‘Growing Old’ in Shelters and ‘On the Street’: Experiences of Older Homeless People

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.     

Multinomial Selection in the Presence of Infinite Alternatives

We propose a new procedure for the multinomial selection problem to solve a real problem of any modern Air Force: the elaboration of better air-to-air tactics for Beyond Visual Range air-to-air combat that maximize its aircraft survival probability H(θ, ω), as well as enemy aircraft downing probability G(θ, ω). In this study, using a low-resolution simulator with generic parameters for the aircraft and missiles, we could increase an average success rate of 16.69% and 16.23% for H(θ, ω) and G(θ, ω), respectively, to an average success rate of 76.85% and 79.30%. We can assure with low probability of being wrong that the selected tactic has greater probability of yielding greater success rates in both H(θ, ω) and G(θ, ω) than any simulated tactic.     

Sensory Work of Diagnosis: A Crisis of Legitimacy

Sensory judgments have always been a part of medical practice, as sensory studies scholars have emphasized. However, in current regulatory, management and technological contexts, there is a push toward rational decision-making procedures and test-based evidence over clinical diagnosis. Sociological scholarship highlights that in focusing on explicit medical knowledge and disembodied data we take for granted aspects of healthcare work, including the ways in which health and illness is sensed. Research in sociologies of diagnosis and social studies of science and technology has captured that while the senses continue to play a role in medical work, the status and practice of this sensory work is not straightforward as evidenced by dual use of the senses and tests and the delegation of sensory work. Based on semi-structured interviews with expert doctors in diverse specialties, this article examines the sensory work of medical decision-making, with attention to its legitimacy. It examines applications of the senses from auscultation to ongoing sensing of patients’ bodies unmediated and via technological outputs. While critical to clinical judgments, there is discomfort with this sensory work in light of medico-legal pressures. I argue that the sensory work of diagnosis is vital, to the extent that gaps in sensory information imply gaps in understanding.     

A Deprivation Analysis for Andalusia (Spain): An Approach Based on Structural Equations

The study of deprivation, as a social indicator, is basic in the design and development of public policies because it allows decision makers to identify and analyse needy areas in order to improve their citizens’ well-being. The methodological approach proposed for the development of a new deprivation index is based on the Causal Theory whose conceptual model is analysed using Structural Equations. The domains selected for the deprivation index are: education, employment, income, housing, infrastructures and health. A structural equation model based on variance is the exploratory method used to obtain the indices pertaining to the above mentioned areas; the results obtained are seen to be quite reliable. There is a positive connection between the areas of education, employment and income while the relations between infrastructures and health are found to be negative. The results can be projected at a local level and show basic territorial deficiencies. The spatial units studied are the Andalusian (south of Spain) municipalities (770). The spatial projection of the indices obtained for the domains of deprivation highlights the existence of geographical areas which could be a potential target for public action.     

Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Normalizing Denominational Statistics with Demographic Data: The Case of the United Church of Canada

In the Canadian context, one type of data has been underutilized in the study of contemporary religious trends: church collected statistics. The present article explores the advantages and limitations of such data by analyzing the evolution of key church indicators of the United Church of Canada over the past four decades. Figures regarding church membership, child baptisms, and funerals are examined and compared with demographic data from four Canadian regions. Results show that virtually all United Church statistics are in decline with regard to larger society since the 1970s. However, there are regional variations, most notably in the Atlantic provinces, which show later and lesser rates of decline.     

FamilyLive: Parental Skill Building for Caregivers with Interpersonal Trauma Exposures

Mental health treatments for emotionally traumatized children incorporate family and caregiver-child therapy sessions to promote child recovery and minimize developmental disruption. Such sessions require that caregivers regulate their emotions to remain productively engaged in the therapeutic process. However, caregivers with histories of unresolved interpersonal trauma have difficulty with emotional regulation. Interpersonal trauma also negatively affects the ability to reflect on one’s own and others’ feelings and intentions. This limitation interferes with caregiver engagement in psychotherapy relationships aimed at supporting child trauma work. FamilyLive is an innovative caregiver-focused family therapy model that uses a one-way mirror, a specially trained reflecting team, structured routines and individualized verbalizations to address this complex clinical phenomenon. Guided by the literature on attachment and trauma, FamilyLive has yielded anecdotal successes and positive pilot results. FamilyLive is a viable approach to engaging caregivers with histories of interpersonal trauma in trauma-focused child and family therapy relationships.     

Bayesian adaptive dose‐escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy

The main purpose of dose‐escalation trials is to identify the dose(s) that is/are safe and efficacious for further investigations in later studies. In this paper, we introduce dose‐escalation designs that incorporate both the dose‐limiting events and dose‐limiting toxicities (DLTs) and indicative responses of efficacy into the procedure. A flexible nonparametric model is used for modelling the continuous efficacy responses while a logistic model is used for the binary DLTs. Escalation decisions are based on the combination of the probabilities of DLTs and expected efficacy through a gain function. On the basis of this setup, we then introduce 2 types of Bayesian adaptive dose‐escalation strategies. The first type of procedures, called “single objective,” aims to identify and recommend a single dose, either the maximum tolerated dose, the highest dose that is considered as safe, or the optimal dose, a safe dose that gives optimum benefit risk. The second type, called “dual objective,” aims to jointly estimate both the maximum tolerated dose and the optimal dose accurately. The recommended doses obtained under these dose‐escalation procedures provide information about the safety and efficacy profile of the novel drug to facilitate later studies. We evaluate different strategies via simulations based on an example constructed from a real trial on patients with type 2 diabetes, and the use of stopping rules is assessed. We find that the nonparametric model estimates the efficacy responses well for different underlying true shapes. The dual‐objective designs give better results in terms of identifying the 2 real target doses compared to the single‐objective designs.     

Nonparametric Shrinkage Estimation for Aalen's Additive Hazards Model

Aalen's nonparametric additive model in which the regression coefficients are assumed to be unspecified functions of time is a flexible alternative to Cox's proportional hazards model when the proportionality assumption is in doubt. In this paper, we incorporate a general linear hypothesis into the estimation of the time‐varying regression coefficients. We combine unrestricted least squares estimators and estimators that are restricted by the linear hypothesis and produce James‐Stein‐type shrinkage estimators of the regression coefficients. We develop the asymptotic joint distribution of such restricted and unrestricted estimators and use this to study the relative performance of the proposed estimators via their integrated asymptotic distributional risks. We conduct Monte Carlo simulations to examine the relative performance of the estimators in terms of their integrated mean square errors. We also compare the performance of the proposed estimators with a recently devised LASSO estimator as well as with ridge‐type estimators both via simulations and data on the survival of primary billiary cirhosis patients.