Lesbian Health Care: Women's Experiences and the Role for Social Work

ABSTRACT

Lesbian patients and their families may be exposed to discriminatory practices in the health care system. This qualitative study of 57 Midwestern lesbian parents used open- and closed-ended questions to examine the experiences the respondents had with their primary and secondary health care providers. Four themes emerged from the data: systemic barriers to health care, coming out to providers, seeking lesbian, gay, bisexual, and transgender-friendly health care providers, and concern about mistreatment and prejudice within the health care system. Implications for service delivery, health care education, and directions in policy and research are explored.     

Defining estimands for efficacy assessment in single arm phase 1b or phase 2 clinical trials in oncology early development

The addendum of the ICH E9 guideline on the statistical principles for clinical trials introduced the estimand framework. The framework is designed to strengthen the dialog between different stakeholders, to introduce greater clarity in the clinical trial objectives and to provide alignment between the estimand and statistical analysis. Estimand framework related publications thus far have mainly focused on randomized clinical trials. The intention of the Early Development Estimand Nexus (EDEN), a task force of the cross-industry Oncology Estimand Working Group ( www.oncoestimand.org ), is to apply it to single arms Phase 1b or Phase 2 trials designed to detect a treatment-related efficacy signal, typically measured by objective response rate. Key recommendations regarding the estimand attributes include that in a single arm early clinical trial, the treatment attribute should start when the first dose is received by the participant. Focusing on the estimation of an absolute effect, the population-level summary measure should reflect only the property used for the estimation. Another major component introduced in the ICH E9 addendum is the definition of intercurrent events and the associated possible ways to handle them. Different strategies reflect different clinical questions of interest that can be answered based on the journeys an individual subject can take during a trial. We provide detailed strategy recommendations for intercurrent events typically seen in early-stage oncology. We highlight where implicit assumptions should be made transparent as whenever follow-up is suspended, a while-on-treatment strategy is implied.     

Homeless and financially dependent adolescents as clients of a family agency 1

A wide range of issues are explored that are identified by incarcerated mothers during their participation in a Family Reunification Group at a prison for women. They include concerns regarding parent–child visits; lack of communication by child welfare social workers, attorneys, foster parents, and other caregivers; the Adoption and Safe Families Act (ASFA); lack of finances; past and present unresolved trauma issues; and the absence of notification of scheduled court hearings. This article also provides an in-depth look at how a group therapist established a therapeutic alliance with varied women in the group over a period of 5 years (2008–2013) and maintained a sense of professional self in this controlled setting. Finally, the implications for clinical social work practice and social work education are presented. Confidentiality is ensured with the use of de-identified case composite clinical material.     

Quantitative Risk Assessment of Rabies Entering Great Britain from North America via Cats and Dogs

Great Britain has been rabies-free since 1922, which is often considered to be in part due to the strict laws requiring that imported cats and dogs be vaccinated and quarantined for 6 months immediately on entry into the country. Except for two isolated incidents, this quarantine policy has contributed to ensuring that Great Britain has remained free of rabies. In 2000, amendments to the UK quarantine laws were made and the Pet Travel Scheme (PETS) was launched for companion animals traveling from European Union countries and rabies-free islands. Since its introduction, it has been proposed that other countries including North America should be included within the UK scheme. A quantitative risk assessment was developed to assist in the policy decision to amend the long-standing quarantine laws for dogs and cats from North America. It was determined that the risk of rabies entry is very low and is dependent on the level of compliance (i.e., legally conforming to all of the required regulations) with PETS and the number of pets imported. Assuming 100% compliance with PETS and the current level of importation of cats and dogs from North America, the annual probability of importing rabies is lower for animals traveling via PETS (7.22 x 10(-6), 95th percentile) than quarantine (1.01 x 10(-5), 95th percentile). These results, and other scientific evidence, directly informed the decision to expand the PETS scheme to North America as of December 2002.     

Verstehen als Grundlage supervisionsgeleiteter Veränderung Individualpsychologische Gruppensupervision mit Lehrer/innen

Understanding as basics of change processes by supervision. Individualpsychological group supervision with teachersThe author delineates the concept of the individualpsychological supervision, its theoretical background, the main topics and the detailed procedure. This article firstly discusses the goals and the task of the depth psychological founded approach. The individualpsychological work is described in process and explained by an example. The main item of the individualpsychological procedure is explained by analysing and working on the lifestyle and embedded in a model. Hereby teachers are helped to achieve new pattern of thought and of action by sensitive understanding concerning the field of school.     

Estimating the Predicted Environmental Concentration of the Residues of Veterinary Medicines: Should Uncertainty and Variability Be Ignored?

European directives require that all veterinary medicines be assessed to determine the harmful effects that their use may have on the environment. Fundamental to this assessment is the calculation of the predicted environmental concentration (PEC), which is dependent on the type of drug, its associated treatment characteristics, and the route by which residues enter the environment. Deterministic models for the calculation of the PEC have previously been presented. In this article, the inclusion of variability and uncertainty within such models is introduced. In particular, models for the calculation of the PEC for residues excreted directly onto pasture by grazing animals are considered and comparison of deterministic and stochastic results suggest that uncertainty and variability cannot be ignored.     

Realisierung von Cross-Selling Potenzialen durch das Management von kundeninitiierten Kontakten

Existing research has not sufficiently addressed the question of how to cross-sell additional products and services to customers and what the behavioral consequences of cross-selling are. Moreover, these cross-selling-related questions have not been investigated in the context of customer-initiated contacts.The contribution of the paper is the empirical analysis of metrics which can be used to predict cross-selling success, e.g., in a call-center. The results show that two metrics, namely first contact resolution and reason for contact, significantly predict cross-selling success. Another contribution is the analysis of behavioral consequences. Here the results show that usage intensity significantly increases the time directly after the cross-selling took place but relapses to the original level within a few weeks.The results of the study can be used to derive managerial implications for managing and controlling cross-selling initiatives and for increasing and stabilizing cash-flows.     

Using an Objective Structured Clinical Examination for Bachelor of Midwifery students’ preparation for practice

BackgroundContemporary midwifery practice needs a rigorous and standardised assessment of practical skills, and knowledge to ensure that safety is maintained for both women and neonates before, during and after childbirth.AimTo evaluate the use of Best Practice Guidelines (BPG) for Objective Structured Clinical Examinations (OSCE) as a standardised tool to develop clinical competence of Bachelor of Midwifery students.MethodA pragmatic mixed method approach with surveys, focus groups and interviews was used to evaluate the OSCEs for first year students. Quantitative and qualitative data were combined to understand student and academic perceptions of students’ confidence for clinical practice following the OSCE.FindingsThirty-four students responded to surveys (response rate 94%); and 13 participated in focus groups. Two academic lecturers participated in an interview (100%). Two main themes emerged (1) the OSCEs improved student confidence (2) the OSCEs were relevant and prepared students for practice. Most students indicated that they practised for the OSCE using an integrated approach (70%), and that this assisted them in their approach to the assessment of the neonate or post-partum mother.ConclusionThe use of BPGs to ensure that OSCEs focus on important aspects of knowledge and practice helped students to learn and to perform well. Students’ confidence in their ability for the imminent professional experience placement was high. OSCEs designed with the BPGs should be implemented broadly across midwifery education to enhance students’ competence and provide rigorous meaningful assessment.