Old and thin

Viewing an elderly patient's refusal of food from the perspective of the jain tradition of sallekhana (voluntary starvation) permits the author to reconcile her need to "do something" with her belief in the principle of patient autonomy.     

Is the American health care delivery system ready for change?

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed.     

Ropes course training for youth in a rural setting: “At first I thought it was going to be boring ...”

Outdoor structured activities, such as Ropes Challenge Courses, are typically utilized as interventions for youth coming from urban settings. Evaluation of such programs is scanty at best. In this instance, the course experience is used as a prevention tool for high risk youth in a remote, rural setting of high unemployment, alcohol problems, and low income. The authors discuss the effectiveness of this approach, and the intended and unintended consequences for the rural community at large. The evaluation design relies on extensive qualitative methodology as well as quantitative methods to capture the unique nature of this rural project.     

The American emigrant in Canada: trends and consequences

"This article discusses the nature of out-migration from the United States to Canada and assesses the consequences of such emigration for the two countries. It is concluded that, excluding the British born population, being foreign born is a handicap in Canada, not as asset, and the American born overcome this occupational disadvantage by virtue of their higher social origins and education."     

Demographic determinants of perceived well-being in eight European countries

This paper reports results of a harmonised study of subjective social indicators carried out in eight member countries of the European Community, sponsored, on an experimental basis, by the Statistical Office of the European Communities (Luxembourg). Comparative data from nationwide representative samples from Germany, France, Italy, the Netherlands, Belgium, the United Kingdom, Ireland and Denmark are presented for three key dependent measures of perceived well-being: Self-Assessed Health, Satisfaction with Housing and Life Satisfaction. The cross-cultural generalisability of the influence of demographic variables on these three measures in examined, using 4-way analysis of variance. The analyses revealed a remarkable consistency across nations in terms of the effects of certain demographic variables on some of the dependent measures; however, some inconsistencies were also revealed. Substantial discrepancies in mean scores of the same sub-groups in different countries were also observed. While further research would be required to determine whether these differences were due to objective circumstances or to cultural differences in subjective perceptions or response patterns, some tentative interpretations of the differences were put forth.     

Snake parasitism in an urban old-growth forest

Urban-associated changes can have immediate or long-term consequences on animal populations. Such changes may be assessed through parasite prevalence and abundance in wildlife hosts, as urbanization can influence parasitism and disease transmission in wildlife. Snakes are widespread and diverse vertebrates that often persist in urban environments; however, parasitism of snakes in urban environments has yet to be studied, leaving the roles of snakes in parasite transmission uncharacterized. Field ecology, microscopy, molecular techniques, and geographic information science (GIS) were integrated to characterize parasitism of snakes in an urban old-growth forest park. The species, sex, mass, length, location, and prevalence of ecto-, hemo-, and fecal parasites were determined for 34 snakes of 6 species. Ectoparasites (mite), hemoparasites (Hepatozoon spp.), and fecal parasites (Entamoeba spp., Trichomonas spp., Strongloides spp., and an unidentified helminth) were detected in snakes and 64.7?% of snakes were infected by at least one of these parasites. Parasite infections were generally not related to the sex, age, or body condition of snakes. The locations of infected snakes were used to produce risk maps indicating where parasite prevalence is predicted to be greatest. The analysis of these maps indicated that snakes with fecal parasites were closer than non-infected snakes to the edge of the forest. This study confirms that snakes may be important parasite hosts or reservoirs in parasite transmission pathways in urban environments and it provides an integrative multidisciplinary approach that may be used to monitor parasitism dynamics in other urban wildlife areas.     

Are some disabilities more equal than others? Conceptualising fluctuating or recurring impairments within contemporary legislation and practice

In recent years, the concept of fluctuating or recurring impairments has grown both in the public consciousness as well as in frequency of note within policy documentation and legislation. However, contention still surrounds the perceived legitimacy of such impairments, including chronic fatigue syndrome/myalgic encephalomyelitis, epilepsy and diabetes, which have the potential to vary in intensity over time, versus more ‘traditional’ and accepted forms of disability. By drawing on current conceptual discussion and research activities in Canada around what have been termed episodic disabilities, as well as legislative developments in the United Kingdom, this paper will provide an overview of how fluctuating or recurring impairments have to date been conceptualised, contested, and the central issue of competing definitions within this context     

Depressive Symptoms,Acute Alcohol Intoxication,and Risk Rationale Effects on Men’s Condom Use Resistance

This study examined the role of depressive symptoms, acute intoxication, and risk rationale in men’s use of condom use resistance (CUR) tactics in an experimental study. Participants included 313 heterosexual male, nonproblem drinkers, ages 21 to 30. Participants were randomized to one of four beverage conditions: no alcohol, placebo, low (.04%) alcohol dose, or high (.08%) alcohol dose. They read an eroticized scenario depicting a consensual sexual encounter with a female partner who requested a condom to prevent either pregnancy or sexually transmitted infections (STIs) (risk rationale) and then indicated their intentions to use 10 different CUR tactics. Hypotheses related to the pharmacological, dosage, and expectancy effects of alcohol were tested in a generalized linear model. In intoxicated (.04% and .08%) men who were given a pregnancy risk rationale, depressive symptoms were associated with stronger intentions to use CUR tactics than in sober (control and placebo) men. Men who received a high alcohol dose (.08%) and who were given a pregnancy risk rationale reported higher intentions to use CUR tactics than those who received a lower alcohol dose (.04%). Findings suggest that the pharmacological effects of alcohol on men’s likelihood to resist condoms vary by the saliency of the risk rationale and mood-related variables.     

Optimal representative sample weighting

Statistics and Computing - To overcome the inherent limitations of axis-aligned base learners in ensemble learning, several methods of rotating the feature space have been discussed in the...