Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

Reexamining the moving to opportunity study and its contribution to changing the distribution of poverty and ethnic concentration

For the past decade and a half a concerted effort has been undertaken to determine whether policy interventions in residential location can solve the problems of inner-city poverty and racial concentration. Studies based on data from the Gautreaux litigation and the U.S. Department of Housing and Urban Development (HUD)-sponsored Moving to Opportunity (MTO) program have provided an overall optimistic interpretation of the possibilities of improving inner-city lives via mobility vouchers and counseling. A reanalysis of the data from the MTO program, focusing specifically on African American households, suggests greater caution in the interpretation of the findings from either Gautreaux or the MTO program. No statistically significant difference exists between the percentage of poor or the percentage of African Americans in the current neighborhoods between MTO and Section 8 experimental groups. In some cases, there is no statistically significant difference between those who move with a voucher and those who move without any assistance at all. Although there is some evidence that MTO programs have brought specific gains for individual families, claims for the MTO program as a whole need to be treated with a great deal more caution than they have been to date.     

An intuitive risk factors search algorithm: usage of the Bayesian network technique in personalized medicine

The article focuses on the application of the Bayesian networks (BN) technique to problems of personalized medicine. The simple (intuitive) algorithm of BN optimization with respect to the number of nodes using naive network topology is developed. This algorithm allows to increase the BN prediction quality and to identify the most important variables of the network. The parallel program implementing the algorithm has demonstrated good scalability with an increase in the computational cores number, and it can be applied to the large patients database containing thousands of variables. This program is applied for the prediction for the unfavorable outcome of coronary artery disease (CAD) for patients who survived the acute coronary syndrome (ACS). As a result, the quality of the predictions of the investigated networks was significantly improved and the most important risk factors were detected. The significance of the tumor necrosis factor-alpha gene polymorphism for the prediction of the unfavorable outcome of CAD for patients survived after ACS was revealed for the first time.     

A Bayesian Approach for Analyzing Results of Vehicle Collision Tests

Certain motor vehicle safety standards stipulate a collision test speed and a set of performance criteria that vehicles must satisfy during or after the collision test. For example, Federal Motor Vehicle Safety Standard 301 requires a 30 mile per hour (mph) barrier collision and specifies a certain maximum allowable limit on the total spillage of fuel. Vehicle designs are required to meet this standard; however, when collision tests are conducted at speeds higher than the standard, vehicles do not always satisfy the performance criteria. This paper develops a mathematical model for estimating the probability of meeting the standard by using a Bayesian framework to incorporate engineering judgment with collision test results. The model is based on the idea that there are random features to a vehicle's ability to meet performance standards in a collision, especially at such elevated speeds. Example calculations are included to illustrate the estimation of the probability of meeting the standard and to compare it with a maximum likelihood approach.     

Effects of Group Practice of the Transcendental Meditation Program on Preventing Violent Crime in Washington,D.C.: Results of the National Demonstration Project,June--July 1993

This paper reports the results of a prospective experiment in which a group of approximately 4,000 participants in the Transcendental Meditation and TM-Sidhi programs of Maharishi Mahesh Yogi assembled in Washington, D.C., from June 7 to July 30, 1993. It was hypothesized that levels of violent crime in the District of Columbia would fall substantially during the Demonstration Project, as a result of the group's effect of increasing coherence and reducing stress in the collective consciousness of the District. A 27-member Project Review Board comprising independent scientists and leading citizens approved the research protocol and monitored the research process. Weekly crime data was derived from database records provided by the District of Columbia Metropolitan Police Department (DCMPD), which are used in the FBI Uniform Crime Reports. Statistical analysis considered the effect of weather variables, daylight, historical crime trends and annual patterns in the District of Columbia, as well as trends in neighboring cities. Consistent with previous research, levels of homicides, rapes and assaults (HRA crimes) correlated with average weekly temperature. Robberies approximately followed an annually recurring cycle. Time series analysis of 1993 data, controlling for temperature, showed that HRA crimes dropped significantly during the Demonstration Project, corresponding with increases in the size of the group; the maximum decrease was 23.3% (p < 2 × 10–9) [24.6% using a longer baseline, with 1988--1993 data (p < 3 × 10–5)], coincident with the peak number of participants in the group during the final week of the assembly. When the same period in each of the five previous years was examined, no significant decreases in HRA crimes were found. Robberies did not decrease significantly. However, a model that jointly estimated the effect of the Demonstration Project on both HRA crimes and robberies showed a significant reduction in violent crimes overall of 15.6% (p = 0.0008). Further analysis showed that the effect of the coherence-creating group on reducing HRA crimes could not be accounted for by additional police staffing. The time series analysis for HRA crimes gave results that are highly robust to alternative model specifications, and showed that the effect of the group size was cumulative and persisted after the Demonstration Project ended. Also, calculation of the steady state gain based on the time series model predicted that a permanent group of 4,000 coherence-creating experts in the District would have a long-term effect of reducing HRA crimes by 48%.     

Residential preferences and population distribution

Public opinion research has revealed decided preferences for living in rural areas and small towns, and proponents of population deconcentration have interpreted this as support for their policies. This study, based on a national sample, yielded similar results, but when we introduced the additional possibility of a preference for proximity to a larger city, then the rural areas preferred were found, for most respondents, to be those within the commuting range of a metropolitan central city. Although persons wishing to live near large cities were found to be looking for the same qualities of living sought by those who prefer a more remote location, these findings are not, in general, consistent with the argument that public preferences support strategies of population dispersal into nonmetropolitan areas. Instead they indicate that most of those who wish to live in a different location favor the peripheral metropolitan ring areas that have, in fact, been growing rapidly by in-migration.     

Congestion,quality deterioration,and optimal use: Wilderness recreation in the Spanish peaks primitive area

With increasing demand for low-density recreational services and limited supply of facilities to provide them, congestion is becoming an important management problem. The purpose of this paper is to outline a model of congestion, estimate the effect of it upon individual willingness to pay for wilderness experiences, and illustrate how these results might be used for efficient management. A survey of users of the Spanish Peaks Primitive Area indicates that their revealed willingness to pay is significantly affected by encroachments upon the solitude they experience during their trip. Consequently, congestion effects for such services can be measured and used in the formation of administrative policy.     

Using the Delphi Method to Classify Medical Specialties

One medical specialty classification system applicable for research and career counseling is the person‐oriented versus technique‐oriented taxonomy. Given that the model was conceptualized in the 1960s, verification based on how medical specialties are practiced and viewed today is necessary. Five specialists in medical career development and advising verified the categorization of specialties. Based on their review, 100% consensus was reached regarding grouping of specialties. This outcome validates the taxonomy of medical specialties and supports its continued use for medical career specialty advising and choice.