Inside and outcast: multifaceted stigma and redemption in the lives of gay and lesbian Jehovah's Witnesses

Homosexuality has become a divisive issue in many religions and congregations. Like many other fundamentalist denominations, Jehovah's Witnesses condemns homosexual acts, thoughts, and feelings. Consequently, gay and lesbian Witnesses experience not just stigmatization and conflict between their sexual and religious identities in the social world, but also a nearly impossible task in their inner world. This inner task adds a new facet to our understanding of stigma (Goffman, 1963). This study explores the written narratives of a subset of gay and lesbian former Jehovah's Witnesses who were able to comprehend, negotiate, and, in most cases, resolve their multifaceted stigmas and conflicts through struggle, self-determination, and eventually connecting with networks of peers who faced or are facing similar stigmas. This research contributes to other work on the intersection of religion, family, and homosexuality; in particular, the findings have implications for the study of other strict fundamentalist religions.     

人为因素

人为因素是对工程学、实验心理学、神经科学、计算机科学和人类工程学的一种折中组合，按照字面意思来看，即为“工作科学”。它是应用科学的方法和原理来研究、设计、维修和操作复杂的人一机器系统。人为因素不但针对个体、小组和团体，而且针对控制、显示和作业。人为因素工程的首要目标，一是通过使人适应机器来优化系统的性能，例如，通过培训使操作人员熟悉机器；二是通过使机器适应人来优化系统的性能，例如，通过应用诸如“控制一显示兼容”的设计原理使机器适用于操作人员。简而言之，人为因素是系统工程的一个关键的中心组成部分。     

Evaluating risk: global fees and episodic care

In 1999, two articles in The Physician Executive -- "Part I: Global Theory and the Nature of Risk (July-August)." and "Part II: Towards a Choice-Based Model of Managed Care (October-November)" -- outlined the flaws of orthodox managed care theory and highlighted the unique advantages of moving to a genuinely market-based model, which included the concept of direct contracting for integrated episodes of care. This follow-up focuses on comparing an episode contracting system to a traditional capitated program and outlines the features that make this approach much more attractive to physicians, payers, and most importantly patients.     

Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.     

A campus-community coalition to control alcohol-related problems off campus: an environmental management case study

The authors report on the effects of a university and community coalition in preventing problems related to college students' off-campus drinking. The Albany, New York, Committee on University and Community Relations used strategies based on an environmental-management approach that focuses on changing the environment in which individuals make decisions about alcohol consumption and related behaviors. Committee initiatives included improving enforcement of local laws and ordinances, creating a safety-awareness campaign for off-campus students, and developing a comprehensive advertising and beverage-service agreement with local tavern owners. The initiatives were associated with a decline in the number of alcohol-related problems in the community, as indicated by decreases in the number of off-campus noise ordinance reports filed by police and the number of calls to a university-maintained hotline for reporting off-campus problems. An environmental management approach, the authors suggest, has promise as an effective means of preventing alcohol-related problems among college students.     

The ideal physician entrepreneur

How does the sometimes elusive and high-stakes world of venture capital really work? How can physician executives with innovative ideas or new technologies approach venture capitalists to help them raise capital to form a start-up company? These important questions are explored in this new column on the physician as entrepreneur. The ideal physician executive is described as: (1) an expert in an area that Wall Street perceives as hot; (2) a public speaker who can enthusiastically communicate scientific and business plans to a variety of audiences; (3) a team leader who is willing to share equity in the company with other employees; (4) a recruiter and a motivator; (5) an implementer who can achieve milestones quickly that allow the company to go public as soon as possible; and (6) a realist who does not resent the terms of the typical deal. The lucrative world of the venture capitalists is foreign territory for physician executives and requires a great idea, charisma, risk-taking, connections, patience, and perseverance to navigate it successfully.     

Psychopharmacology RACE: a fun road to competence

1 In this era of rapidly changing mental health services and new psychotropic drugs, health professionals are challenged to develop and maintain psychopharmacology competencies. 2 The Psychopharmacology RACE provides an interactive and learner-oriented method of developing and assessing theoretical and clinical competencies for psychopharmacology. 3 The Psychopharmacology RACE is also well suited for modification and application toward the professional development of nurses and the education of clients.     

Death at the border

"Debates about United States border control policies have generally ignored the human costs of undocumented migration. We focus attention on these costs by estimating the number, causes and location of migrant deaths at the southwest border of the United States between 1993 and 1997.... Deaths from hyperthermia, hypothermia and dehydration increased sharply from 1993 to 1997 as intensified border enforcement redirected undocumented migration flows from urban crossing points to more remote crossing areas where the migrants are exposed to a greater risk of death."