The changing of the guard: groupwork with people who have intellectual disabilities

This paper considers the impact of service systems on group activities. It describes an inter-professional groupwork project facilitated by a social worker and a community nurse. The project provided an emancipatory experience for a group of adults who had intellectual disabilities. The group was charged with the task of reviewing and updating the recruitment and interview processes used by a 'Learning Disability Partnership Board', when employing new support workers. The paper begins with a brief history of intellectual disability and provides a context to the underpinning philosophical belief that people should be encouraged and supported to inhabit valued social roles no matter what disability they may have. It then identifies the ways in which the sponsoring health, education and social care services impacted on the creation and development of a groupwork project. It might have been expected that the nature of the intellectual disability would have been the major influence on group process. However the paper reveals that organisational constraints had a significant impact on group functioning. Issues including, staffing budgets and transport contracts impacted on group process and function. The results of the project show how, with adequate support, people with intellectual disability can make important decisions that have long-reaching impacts on the services

The Refederalization of American Health Care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69090/2/10.1177_107755878704400103.pd

Possible origins of macroscopic left-right asymmetry in organisms

I consider the microscopic mechanisms by which a particular left-right (L/R) asymmetry is generated at the organism level from the microscopic handedness of cytoskeletal molecules. In light of a fundamental symmetry principle, the typical pattern-formation mechanisms of diffusion plus regulation cannot implement the "right-hand rule"; at the microscopic level, the cell's cytoskeleton of chiral filaments seems always to be involved, usually in collective states driven by polymerization forces or molecular motors. It seems particularly easy for handedness to emerge in a shear or rotation in the background of an effectively two-dimensional system, such as the cell membrane or a layer of cells, as this requires no pre-existing axis apart from the layer normal. I detail a scenario involving actin/myosin layers in snails and in C. elegans, and also one about the microtubule layer in plant cells. I also survey the other examples that I am aware of, such as the emergence of handedness such as the emergence of handedness in neurons, in eukaryote cell motility, and in non-flagellated bacteria.Comment: 42 pages, 6 figures, resubmitted to J. Stat. Phys. special issue. Major rewrite, rearranged sections/subsections, new Fig 3 + 6, new physics in Sec 2.4 and 3.4.1, added Sec 5 and subsections of Sec

The impact of breastfeeding patterns on regional differences in infant mortality in Germany, 1910

This paper examines the impact of breastfeeding practices on the large regional differences in infant mortality in Germany around 1910. Breastfeeding is strongly negatively associated with infant mortality and remains so after controlling for public health measures and for demographic, economic, and social factors that also affect infant mortality. But it contributes much less to regional differences in infant mortality than do access to medical care, percentage illegitimate and marital fertility. Breastfeeding is less important than these other factors because it affects fewer causes of death and has a smaller impact on cause-specific infant mortality rates. L'auteur étudie l'impact des pratiques d'allaitement sur les grandes différences régionales de mortalité infantile observées en Allemagne aux alentours de 1910. Il existe une association fortement négative entre l'allaitement et la mortalité infantile, même quand on contrôle les facteurs démographiques, économiques, sociaux et de politique sanitaire, qui, eux aussi, affectent la mortalité infantile. Mais les différences régionales de mortalité infantile s'expliquent nettement moins par l'allaitement que par l'accessibilité des soins médicaux, le taux d'illégitimité des naissances et la fécondité légitime. L'allaitement est un facteur de moindre importance que ceux-ci parce qu'il n'a d'impact que sur un petit nombre de causes de décès, et un faible impact sur les taux de mortalité infantile par cause.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42730/1/10680_2005_Article_BF01796777.pd

Comparative empirical evaluations of internal migration models in subnational population projections

While population forecasters place considerable emphasis on the selection of appropriate migration assumptions, surprisingly little attention has been given to the effects on projection outcomes of the way internal migration is handled within population projection models. This paper compares population projections for Australia's states and territories prepared using ten different internal migration models but with identical assumptions for fertility, mortality and international migration and with the internal migration model parameters held constant. It is shown that the choice of migration model generates large differences in total population, geographical distribution and age--sex composition. It is argued that model choice should be guided by balancing model reality with practical utility and model performance is examined against these criteria. Of the ten models evaluated the authors argue that the migration pool, biregional, and biregional with net constraints models offer a good compromise between conceptual rigour and practicality. If the projected origin-destination flows are required then one of the versions of the standard multiregional model with reduced data inputs is preferred. The large variation in projection outputs points to the need for a better understanding of the spatio-temporal structure of migration in Australia

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Population, Land Use and Deforestation in the Pan Amazon Basin: a Comparison of Brazil, Bolivia, Colombia, Ecuador, Perú and Venezuela

This paper discusses the linkages between population change, land use, and deforestation in the Amazon regions of Brazil, Bolivia, Colombia, Ecuador, Perú, and Venezuela. We begin with a brief discussion of theories of population–environment linkages, and then focus on the case of deforestation in the PanAmazon. The core of the paper reviews available data on deforestation, population growth, migration and land use in order to see how well land cover change reflects demographic and agricultural change. The data indicate that population dynamics and net migration exhibit to deforestation in some states of the basin but not others. We then discuss other explanatory factors for deforestation, and find a close correspondence between land use and deforestation, which suggests that land use is loosely tied to demographic dynamics and mediates the influence of population on deforestation. We also consider national political economic contexts of Amazon change in the six countries, and find contrasting contexts, which also helps to explain the limited demographic-deforestation correspondence. The paper closes by noting general conclusions based on the data, topics in need of further research and recent policy proposals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42720/1/10668_2003_Article_6977.pd