Understanding Individual Experiences of Chronic Illness with Semantic Space Models of Electronic Discussions

Electronic discussion groups provide a convenient forum for individuals to share their experiences of chronic illness. The language use of individual participants, and the way their language shifts over time, may provide implicit indications of important shifts in sense-of-self. This paper relates experience with application of the hyperspace analogue to language (HAL) model for automatic construction of a dimensional model from a corpus of text. HAL is applied to 17 months of discussion on a closed list of 20 women coping with chronic illness. The discussion group was moderated for a focus the phenomenon of "Transition' - how people can learn to incorporate the consequences of illness into their lives. The current phase of research focuses on identification of clusters of words that can represent key aspects of Transition. The HAL models for two participants have been analyzed by experts in Transition to form candidate clusters. These clusters are then used as a basis for contrasting the language usage of an individual participant over time as compared to the entire corpus. We have not yet found a reliable basis for identifying transitions in an individual based on their entries into a discussion forum, although the clusters may have some inherent value for introspection on individual experiences and Transition in general. We report challenges for interpretation of the HAL model related to the correlation of dimensions and the impact of group dynamics

A Case for Context-Free Grammar

System administrators agree that permutable methodologies are an interesting new topic in the field of programming languages, and electrical engineers concur. In this paper, authors demonstrate the study of DHCP, demonstrates the natural importance of machine learning. Our focus in our research is not on whether object-oriented languages and replication are often incompatible, but rather on constructing a psychoacoustic tool for evaluating I/O automata (Outlier)

South Carolina's fourth forest

Forests have always played a significant role in the life of South Carolinians. The many benefits that flow from the wooded acres that make up the predominant land cover of our beautiful state accrue to all our citizens, both rural and urban. Many who benefit take the enhanced quality and enjoyment of life for granted. However, those of us entrusted with the protection and development of the forest resources must not only redeem these responsibilities, but must also bring to the forefront and attention of each person the values of these benefits. The publication of South Carolina's FOURTH FOREST report is part of that effort. The report is the culmination of many people's work and careful thought. Much of the report concerns itself with projections based on the best estimates of what will occur. The reality of the future can be very different from the "word pictures" printed in these pages. The result could be more disappointing, but hopefully the Fourth Forest will be more beneficial for our succeeding generations

Tribute to Professor Mary Z. Natkin

A tribute to Professor Mary Z. Natkin, who served on the faculty of the Washington and Lee University School of Law from 1987 to 2020. Professor Natkin is also an alumna of W&L Law, having graduated with the Class of 1985

“I fear those things”: non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda

BackgroundAdolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14–24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost.MethodsWe conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically.ResultsAll 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20–24 years) (aOR = 0.32, 95% CI 0.16–0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception.ConclusionNon-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives

An economic model of school-based behavioral interventions to prevent sexually transmitted infections

Objectives: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people. Methods: We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs. Results: The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively. Conclusions: School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters

Sex and area differences in the association between adiposity and lipid profile in Malawi.

BACKGROUND: Evidence from high-income countries shows that higher adiposity results in an adverse lipid profile, but it is unclear whether this association is similar in Sub-Saharan African (SSA) populations. This study aimed to assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence (rural/urban). METHODS: In this cross-sectional study, data from 12 096 rural and 12 847 urban Malawian residents were used. The associations of body mass index (BMI) and waist to hip ratio (WHR) with fasting lipids (total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG)) were assessed by area and sex. RESULTS: After adjusting for potential confounders, higher BMI and WHR were linearly associated with increased TC, LDL-C and TG and reduced HDL-C. BMI was more strongly related to fasting lipids than was WHR. The associations of adiposity with adverse lipid profile were stronger in rural compared with urban residents. For instance, one SD increase in BMI was associated with 0.23 mmol/L (95% CI 0.19 to 0.26) increase in TC in rural women and 0.13 mmol/L (95% CI 0.11 to 0.15) in urban women. Sex differences in the associations between adiposity and lipids were less evident. CONCLUSIONS: The consistent associations observed of higher adiposity with adverse lipid profiles in men and women living in rural and urban areas of Malawi highlight the emerging adverse cardio-metabolic epidemic in this poor population. Our findings underline the potential utility of BMI in estimating cardiovascular risk and highlight the need for greater investment to understand the long-term health outcomes of obesity and adverse lipid profiles and the extent to which lifestyle changes and treatments effectively prevent and modify adverse cardio-metabolic outcomes

Health professionals' and managers' definitions of developmentally appropriate healthcare for young people:Conceptual dimensions and embedded controversies

Objectives: We aimed to (i) explore how health professionals and managers who work with young people seek to define developmentally appropriate healthcare (DAH), (ii) identify the range of conceptual dimensions present in their definitions and (iii) explore the controversies embedded in their characterisations of DAH. Methods: A qualitative multisite ethnographic study was conducted across three hospitals in England. We undertook face-to-face semi-structured interviews with health professionals and managers; and non-participant observation in clinics, wards and meetings. Anonymised field notes and interview transcripts were analysed using thematic analysis. The theme conceptualisations of DAH' was then further analysed, and the resulting themes categorised to form conceptual dimensions. Results: We recruited 192 participants and conducted 65 interviews (41 with health professionals and 24 with managers) and approximately 1600 hours of non-participant observations (involving 103 health professionals and 72 managers). Despite the wide range of definitions provided by participants, five conceptual dimensions of DAH were identified: (i) biopsychosocial development and holistic care, (ii) acknowledgement of young people as a distinct group, (iii) adjustment of care as the young person develops, (iv) empowerment of the young person by embedding health education and health promotion and (v) interdisciplinary and interorganisational work. Also, some controversies were identified within most dimensions. Conclusions: This study illustrates the lack of a generalised definition of DAH for young people among UK health professionals and managers, and presents a set of five core dimensions that can inform future research to help define and evaluate DAH for young people