Physiological Responses to Near-Miss Outcomes and Personal Control During Simulated Gambling

Near-miss outcomes during gambling are non-win outcomes that fall close to a pay-out. While objectively equivalent to an outright miss, near-misses motivate ongoing play and may therefore be implicated in the development of disordered gambling. Given naturalistic data showing increases in heart rate (HR) and electrodermal activity (EDA) during periods of real gambling play, we sought to explore the phasic impact of win, near-miss and full-miss outcomes on physiological arousal in a controlled laboratory environment. EDA and HR were monitored as healthy, student participants (n = 33) played a simulated slot-machine task involving unpredictable monetary wins. A second gambling distortion, perceived personal control, was manipulated within the same task by allowing the participant to select the play icon on some trials, and having the computer automatically select the play icon on other trials. Near-misses were rated as less pleasant than full-misses. However, on trials that involved personal choice, near-misses produced higher ratings of ‘continue to play’ than full-misses. Winning outcomes were associated with phasic EDA responses that did not vary with personal choice. Compared to full-misses, near-miss outcomes also elicited an EDA increase, which was greater on personal choice trials. Near-misses were also associated with greater HR acceleration than other outcomes. Near-miss outcomes are capable of eliciting phasic changes in physiological arousal consistent with a state of subjective excitement, despite their objective non-win status.     

Modelling human immunodeficiency virus ribonucleic acid levels with finite mixtures for censored longitudinal data

The measurement of human immunodeficiency virus ribonucleic acid levels over time leads to censored longitudinal data. Suitable models for dynamic modelling of these levels need to take this data characteristic into account. If groups of patients with different developments of the levels over time are suspected the model class of finite mixtures of mixed effects models with censored data is required. We describe the model specification and derive the estimation with a suitable expectation-maximization algorithm. We propose a convenient implementation using closed form formulae for the expected mean and variance of the truncated multivariate distribution. Only efficient evaluation of the cumulative multivariate normal distribution function is required. Model selection as well as methods for inference are discussed. The application is demonstrated on the clinical trial ACTG 315 data.     

Opportunities for woman-initiated HIV prevention methods among female sex workers in southern China

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.     

Male bisexuality and condom use at last sexual encounter: results from a national survey

Relatively little is known about condom use among bisexual men as separate and distinct from exclusively homosexual and heterosexual men. Most previous research on bisexual men has relied on non-probabilistic, high risk samples with limited generalizability. We examined the relationship between male behavioral bisexuality and condom use in the 2002 cycle of the National Survey of Family Growth (NSFG). Bisexually-active men positively differed from heterosexually- and homosexually-active men on every indicator of confounding risk. However, bisexually-active men did not report using condoms less often than other men during their last sexual encounters with males and females. Indeed, with female partners, bisexually-active men reported higher rates of condom use than other men. These relationships remained when all sociodemographic and confounding risk factors were held constant. Our results suggest that caution must be used when making assumptions about condom use in the general population of bisexual men from non-probabilistic samples.     

Improving healthcare for children entering foster care

Despite the fact that children in foster care are, perhaps, the most vulnerable children, healthcare for them has been lacking woefully for many years. A growing body of research has documented the need for such care as well as the failure of child welfare agencies to make major improvements in providing healthcare to foster children. Nonetheless, current efforts are being made to change this situation. This article reports on one effort to improve the provision and timeliness of health exams for children entering care. One rural and one urban county served as project treatment sites, with two additional rural and urban counties serving as control sites. The treatment sites achieved a statistically significant improvement in their rate of exam completion as compared to the control sites. The study finds that despite an existing policy for healthcare for children entering foster care, legislation mandating additional efforts, shortened time frames, and provision for judicial oversight are needed for improvement.     

Hospital-to-community transitions. A bridge program for adolescent mental health patients

Making the transition from the hospital to a community setting can be extremely challenging for patients with acute mental health conditions. Transitional services have been created to help patients overcome difficulties associated with this transition. Nurses frequently play an integral role in the success of these services. By providing patients with individualized support during such transitions, nurses act as clinical liaisons and directly contribute to an increase in positive patient and system-level outcomes. This article describes a transitional service called the Bridge Program, designed to help adolescents make a successful transition from the hospital to the community. An overview of the Bridge Program is provided, and the results of an evaluation of this program are presented. Results suggest that the Bridge Program contributes to a decrease in the length of hospital stays and improves continuity of care for patients and their families.     

Staying safe while consuming alcohol: a qualitative study of the protective strategies and informational needs of college freshmen

OBJECTIVE: In this qualitative study, the authors examined how students attempt to minimize harm to themselves and others when drinking. PARTICIPANTS: The authors recruited freshmen at a large, mid-Atlantic US public university during the fall semester of 2005 to participate in 8 focus groups. METHODS: The moderator's guide was developed through an iterative process that included input from experts and pilot testing. The researchers audiotaped focus group conversations, transcribed them, and subjected them to an interrater reliability check. Analysis was based on the framework of Information-Motivation-Behavioral Skills Model and a phenomenological approach. RESULTS: College students have a repertoire of coping strategies they use in an attempt to safeguard themselves and their friends from harm when drinking. Strategies encompass planning a safe context for drinking, using safety measures to minimize harm when drinking, and taking care of someone who has consumed too much alcohol. CONCLUSIONS: A harm-reduction focus that acknowledges and builds on existing protective strategies may be a promising avenue for alcohol interventions.