Characteristics of effective providers of marital and family therapy in rural mental health settings

Characteristics of effective providers of marital and family therapy (MFT) in rural mental health settings were investigated. The survey sample included 74 members of the National Association for Rural Mental Health who, through a modified Delphi process, created a composite picture of effective MFT providers. The findings yielded six major rank-ordered characteristics of effective MFT providers in rural mental health settings, with effective skills in MFT ranked first. Rural community understanding, appreciation and participation ranked second. Specific competencies contributing to each major characteristic were also identified and are discussed. Recommendations for use of this information are provided.     

Quality improvement in patient distribution at a major university student health center

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Mitochondrial abnormalities and oxidative imbalance in neurodegenerative disease

An increasing body of evidence now suggests the involvement of mitochondrial abnormalities in the etiology of neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer disease. In this Perspective, we describe a recent study that shows that treatment of human patients with the antioxidant coenzyme Q(10'), which functions in concert with certain mitochondrial enzymes, reduced the worsening of symptoms associated with PD. These findings are consistent with the hypothesis that mitochondrial dysfunction plays a role in the pathogenesis of PD and that treatments that target mitochondrial biochemistry might ameliorate the functional decline observed in patients suffering from PD.     

Calculating the density and distribution function for the singly and doubly noncentral F

Simple, closed form saddlepoint approximations for the distribution and density of the singly and doubly noncentral F distributions are presented. Their overwhelming accuracy is demonstrated numerically using a variety of parameter values. The approximations are shown to be uniform in the right tail and the associated limitating relative error is derived. Difficulties associated with some algorithms used for exact computation of the singly noncentral F are noted.     

Perfect simulation for correlated Poisson random variables conditioned to be positive

In this paper we present a perfect simulation method for obtaining perfect samples from collections of correlated Poisson random variables conditioned to be positive. We show how to use this method to produce a perfect sample from a Boolean model conditioned to cover a set of points: in W.S. Kendall and E. Thönnes (Pattern Recognition 32(9): 1569–1586, 1999), this special case was treated in a more complicated way. The method is applied to several simple examples where exact calculations can be made, so as to check correctness of the program using ²-tests, and some small-scale experiments are carried out to explore the behaviour of the conditioned Boolean model.     

Gay youth and gay adults: bridging the generation gap

Recent discussion of lesbian, gay, bisexual, and trans (LGBT) youth has included two emphases: the burgeoning trend toward youth-supportive organizations and focus on risk factors experienced by these youth. In practice, the two are intertwined: the need for youth-supportive endeavors is typically demonstrated by appeals to the risks LGBT youth face. Relatively little attention has been given to relationships between youth and adults in LGBT communities. This article employs data from a long-term qualitative study with LGBT youth, supported by information from numerous other settings to suggest that a failure on the part of both groups fully to comprehend the experience of the other hampers the optimal functioning of everyone involved. In particular, we suggest that the discourse about the dangers faced by LGBT youth, despite its being thoroughly well-intentioned. may actually place these teens at greater risk.     

The right-to-die movement: extrapolating from the National Hemlock Society U.S.A. membership survey

A national membership survey of Hemlock Society USA was conducted by Fox and Kamakahi (1995). Respondents (N=6398) were asked a variety of questions, but in this paper we perform a longitudinal analysis of the characteristics of Hemlock Society USA members. Hemlock Society USA members are divided into three 5-year cohorts: Early Joiners (11 or more years of membership), Middle Joiners (6 to 10 years membership), and Late Joiners (5 or fewer years of membership). Differences between cohorts are examined and extrapolations made regarding Hemlock Society USA and the Right-to-Die Movement. A series of one-way ANOVAs were used with Scheme post-hoc comparisons as heuristic tools for assessing between-cohort differences. Late Joiners are different from earlier members, but are more like other Hemlock Society USA members than the adult U.S. population at large. Hemlock Society USA members are essentially societal "elites" (based on socio-demographic variables) who work in social environments that are decidedly split on the issue of voluntary suicide and euthanasia.     

True patient safety begins at the top. Leaders at one large health system rally around safety,avoid blame game

Making patient safety the No. 1 priority at a hospital or clinic sounds like a easy task. It isn't. At one Oklahoma health system, an improved patient safety program is a massive effort requiring input and participation from every member of the staff. Figuring out how to convince employees that patient safety is their first priority means developing an extensive communication and education program.     

Customized clinical case management for chronically ill patients. Health system sees remarkable results with teams of case managers,physicians, patients

Securing excellent care and positive outcomes for seriously ill, high-risk patients requires extraordinary measures. A health system in Georgia is experiencing strong results by taking a team approach to health care with case managers, physicians and patients working together.     

Gays and lesbians in local races: a study of electoral viability

Although lesbians and gays are more visible in the political arena than in the past, there is little published research on their electoral viability. This article helps to fill that void by presenting results of experimental research featuring respondents' reactions to a hypothetical candidate for a non-partisan city council seat. Sex and sexual orientation of the candidates were manipulated so that six categories were tested: a straight woman, a lesbian, a woman rumored to be lesbian, a straight man, a gay man, and a man rumored to be gay. The findings suggest that openly gay and lesbian candidates are seen as less viable than straight candidates or those rumored to be homosexual. Hence, the extent to which a candidate portrays his or her sexual orientation appears to make a difference in the chance to win elective office.