bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Hospice Philosophy of Care in Nonhospice Settings
Authors: Conant Loring , Lowney Arlene
Published: June 2007

Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.

Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.
Christian Perspectives on Assisted Suicide and Euthanasia: The Anglican Tradition
Authors: Cohen Cynthia B.
Published: June 2007

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?

The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia.
Parental Autonomy and the Obligation Not to Harm One's Child Genetically
Authors: Green Ronald M.
Published: June 2007

Until recently, genetics counselors and medical geneticists considered themselves lucky if they could provide parents with predictive information about a small number ofsevere genetic disorders. Testing and counseling were indicated primarily for conditions of thithis s sort. Out of respect for the autonomy of parental reproductive decision making, the prevailing ethic of genetic counseling stressed nondirectiveness and value neutrality As summarized by Arthur Caplan, the hallmarks of this stance include

a willingness to provide testing and counseling to all who voluntarily seek it, the presentation of information concerning findings in a manner that is balanced and comprehensible to patients or clients, the fair and balanced presentation of all options for action if a problem is discovered, a willingness to answer all questions asked by those seeking services, and an obligation to protect privacy and confidentiality at all times regardless of societal needs or benefits.
Substituted Judgment in Medical Practice: Evidentiary Standards on a Sliding Scale
Authors: Tonelli Mark R.
Published: June 2007

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment.
Medicaid, Managed Care, and America's Health Safety Net
Authors: Manski Richard J. , Peddicord Douglas , Hyman David
Published: June 2007

During the past decade, Medicaid has experienced extraordinary growth, in both number of beneficiaries and total expenditures. Between 1988 and 1993, the number of Medicaid beneficiaries grew from 22 million to 32 million. While the number of Medicaid beneficiaries increased by 45 percent, expenditures increased by 145 percent, from 51 billion to 125 billion. Expressed in terms of its percentage of state budgets, Medicaid doubled from 10 percent to 20 percent over the same time period, to the point that it is currently the second largest budget item for most states.

Faced with unsustainable rates of program budget growth and serious concerns about the level of access and the continuity of care afforded by the Medicaid program, states have turned to managed care. Almost every state has introduced some form of managed care for a subset of their Medicaid beneficiary population. Twenty-three states have gone farther, and implemented, proposed, or are developing section 1115 waivers to overhaul their Medicaid programs. These waivers allow states to develop and introduce nonstandard approaches to benefits, eligibility, service delivery, and financing for the Medicaid beneficiary population.
Acetaminophen (Tylenol): Johnson & Johnson and Consumer Safety
Authors: Trinkhaus John , Nathan Jay , Beane Leona , Meltzer Barton
Published: June 2007

Controversies associated with the use of Tylenol (acetaminophen) are not new to Johnson & Johnson. Reported cases of poisoning in 1982 and 1986 raised serious concerns about both the life of the analgesic and the well-being of consumers. In 1994, the results of two clinical studies raised product safety concerns about acetaminophen-based over-the-counter (OTC) analgesics, suggesting development of hepatotoxicity, and an increased risk of end-stage renal disease (ESRD). The alarm created by the studies is not of the same magnitude as the 1980s poisonings and the circumstances differed in that the findings did not only apply to acetaminophen-based analgesics; nonetheless, the implications of the latter are equally significant. Still operating by the same company credo, how Johnson & Johnson has handled the link between acetaminophen and hepatotoxicity and ESRD is of interest (especially when contrasted with its response to the 1980s poisonings); in particular, management's efforts to reassure both consumers and company shareholders.
Medical Malpractice Implications of PSA Testing for Early Detection of Prostate Cancer
Authors: Collins Mary McNaughton , Fowler Floyd J. , Roberts Richard G. , Oesterling Joseph E. , Annas George J. , Barry Michael J.
Published: June 2007

Prostate cancer has become a major health concern of male Americans. It is now the most commonnondermatologiccancer and the second leading cause of cancer death among men. The incidence of detected prostate cancer rose rapidly in recent years, partly because of prostate-specific antigen (PSA) testing; it is only now tapering off. Screening for prostate cancer with PSA is widespread in the United States, yet controversial: the American Urological Association recommends PSA screening and the American Cancer Society recommends offering screening; however, the United States Preventive Services Task Force (USPSTF) and the American College of Physicians (ACP) recommend against routine screening; and the American Academy of Family Physicians believes that the decision to screen should be left to the patient.
Weaving Technology and Policy Together to Maintain Confidentiality
Authors: Sweeney Latanya
Published: June 2007

Organizations often release and receive medical data with all explicit identifiers, such as name, address, telephone number, and Social Security number (SSN), removed on the assumption that patient confidentiality is maintained because the resulting data look anonymous. However, in most of these cases, the remaining data can be used to reidenafy individuals by linking or matching the data to other data bases or by looking at unique characteristics found in the fields and records of the data base itself. When these less apparent aspects are taken into account, each released record can map to many possible people, providing a level of anonymity that the recordholder determines. The greater the number of candidates per record, the more anonymous the data.

I examine three general-purpose computer programs for maintaining patient confidentiality when disclosing electronic medical records: the Scrub System, which locates and suppresses or replaces personally identifying information in letters between doctors and in notes written by clinicians; the Datafly System, which generalizes values based on a profile of the data recipient at the time of disclosure; and the μ-Argus System, a somewhat similar system which is becoming a European standard for disclosing public use data.
Religious Exemptions to the Immunization Statutes: Balancing Public Health and Religious Freedom
Authors: Ross Lainie Friedman , Aspinwall Timothy J.
Published: June 2007

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics (AAP) updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was discussed in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect.
Scientific Commentary: The Scientific Foundations and Medical and Social Prospects of the Human Genome Project
Authors: Lander Eric S.
Published: June 2007

We are living through one of the greatest scientific revolutions in history: the “information revolution” in genetics. The revolution is leading to a deep understanding of biological processes and is uncovering the molecular basis of many human diseases and susceptibilities. It is also confronting society with a vast array of choices, and presenting each individual with the question of what knowledge to seek and how to act on that knowledge, My purpose is to discuss the scientific foundations of this revolution and to foreshadow its consequences.

The current scientific revolution has perhaps one appropriate historical precedent: the chemical revolution that followed Dmitri Mendeleev's key insight in 1869 that the elements could be organized in a simple periodic table.
Hospital Consent for Disclosure of Medical Records
Authors: Merz Jon F. , Sankar Pamela , Yoo Simon S.
Published: June 2007

Physicians and other health care providers owe ethical and legal duties to patients to maintain the secrecy of the information learned during the course of patient care. This obligation is fulfilled by limiting access to such information to only those involved in the patient's care-that is, to those within the “circle of confidentiality.” As a general rule, providers may only disclose to others with the written prior consent of the patient. Exceptions may be “ethically and legally justified because of overriding social considerations,” when permitted or compelled by law. For example, eleven states permit providers to disclose identified records to approved researchers.’ Many states compel disclosure in cases where a patient threatens serious bodily harm to another; require reporting to health or law enforcement authorities of communicable diseases, gunshot or knife wounds, or child abuse; and mandate reporting of cancer or other health care cases to state registries (such as immunization, birth, and abortion).
Managed Care and the Expanding Scope of Primary Care Physicians' Duties: A Proposal to Redefine Explicitly the Standard of Care
Authors: Friedland Bernard
Published: June 2007

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so.
The Collision of Confinement and Care: End-of-Life Care in Prisons and Jails
Authors: Dubler Nancy Neveloff
Published: June 2007

In 1997, the United States incarcerated over 1.7 million persons in local jails and in state and federal prisons. These inmates are disproportionately poor and persons of color. Many lack adequate access to health care before incarceration and present to correctional services with major unaddressed medical problems.

Convictions for drug possession and use have increased the number of injection drug users with HIV and AIDS in prisons. Determinate sentencing and “three strikes and you’re out” laws have increased the number of inmates who are aging and dying during their sentences. Their feelings reflect those of Larry Rideau, sentenced to life without parole and founder of The Angolite—an award-winning prison newspaper at Louisiana's Angola Prison—“The dream of getting out, you equate with heaven. Dying in prison you equate with hell.”
Doubts about Death: The Silence of the Institute of Medicine
Authors: Menikoff Jerry
Published: June 2007

Traditionally, organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria. Under these criteria, specific tests are performed to demonstrate directly a lack of brain activity. Recently, as a result of efforts to increase organ procurement, attention has been directed at the use of so-called “non-heart-beating” donors (NHBDs): individuals who are declared dead not as a result of direct measurements of brain function, but rather as a result of the cessation of heart and respiratory functions. Attempts to obtain organs from such individuals have recently resulted in substantial negative publicity. Claims were made that the deaths of patients were being accelerated in order to get organs, and that sometimes organs were being removed from patients who were not yet dead.
Criminal Act or Palliative Care? Prosecutions Involving the Care of the Dying
Authors: Alpers Ann
Published: June 2007

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as a watershed isPeople u. Einaugfer,which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.

How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand.
Cell and Molecular Biological Challenges of ICSI: ART before Science?
Authors: Schatten Gerald , Hewitson Laura , Simerly Calvin , Sutovsky Peter , Huszar Gabor
Published: June 2007

The general perception of how innovative assisted reproductive technologies (ART) are introduced is through a carefully controlled series of experiments in an animal model, such as the mouse. Only after the technique has been proven can one consider confirmatory studies on mammals closely related to humans, such as rhesus monkeys or other nonhuman primates. With this background of a peer-reviewed body of well-established published data, there is sufficient foundation and rationale to propose a clinical investigation to a responsible human subjects institutional review board (IRB). IRBs weigh the benefits and risks of the new methods to human subjects, and then consider the appropriate informed consent procedures for the particular case. Only after a large number of clinical studies are performed at multiple sites and are peer reviewed can the efficacy and safety of the innovative approach be clearly evaluated. At that time, the potential therapy can be responsibly offered to suitable beneficiaries.
Genetic Research as Therapy: Implications of “Gene Therapy” for Informed Consent
Authors: Churchill Larry R. , Collins Myra L. , King Nancy M.P. , Pemberton Stephen G. , Wailoo Keith A.
Published: June 2007

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy exists regarding whether certain medical procedures should be categorized as research.”

This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy.
Choosing for others as Continuing a Life Story: The Problem of Personal Identity Revisited
Authors: Blustein Jeffrey
Published: June 2007

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else.
Advertising Policies of Medical Journals: Conflicts of Interest for Journal Editors and Professional Societies
Authors: Orentlicher David , Hehir Michael K.
Published: June 2007

As the medical profession becomes more and more of a commercial enterprise, commentators are subjecting conflicts of interest in medicine to increasing scrutiny. However, one critical area of conflict has largely escaped discussion—the conflicts of interest raised by the advertising policies of medical journals. Moreover, when these conflicts are discussed, they are examined almost exclusively in terms of the concerns that they pose for journal editors. Yet, there is a second critical concern with journal advertising policies. The policies also create serious conflicts of interest for the professional societies that own medical journals.

In this article, we will discuss the conflicts of interest that are raised for journal editors and professional societies by journal advertising policies, and we will conclude that the policies are exactly backward. Currently, medical journals rely on advertisements from pharmaceutical companies and other health-related businesses and avoid—indeed exclude—advertisements from consumer-oriented companies, like producers of automobiles, golf equipment, or jewelry. We submit that the medical journals, the medical profession, and the public would be better served if consumeroriented advertisement were preferred over health-related advertising.
This Little Piggy Went to Market: The Xenotransplantation and Xenozoonose Debate
Authors: Clark Margaret A.
Published: June 2007

New technologies are changing our lives radically and quickly. New biotechnologies are moving to commercial uses faster than government regulators or private citizens can monitor. This tension manifests itself in the current debates over xenotransplantation technologies in medicine. The possibility of removing cells, tissues, and organs from animals and transplanting them into human beings is startling and unnerving. Natural immunesystem barriers between species, and even between individuals within a species, are formidable. Typically, transplantation results in violent rejection and death of the grafted organ. But despite the natural barriers to transplantation, xenotransplantation aims specifically to overcome them.

In this paper, I will discuss applications of xenograft technology, which raises clinical risks, ethical concerns, and policy issues. I conclude with a set of specific recommendations. As a recent letter to the journalNatureputs it, there is a “split between those who want to get it right, and those who want to get it right now.” No one knows what all the risks, benefits, and unintended consequences of xenotransplantation will be.
Jehovah's Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of All Pregnant Women
Authors: Levy Joelyn Knopf
Published: June 2007

The liberty of the woman is at stake in a sense unique to the human condition and so unique to the law. The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. That these sacrifices have from the beginning of the human race been endured by woman with a pride that ennobles her in the eyes of others and gives to the infant a bond of love cannot alone be grounds for the State to insist that she make the sacrifice. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman's role ….

For years, Jehovah's Witnesses have posed a challenge to the medical profession. Bound by religious belief to refuse blood and blood products, they can frustrate physicians who, since World War II, have utilized transfusions when indicated in the course of treatment.
Informed Consent and the Refusal of Medical Treatment in the Correctional Setting
Authors: Parker Frederick R. , Paine Charles J.
Published: June 2007

It was not until the nineteenth century that Western nations came to replace mutilation, corporal punishment, and banishment as the favored method of criminal punishment with the more humane concept of imprisonment. Even then, however, a convicted inmate was viewed as nothing more than a slave of the state, entitled only to the most basic of human rights and subject to the whim and peril of his jailor's desire. The shift to imprisonment gradually was accompanied by the additional humanitarian demand that prisons avail their charges of some minimum standard of human decency and necessity, which, by the early part of the twentieth century, had come to encompass the provision of medical care. The courts later came to acknowledge this as a fundamental right grounded in the Eighth Amendment's proscription against cruel and unusual punishments.

Although the scope of a prisoner's constitutional right to medical care has been the subject of much debate before the courts, the majority of cases have focused only on the circumstances under which the deprivation of care will amount to a violation of the rights guaranteed by the Eighth Amendment.
The Ethics of End-of-Life Care for Prison Inmates
Authors: Cohn Felicia
Published: June 2007

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.

In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy.
Commentary: A Consensus about “Consensus”?
Authors: Aulisio Mark P. , Arnold Robert M.
Published: June 2007

In “Bioethics and the Whole: Pluralism, Consensus, and the Transmutation of Bioethical Methods into Gold,” Patricia Martin identifies themes common to three emerging approaches to clinical bioethics--clinical pragmatism, ethics facilitation, and mediation-in order to develop an “ethical consensus method” that can serve as a “practical, step-by-step guide” for decision making She is to be applauded both for her identification of themes common to these three approaches and for her contribution to what we hope will be a growing literature on practical methods for problem solving in clinical bioethics that take seriously the ideal of consensus. After a few preliminary remarks concerning Martin's working model, we focus the majority of our commentary on the notion of “consensus,” which is at the heart of her “ethical consensus method,” and the three approaches from which it is drawn.
From Smallpox to SARS: Is the Past Prologue?
Authors: Hamre John J. , Young James G. , Shurtleff Mark
Published: June 2007

I am really quite honored to have a chance to be here. Also let me say how much I appreciate what all of you public health professionals do. One of the unfortunate dimensions of modern American life is that we have chosen to privatize all aspects of life. People do not live on their front porches anymore and watch their neighbors in the evening. They go out back in their wall-enclosed backyards. And we have done the same with medicine.

Medicine has been privatized in America. We have lost a sense of the public obligations of health and hygiene and sanitation. So I thank you for keeping the flame alive on what we clearly now know is the far bigger issue of health care in modern society.
Legal Preparedness for Public Health Emergencies: TOPOFF 2 and other Lessons
Authors: Heaton John A. , Murphy Anne M. , Allan Susan , Pietz Harald
Published: June 2007

There is a fine balance between civil liberties and protection of the public’s health.

Legislators, especially those in the western United States, are concerned about selling the Model State Act (“Act”) because of the loss of civil liberties. State constitutions give governors broad powers, such as declaring martial law and giving public health leaders the authority to act. State laws should consider issues such as property rights; taking of businesses and supplies; quarantine and isolation; due process; coordination among states, counties and cities; communication systems; conscription of doctors and nurses; and compensation. When two mock emergency response drills were held in New Mexico, concerns arose regarding opening records associated with dams, national laboratories, waste repositories, and three air force bases.
The Challenge of For-Profit Health Care Conversions
Authors: Fremont-Smith Marion R. , Urban Mark , Praeger Sandy
Published: June 2007

Most hospitals are considered charities under common law because they were established for the benefit of the public. The law granted them benefits, but also imposed duties. Under the cy-pres doctrine, if a charitable purpose becomes obsolete or incapable of being carried out, the court could modify those purposes to meet current needs of the organization and the community. Modern laws attempt to find a purpose as near as possible to original purposes set up by donors. In the case of hospital conversion, some regulators say assets must be used to support hospital health care, while others say they can be used in the broad sense of health care. That has been a continuing conflict between communities and regulators.

Since 1996, 30 conversion statutes have been enacted, covering hospitals, HMOs, and insurers.
New Directions in Health Insurance Design: Implications for Public Policy and Practice
Authors: Pollitz Karen , Imhoff Donna , Scott Charles , Rosenbaum Sara
Published: June 2007

This is a volatile time for health insurance policy. Medicare and Medicaid are in turmoil, as is the private health insurance market. Public and private health insurance costs constitute eighty percent of healthcare spending in the United States. Public health professionals depend on the insurance system to behave in ways that are responsive to public health in prevention and crisis management.

Seventy-five percent of the American population, excluding the elderly, has coverage through the private health insurance system. Ninety percent of this group receives their insurance through employer-sponsored programs, and the remaining ten percent buy their own coverage. Approximately ten percent of the non-elderly population has insurance through a government program, and fifteen percent of the non-elderly population, almost forty-one million Americans, is uninsured.
Quarantine in Severe Acute Respiratory Syndrome (SARS) and other Emerging Infectious Diseases
Authors: Speakman Jane , González-Martin Fernando , Perez Tony
Published: June 2007

SARS and monkeypox have given the public health community a unique opportunity to examine the use of quarantine measures. Until recently, the word “quarantine”was not used in polite conversation, and evoked unsavory images. The recent SARS epidemic illustrated the important role of quarantine and isolation as a public health response to communicable disease.

As public health officials in Toronto began to take control of the SARS epidemic, a second wave of the disease (SARS II) emerged. In the first SARS epidemic, approximately 8,200 individuals were isolated. There were approximately 82 probable cases, 66 suspect cases, and 24 deaths. On May 22, 2003, SARS II emerged. In total, approximately 13,000 people were quarantined. SARS II saw the onset of difficult questions being asked about the control and spread of SARS.

The province of Ontario establishes the public health policies and legislative framework for the entire province.
School-Based Policies: Nutrition and Physical Activity
Authors: Louie Dexter , Sanchez Eduardo J. , Faircloth Sean , Dietz William A.
Published: June 2007

In spite of laws in many states regulating the nutritional content of foods and the availability of “junk food” and soda, a 2001 Surgeon General’s Report indicated that 15% to 20% of the nation’s children are overweight or obese. In areas that are predominately Hispanic and African American, the numbers rise to between 40% and 50%. Although there are continuing efforts to educate the adult population, many school systems and public health jurisdictions have had little impact on the rising numbers of overweight and obese children. This session described the process of initiating a student-based, student driven approach to obesity, junk food, and diabetes and disease prevention.

A need existed for a grassroots approach at the student level to raise awareness of increasing obesity rates and diabetes and other related diseases in the adolescent population.
Who Will Keep the Public Healthy? Assuring a Legally Prepared Workforce
Authors: Viverette Mary Anne , Leaning Jennifer , Steeg Susan K. , Gebbie Kristine M. , Litchveld Maureen
Published: June 2007

The Commission on the Accreditation of Law Enforcement (CALEA) employs rigorous evaluation techniques. Objective accreditation, such as made possible by CALEA, is important from the public’s perspective and in the national community of law enforcement.

To counteract a general distrust of law enforcement agencies, the Law Enforcement Assistance Administration (LEAA) developed a grant to develop standards by which the quality and performance of law enforcement could be measured. LEAA developed 107 standards and, though well received by the law enforcement community, no single group or agency took the initiative to begin a program to evaluate and implement the standards. In 1979, the Department of Justice established an additional grant that effectively organized the four major law enforcement groups: the International Association of Chiefs of Police, the National Sheriff’s Association, the National Organization of Black Law Enforcement Executives, and the Police Executive Research Forum.
Preemption in Public Health: The Dynamics of Clean Indoor Air Laws
Authors: Yañez Elva , Cox Gary , Cooney Mike , Eadie Robert
Published: June 2007

Preemption is a powerful strategy used by special interest groups to undermine strong, local public health standards. Currently, 20 states in the U.S. have preemption ordinances in place related to clean indoor air initiatives. These preemption laws are the direct result of an ongoing and aggressive campaign of tobacco companies to thwart clean indoor air initiatives, which ultimately, according to tobacco industry internal documents, cause significant reductions in their annual revenues. Clean indoor air policies have arisen from a greater understanding of the documented health risks associated with exposure to secondhand smoke and action by local government (city councils, county commissions, and boards of health) to protect the public from these hazards. The efforts of the tobacco industry undermine local authority and seek to shift policy action to the state and federal levels, where the industry has greater political influence.
Sociolinguistic Folklore in the Study of African American English
Authors: Wolfram Walt
Published: June 2007

Although sociolinguists have performed a valuable service in challenging folk theories about African American English (AAE), they also have unwittingly participated in the construction of sociolinguistic folklore about variation and change in AAE. Several examples of sociolinguistic myths are presented, including the supraregional myth, the change myth, and the social stratification myth. Data used to challenge the canon of AAE description include empirical studies of different types of rural Southern African American communities as well as ethnographic observation. Historical circumstance, social and professional enculturation, and academic exclusivity are considered in explaining the construction of these questionable axioms about AAE. The examination indicates that unchallenged assumptions, unilateral explanations, and imagined dichotomies need to be scrutinized more critically with regard to the canon of AAE description.
Linguistics in a Primary School
Authors: Denham Kristin
Published: June 2007

In this article, I discuss a linguistics course that I have been teaching for the past 3 years in a multiage primary school classroom. This experience has led to work in other schools, has changed the way I teach introductory linguistics courses for teachers, and has led to the development of materials and curricula for use in K‐12 classrooms. I hope the sharing of these experiences will help to effect real change in the way in which knowledge about language is taught in K‐12 classrooms in the USA.
Prediction of Frozen Food Properties during Freezing Using Product Composition
Authors: Boonsupthip W. , Heldman D.R.
Published: June 2007

ABSTRACT:  Frozen water fraction (FWF), as a function of temperature, is an important parameter for use in the design of food freezing processes. An FWF‐prediction model, based on concentrations and molecular weights of specific product components, has been developed. Published food composition data were used to determine the identity and composition of key components. The model proposed in this investigation had been verified using published experimental FWF data and initial freezing temperature data, and by comparison to outputs from previously published models. It was found that specific food components with significant influence on freezing temperature depression of food products included low molecular weight water‐soluble compounds with molality of 50 μmol per 100 g food or higher. Based on an analysis of 200 high‐moisture food products, nearly 45% of the experimental initial freezing temperature data were within an absolute difference (AD) of ± 0.15 °C and standard error (SE) of ± 0.65 °C when compared to values predicted by the proposed model. The predicted relationship between temperature and FWF for all analyzed food products provided close agreements with experimental data (± 0.06 SE). The proposed model provided similar prediction capability for high‐ and intermediate‐moisture food products. In addition, the proposed model provided statistically better prediction of initial freezing temperature and FWF than previous published models.
Models of Meditation
Authors: Delmonte Michael , Kenny Vincent
Published: June 2007

ABSTRACT: Experiential aspects of the more common forms of meditation, described in the context of some research findings. Various theoretical models of meditation are reviewed. Meditation is also discussed in terms of behavioural, psychoanalytical and personal construct perspectives. It is concluded that whereas no simple or singular conceptualisation of meditation is adequate, personal construct theory has most to offer in describing meditation phenomena. The objectives of the various meditation techniques appear to be rather similar, i.e., to achieve insight into the workings of the mind, selfmastery, and ultimately to transcend the ego. However, meditation experiences may vary considerably within and between individuals.
The Language of Psychotherapy: Metaphor, Ambiguity, Wholeness
Authors: Holmes Jeremy
Published: June 2007

Psychoanalysis is approached from the perspective of linguistics. It is argued .hat analysis is concerned with a type of communication different in nature and logic from that of the natural sciences. The characteristics of analytic language are illustrated by comparing poetry and psychoanalysis. Transference is discussed as a special type of metaphor; ambiguity is seen as an intrinsic aspect of aesthetic language; wholeness is held to be a goal of both therapy and the arts. The relevance of this view to recent findings in neurophysiology and ethology is discussed.
The Hyperactive Child: A Psycho‐analytical Approach to Theory and Treatment
Authors: Eyre Dean P.
Published: June 2007

A psychoanalytical approach to the causation and treatment of the hyperactive child is given. It is hypothesized that hyperactivity in children is the overt manifestation of a distortion in the mother‐child relationship which is latent. Clinical material and theory are presented from the psychoanalytical treatment of a child and an adult. This is then extrapolated to show that using these theories of brief intervention can change this overt symptom of hyperactivity and reveal the latent meaning ‐ that it is, in Fact, a disturbance in the mother herself, so enabling the mother to have the treatment she needs.
Listening as a Four‐level Activity
Authors: Rowan John
Published: June 2007

This theoretical paper argues that there are many isolated insights offered by practising psychotherapists which would be more usable if they were integrated into a suitable model which would relate them are to another. A model is offered which distingushes between four levels of the person: body, feelings, intellect and soul or spirit. This model is used to examine four types of listening found in the literature: empathy, awareness, counter‐transference and resonance. It is shown that what this is done much more coherence is found, and it is then possible to talk in terms of holistic listening. A set of diagrams is developed which suit the model and make it more teachable.

Some implications are drawn out to, the education of psychotherapists. In, curd, in psychotherapy and for the selection of psychotherapists by potential clients.
Brief Focal Psychotherapy with a Pregnant Woman Presenting with Nightmares of Killing Her Baby: A Case Study
Authors: Chiesa Marco C.
Published: June 2007

This paper reports an 18 session treatment in brief focal psychotherapy of a case that presented with at least two major contra‐indications for this type of therapy: 1) childhood deprivation and 2) the danger of intensification of a depressed illness. This paper shows that the recent traumatic event, in this case a highly ambivalent pregnancy, can help to destabilize the armour of a defensive structure, and bring to the surface primitive fears and conflicts which cause severe symptomatology and distress but which become more accessible to the patient's awareness and more amenable to interpretation. The acuteness of the disturbance brought about by the traumatic event increased the patient's motivation and need for treatment, speeding up the therapeutic process. This brief psychotherapy shows the importance of the working through of the patient's intense hostility towards her mother and towards the therapist in the transference, if a solution of murderous feelings towards her baby are to be achieved. As far as technique is concerned, this paper shows that a thorough interpretation of the negative transference from the early stage of therapy, an unusual number of transference/parents interpretations and the working through of the patients's anger and grief about termination seemed to be essential factors correlated with a positive outcome.
Homework Assignments in Brief Psychotherapy
Authors: Macaskill Norman
Published: June 2007

ABSTRACT: A rationale is offered for the use of homework assignments in brief therapy. It is argued that such assignments help maintain a therapeutic focus, strengthen the therapeutic alliance, enhance motivation and can reduce termination difficulties. The analysis of resistance to carrying out homework is also discussed and it is suggested that it can be a potent tool in clarifying motivational problems and blocks to the generalisation of therapeutic gains into the patient's daily life. Problems for therapists and patients in using such techniques are also briefly discussed. An extended case example is included to illustrate the practical application of homework assignments.
Psychotherapeutic Work with a Ten‐Year‐Old Girl: with particular reference to the development of her introjective potential
Authors: Judd Dorothy
Published: June 2007

ABSTRACT. This paper aims to illustrate with clinical material certain basic concepts which emerged in working psychotherapeutically with a ten‐year‐old girl. These concepts ‐ with particular reference to Klein, Bick and Meltzer ‐ are lack of containment and secondary skin function; adhesive identification and two‐dimensionality; projective identification and inner space. Work began with the patient inaccessibly in a two‐dimensional state eliciting a frequent counter‐transference response of extreme sleepiness. Then at the point at which the therapist was assailed by very powerful physical and emotional sensations in the countertransference, a shift occurred whereby the patient began to use the therapist as an object that could contain some of these projections. A powerful interchange was then under way wherein the patient, with the experience of someone capable of staying with her, developed an awareness of her inner space which could be filled by introjection, as well as that of the therapist which could receive her projections.
Reflections on Violence and the Perversion of Meaning
Authors: Wilson Stephen
Published: June 2007

ABSTRACT Violence can be understood as the exercise of physical force so as to inflict injury on or damage to persons or property. In another sense it denotes the perversion of meaning. I indicate here connections between the two senses of violence in both social and individual spheres. I propose that the perversion of meaning is a condition underlying the use of physical violence.
Shared Phantasy and Therapeutic Structure in a Brief Marital Psychotherapy
Authors: Clulow Christopher , Dearnley Barbara , Balfour Frederick
Published: June 2007

ABSTRACT In this, the first of two related papers, the process is examined by which a couple were helped to separate, temporarily and emotionally, through a brief offer of psychodynamic therapy. The therapy comprised six weekly sessions of one hour's duration, an input often considered inadequate for effective analytic psychotherapy. The paper examines the interrelationship between an unconscious shared phantasy which had produced deadlock in the marriage and two structural aspects of the therapeutic offer ‐ its brevity and the decision to see the partners separately. The concept of shared phantasy is discussed in the second of these papers which describes in the context of one model for outcome assessment, in what terms the therapy might be said to have been effective.
Attitudes of British Psychotherapists Towards the Role of Humour in Psychotherapy
Authors: Bloch Sidney , McNab David
Published: June 2007

In the absence of any studies concerning views that psychotherapists have towards the place of humour in psychotherapy, a questionnaire was devised and distributed to a sample of therapists practising in the United Kingdom. Half the respondents saw a regular place for humour in treatment; 62%0 of the respondents regarded the risks involved as moderate or marked. From their qualitative responses it was possible to identify eight factors relevant to the application of humour in treatment and five categories of risk. Most therapists suggested that the effective promotion of humour depended on the therapist's awareness of his own sense of humour and how this could find expression in therapy. Any theoretical basis for the incorporation of humour into treatment did not seem to be regarded as particularly important.