 8,020), selected from a sampling frame of the 3.5 million Gulf War era US military veterans, completed a computer-assisted telephone interview survey. Application of the prior factor weights to the subjects’ responses generated the case definition. Results: The structural equation model of the case definition fit both random halves of the population sample well (root mean-square error of approximation = 0.015). The overall case definition was 3.87 times (95% confidence interval, 2.61–5.74) more prevalent in the deployed than the deployable nondeployed veterans: 3.33 (1.10–10.10) for syndrome variant 1; 5.11 (2.43–10.75) for variant 2, and 4.25 (2.33–7.74) for variant 3. Functional status on SF-12 was greatly reduced (effect sizes, 1.0–2.0) in veterans meeting the overall and variant case definitions. Conclusions: The factor case definition applies to the full Gulf War veteran population and has good characteristics for research.

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We developed a sampling frame for a probability-based household survey by purchasing an exhaustive list of over 818,000 residential mailing addresses in Dallas County, Texas. The addresses were obtained from the Delivery Sequence File (DSF) offered by the US Postal Service (USPS) through a nonexclusive license agreement with private companies. The DSF is a computerized file that contains all delivery point addresses serviced by the USPS, with the exception of general delivery. We used the geographic coordinates of the addresses to construct digital maps of the immediate vicinity around each selected address to help the field interviewers locate the selected address. To evaluate the coverage of the mailing addresses, we selected a sub-sample of 2,498 addresses and used the Half-Open Interval (HOI) procedure (Kish 1965) to search for missed housing units in the interval between the selected address and the next address in delivery sequence order. A total of 46 missed addresses were found with the HOI procedure. Also, we found that the vast majority of persons who maintain a residential P.O. Box also have mail delivered to their street address. The 90 percent occupancy rate is consistent with other metropolitan household surveys that use traditional on-site enumeration methods.