Gender Confirmation Surgery and the Federal Prison System: Eighth Amendment Framework and Proposed Alternatives

As reform for individuals with gender dysphoria has developed, the prison system\u27s accommodation of those individuals\u27 needs has underperformed. There have been a number of cases in the past few years where inmates who are experiencing gender dysphoria have not received adequate care in the form of gender confirmation surgery. Four of the Federal Appellate Circuit Courts have decided that a physician\u27s refusal to provide an inmate with gender confirmation surgery is not a violation of the 8th Amendment. One circuit ruled differently and held that denial of the surgery to an inmate experiencing gender dysphoria does violate the 8th Amendment\u27s right against cruel and unusual punishment. This Comment discusses the circuit split surrounding the issue of whether denying an inmate with gender dysphoria gender confirmation surgery is a violation of the 8th Amendment. This Comment argues that should SCOTUS grant review of one of these cases, it should hold as the 9th Circuit does in Edmo v. Corizon and rule that denial does violate the 8th Amendment. Further, this Comment discusses whether or not the 8th Amendment is the best way for inmates to seek redress on this issue and concludes that it does not. And while there is no perfect solution, this Comment recommends other ways to sue for this issue in order for inmates to receive better outcomes

The value of choice: A qualitative study

Background Providing choice in health care is part of an ongoing policy initiative Aim To explore how people understand choice in health care provision Setting South East England Design of Study A qualitative study using semi structured interviews Method Twenty two people recruited through advertising were interviewed about choice in general and choice in health care in particular. The data were analysed using template analysis. Results Participants grounded their consideration of choice in the NHS within the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. In particular, there was strong assent to the value of choice in principle and having choice was seen as positive. The provision of choice options, however, was not always associated with the possibility of meaningful choice and participants felt that the appearance rather than the substance of choice was sometimes in evidence. Making – as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP and to occasion regret. Information was seen as a necessary but not sufficient prerequisite of informed choice Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine rather than promote the doctor / patient relationship

Welcoming new life under lockdown:Exploring the experiences of first-time mothers who gave birth during the COVID-19 pandemic

OBJECTIVES: This study aimed to explore how first‐time mothers in the UK experienced new parenthood during the coronavirus (COVID‐19) pandemic. DESIGN: This study used a cross‐sectional exploratory, qualitative interview design. METHODS: Semi‐structured interviews were conducted with ten first‐time mothers who had given birth since COVID‐19 was declared as a pandemic. Verbatim transcripts were analysed using reflexive thematic analysis. RESULT: Experiences of new, first‐time mothers during the COVID‐19 pandemic were organized around two themes. First, new mothers felt an overwhelming sense of responsibility for their baby which was heightened by the pandemic. The challenge of meeting this responsibility was heightened in the context of societal expectations to do the ‘right’ thing and uncertainty and distrust around official guidance about COVID‐19. Secondly, the expected transition into motherhood was altered by the pandemic. Disruption to the birthing experience, an inability to connect with close friends and family, and limited healthcare support was perceived to be detrimental. However, altered social expectations and the increased presence of the partner were perceived as positives. CONCLUSION: Many of the common challenges experienced by new, first‐time mothers have been amplified by the COVID‐19 pandemic. Public policy and scientific research must target this group in order to protect this population from the negative impact of the remaining COVID‐19 pandemic and any future pandemics

The mediating roles of disgust sensitivity and danger expectancy in relation to hand washing behaviour

Copyright © 2010 British Association for Behavioural and Cognitive PsychotherapiesBackground: Recent interest in the role of vulnerability factors in obsessional washing has suggested that disgust sensitivity, danger expectancy and health anxiety may be of interest. Aims: This study explores the differential impact of these factors on both behavioural and cognitive measures of washing behaviour and is based on a replication of the Jones and Menzies (1997) experiment, during which participants immersed their hands in a noxious compound while rating themselves on a range of measures: the time they subsequently took to wash their hands was measured and danger expectancies were found to be the best predictor of this. Method: The present study added measures of disgust sensitivity and health anxiety to this experimental methodology while removing factors they found to be of little import to compulsive washing. Thirty non-clinical participants took part. Results: Results confirmed that disgust sensitivity was related to the behavioural measure of washing time, but that this relationship was almost entirely mediated by the danger expectancy concerning judgements of severity of consequent disease. However, a different pattern emerged when the outcome measure was questionnaire based: danger expectancy was not at all related to this. Disgust sensitivity mediated the relationship between health anxiety and scores on a questionnaire measure of washing compulsions. Interestingly, these scores were not related to the behavioural measure of washing time. Conclusions: The implications of these relationships to the further development of subtypes of Obsessive Compulsive Disorder (OCD) are discussed

Enterprise Software Licensing: New Options - New Obligations

Software licensing options for large enterprises are evolving almost as quickly as the mission-critical software solutions those companies deploy. In the past, most software licensing metrics were based on the software installation itself. Increasingly, software publishers are offer- ing more licensing options and flexibility to meet their customers\u27 software needs; however, that increased flexibility often results in complex software asset management ( SAM ) risks and obligations. Licensing models that once would have required custom agreements with unique protocols, if technologically feasible in the first place, now are offered alongside the traditional licenses in increasingly dense menus of choices for IT teams to weigh. Businesses must equip themselves to recognize the unique challenges that accompany various options in order to avoid unnecessary licensing exposure. The options available depend in large measure on the types of computers on which the software will reside. For workstations, many businesses that once relied on a one-license-per-installation model now are migrating to server-based installations accessed from terminals lacking hard drives (e.g., thin-client architectures) and to hosted software delivered through the cloud; each of these models presents unique infrastructure and licensing challenges. Server-based licensing options are complex, with many companies facing the prospect of having to determine license requirements using intricate calculations that depend on the processing capacity of the computer or on some other metric associated with a particular software product. Unsurprisingly, many companies are finding unique solutions to those challengesincluding the formation of captive IT services providers -but many of those solutions present their own sets of challenges and risks

Development of a Dysphagia Management Protocol for Older Residents in a Care Home Setting. (abstract only)

Purpose: The aim of this study is to develop a co-designed dysphagia management protocol for older residents living in a care home setting. Method: A qualitative study is being conducted within four care homes in a region in the North of England; these were purposively selected to ensure representation of a range of care models across the care home sector. A literature search was conducted to establish good practice in the management of dysphagia in care homes. The findings from the literature review informed the development of semi-structured interview/focus group guides. Eight focus groups have been conducted with 40 members of the nursing and care assistant team and semi-structured interviews conducted with four nursing home managers. These have explored the assessment and management of dysphagia and the barriers and opportunities for improvement in dysphagia management. Interviews will also be conducted with residents (n=16) and nominated relatives, and quality managers (n=4). The interview and focus group data are being analyzed using the Framework Approach. Results: The literature review and preliminary data analysis suggest the following emerging themes: Lack of integrated approaches to education and training; Enablers and barriers to effective dysphagia management; Impact of relationship with other health care professionals on dysphagia management. Conclusion: These findings will lead to the co-design of a protocol for optimizing nutrition and hydration which is based on evidence and best practice principles and which can be adopted in the care home setting. This protocol will be produced by January 2018. The study has been funded by the Abbeyfield Foundation