Access to Health Care for Transgendered Persons: Results of a Needs Assessment in Boston

SUMMARY

The transgender community is a population group that has experienced an increase in visibility, with only a small, concomitant increase in understanding. This study reports on four focus groups, in which 34 transgendered individuals discussed their experiences and interactions with the health care system.

The specific aims of the study were as follows:

• Identify the health needs of transgender and transsexual (TG/TS) individuals;

• Hear the experiences and perceptions of TG/TS individuals who are using the current health care system;

• Identify any barriers to obtaining services, support and/or resources;

• Assess the extent to which health care providers and systems are able to offer sensitive, high quality and user friendly services that meet TG/TS consumers' needs; and

• Identify ways that health care services can be enhanced to better meet the needs of the target population.

What the study found was a system that was anything but high quality in meeting the needs of TG/TS individuals. Ignorance, insensitivity and discrimination appear to be the norm. Specifically, the focus groups found the following:

• Transgendered and transsexual persons frequently encounter providers who will not treat them and blatantly say so. There is a need for education and a change in anti-discrimination law needed to change this.

• The lack of provider training on transgender issues creates insensitivity to simple issues of respect for trans people. One example is the unwillingness to address TG/TS people by the pronoun preferred by the patient/client.

• Many providers lack the knowledge to adequately treat many of the routine health care needs of TG/TS individuals when such treatment relates to issues of hormone use, gynecological care, HIV prevention counseling, or other concerns related to gender or sexuality.

• Providers frequently refer to trans issues in unrelated health care situations such as setting a broken bone, filling a cavity or treating a cold. Greater familiarity with the health care needs of the trans population would reduce such incidents.

• Mental health and substance abuse treatment providers need additional training in order to work cooperatively with TG/TS clients to identify when gender issues are or are not relevant to specific mental health or substance abuse treatment episodes. Sometimes gender issues are central to mental health or substance abuse treatment, sometimes they are peripheral and sometimes they are unrelated.

• Discrimination in health insurance is the rule, not the exception. There is a need for education to encourage policy changes on the part of insurers and public policy changes on the part of legislators and regulators.

     

Parent–child interaction therapy (PCIT) in young children with autism spectrum disorder

Abstract

Parent–child interaction therapy (PCIT) is an evidence-based treatment for typically developing children with disruptive behavior. We conducted a randomized-controlled trial of PCIT versus wait-list control (WLC) with 23 children with ASD (3–7?years) and disruptive behavior. Over 16 treatment sessions, PCIT significantly predicted reductions in disruptive behavior over WLC and explained a significant variation in scores on the ECBI Intensity subscale. Additionally, parent skills improved significantly compared to WLC. However, no statistically significant group differences were found on child compliance rates, autism severity, or parental stress. Results support PCIT as an evidence-based treatment for disruptive behavior in ASD.

• Highlights

• Parent skills were significantly improved for those receiving PCIT

• Intensity of disruptive behaviors decreased significantly for those receiving PCIT

• Parental stress and autism severity did not significantly decrease with PCIT

     

“Beyond Frontiers of Traditional Project Management”: The Concept of “Project Management Second Order (PM-2)” as an Approach of Evolutionary Management

Fundamental changes in sciences offer new perspectives for the management of complexity. Increased complexity in society, economics, and technology requires a new and suitable organization and management. What are the consequences and results for project management? That is the theme of this article. First of all it will given a short introduction to project management, which will be later called “traditional project management” or “project management 1st order (PM-1).” Then, the challenges by the fundamental changes in sciences and the increased complexity in society, economics, and technology will be discussed. It will state that traditional project management cannot solve these challenges. The widespread working-themes and results of the research program “Beyond Frontiers of Traditional Project Management” as an answer to these challenges will be presented at a glance. Subsequently, it will discuss some selected results of the research program:

• The principle-definition and foundation of “Evolution of 1st and 2nd Order.”

• The Evolution of 1st Order and the impact on Project Management methods and processes.

• Evolution of 2nd Order and the Grand Evolutionary Systems Theory (GEST) of E. Laszlo as also the impact on Project Management methods and processes.

• Management of crisis: turn a change to advantage or risk-assurance?

Thereafter, the concept of “Project Management Second Order (PM-2)” is presented as a highlighted result of the research program, as a new paradigm in project management, and as an answer to the challenges, described earlier will be explained in detail. Finally, a real example of transfer evolutionary and self-organizational management principles in a real project life will be demonstrated.     

Seven things to consider when measuring religious identity

Measuring religious identity is complex. The author offers seven suggestions for those who wish to describe and understand religious identity using survey data:

• (1)?Definitions and measures of religious identity shape knowledge about religious groups;

• (2)?Variation in question wording leads to variation in responses;

• (3)?Comparing results across surveys provides valuable perspective;

• (4)?Incentives shape how respondents report their religious identity;

• (5)?Religious identity may be liminal;

• (6)?Salient identity categories are often unmeasured; and

• (7)?Religious identity and religious practice may not seem congruent.

This essay includes many examples to illustrate these measurement suggestions.     

Toward a Theory of Progressive Evolution (Large-Scale Stages of Evolutionary Progress)

Here I discuss the basic elements, major stages, and completion of progressive evolution. The cosmic world of self-realization is based on extensive self-development within a closed contour: temporal counter-transitions of spatial counter-elements (energy bonds and media and, basically, substance structures) form of local worlds within it through evolution of informational structures.

• The organic world of reproduction develops through the open informational path: the initial substance, through energy exchange and metabolism, reproduces similar substance; the latter interacts with the environment and, subsequently, reproduces its like, and so on.

• The animal world of self-regulation builds up a closed informational contour in the environment through the informational input and command output.

• The human world of self-cognition forms the intensive type of development within the internal closed informational contour of cognition. Counter-transitions of ideal images and signs relate to their real prototypes. In the course of cognition, abstractive thinking develops and brings man to the possibility of reflection of the initial world in its integrity (thus, elevates man to the infinite, by Hegel).

     

Consensus and Cognitivism in Habermas’s Discourse Ethics

Abstract

Habermas asserts that his discourse ethics rests on two main commitments:

1. Moral judgements have cognitive content analogous to truth value; and

2. moral justification requires real-life discourse. Habermas elaborates on the second claim by making actual consensus a necessary condition of normative validity. I argue that Habermas’s two commitments sit uneasily together. The second entails that his cognitivism is revisionist in the sense that it must reject the law of the excluded middle. Moreover, Habermas’s argument in defence of the need for real-life discourse is unconvincing and his derivation of the principle which requires consensus is fallacious.

     

Foreign accents reduce false recognition rates in the DRM paradigm

ABSTRACT

More cognitive resources are required to comprehend foreign-accented than native speech. Focusing these cognitive resources on resolving the acoustic mismatch between the foreign-accented input and listeners’ stored representations of spoken words can affect other cognitive processes. Across two studies, we explored whether processing foreign-accented speech reduces the activation of semantic information. This was achieved using the DRM paradigm, in which participants study word lists and typically falsely remember non-studied words (i.e. critical lures) semantically associated with the studied words. In two experiments, participants were presented with word lists spoken both by a native and a foreign-accented speaker. In both experiments we observed lower false recognition rates for the critical lures associated with word lists presented in a foreign accent, compared to native speech. In addition, participants freely recalled more studied words when they had been presented in a native, compared to a foreign, accent, although this difference only emerged in Experiment 2, where the foreign speaker had a very strong accent. These observations suggest that processing foreign-accented speech modulates the activation of semantic information.

Highlights

• The DRM paradigm was used to explore whether semantic activation is reduced when processing foreign-accented speech.

• Across two experiments, false recognition of non-studied semantic associates was lower when word lists were presented in a foreign accent, compared to native speech.

• The above results suggest semantic activation may be reduced when processing foreign-accented speech.

• Additionally, it was found that when the foreign speaker had a mild accent, correct recall of studied words was uninfluenced. If the foreign speaker had a strong accent, however, correct recall of studied words was reduced.

     

Six Levels of Mentality

Abstract

Examination of recent debates about belief shows the need to distinguish:

• (a)?non–linguistic informational states in animal perception;

• (b)?the uncritical use of language, e.g. by children;

• (c)?adult humans' reasoned judgments.

If we also distinguish between mind-directed and object–directed mental states, we have: 1. Perceptual ‘beliefs’ of animals and infants about their material environment.

2. ‘Beliefs’ of animals and infants about the mental states of others.

3. Linguistically-expressible beliefs about the world, resulting from e.g. the uncritical tendency to believe what we are told.

4. Uncritically-formed beliefs about the mental states.

5. Beliefs about the material world arrived at by the weighing of evidence.

6. Beliefs about mental states formed by critical assessment.

     

A new magna charta

In seeking an interpretation of the theory of Gestalt, the analysis revealed that the concept of Gestalt applies to processes and particularly to the way in which events or processes take place. The essential condition for the emergence of Gestalten or configurational properties was found to be—the ability of the parts or factors in the process to influence each other.

In considering first, the more dynamic or formative phase of processes, the significant factors which influence the reciprocity of influence between the parts or factors of the process were found to be

• (i) the properties of the individual parts or factors,

• (ii) the properties of the intervening medium,

• (iii) the ‘distance’ between the parts or factors,

• (vi) ‘factors of rigidity or constraint’.

It was emphasised that these factors operate relatively to one another. The concept of ‘wholeness’ was found to apply to both the dynamic and the more static phase of the process. The resultant or equilibrium position of the process derives some contribution from the whole matrix of interacting factors or influences which are responsible for the resultant being precisely what it is.

The recognition of the causal significance of even small contributions to an event or process is consistent with the concept of ‘wholeness’ and with the ‘matrix’ view of causal explanation. This view of causal explanation is the consistent implication of the theory of Gestalt and the many experimental results associated with this school.     

Identifying Training Needs of Health-Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England

SUMMARY

The Transgender Training Project of the New England AIDS Education and Training Center has been providing training on transgender-related issues to health-care providers in the New England region since 1999, having trained nearly 600 providers in that time. The Transgender Training Project embarked on a study during the 2001–2002 grant year to interview providers of HIV-related care and advocacy on their knowledge and experience with working with trans-gendered people and to assess training needs to increase their effectiveness with transgendered clients.

The methodology consisted of face-to-face interviews with 13 providers of HIV treatment and care who are affiliated with the New England AIDS Education and Training Center network to discuss clinical challenges in working with transgendered people.

In this exploratory study, we found that providers had:

1. Desire to treat transgendered patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.

2. Experience with a range of transgendered patients, but lack of information on distinctions among transgendered experiences.

3. Restrictions based on time constraints that create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care.

4. Concern and frustration with lack of information, studies and research.

5. Concern and frustration with lack of treatment guidelines, (or ability to access them), referral contacts and ways to advocate for transgender clients.

6. Belief that training by transgendered people themselves was an essential teaching element.

These results point to the need for the development and dissemination of specific training materials and resources for health-care providers serving transgendered people living with or at risk for HIV.     

Work function dependence on the thickness and substrate of carbon contamination layers by Kelvin probe force microscopy

The contact potential difference (CPD) between carbon contamination (CC) layers and the several substrates on which they were deposited has been measured as a function of the film thickness by means of Kelvin probe force microscopy (KPFM). The observed CPD trends may be divided into three categories:

2. an increase, or decrease, in CPD with thickness up to a saturation value with sign inversion with respect to the substrates (Al and Si);

3. an oscillation with no sign inversion (substrates, gold and platinum);

4. an oscillation through sign inversion (palladium substrate).

Effects (ii) and (iii) seem to be typical of CC, since they have not been observed for other materials, including evaporated carbon. Several possible causes of the above two effects are examined, but a satisfactory interpretation has not been found yet. The sensitivity of KPFM is such that CC layers 10 nm thick are easily visible, whereas they are hardly detectable by topography.     

The Internal Problem of Dreaming: Detection and Epistemic Risk

Abstract

There are two epistemological problems connected with dreaming, which are of different kinds and require different treatment. The internal problem is best seen as a problem of rational consistency, of how we can maintain all of:

1. Dreams are experiences we have during sleep.

2. Dream‐experiences are sufficiently similar to waking experiences for the subject to be able to mistake them for waking experiences.

3. We can tell that we are awake.

(1)–(3) threaten to violate a requirement on discrimination: that we can only tell Xs from Ys if there is some detectable difference between Xs and Ys. Attempts to solve the problem by Descartes and Williams are considered. It is suggested that if we take account of levels of epistemic risk, we can use Descartes’s criterion of lack of coherence, at least with hindsight – which is the time when we need to use it.     

Enlarged Range of Free Flaps for Phalloplasty in Transsexual Reassignment Surgery

ABSTRACT

Our concept for complete phalloplasty which we applied in 66 female-to-male transsexuals, using free prelaminated osteofasciocutaneous fibula or fasciocutaneous forearm flaps, consisted of the following three operative stages:

1. mastectomy, ovariohysterectomy, urethra lengthening, colpectomy, and neourethra prelamination

2. after 3–6 months, neophallus creation with free sensate and prelaminated osteofasciocutaneous fibula (n = 41) or radial forearm flaps (n = 25)

3. 3–6 months later, urethral connection, neoscrotum formation and testicle prosthesis implantation.

Results: After mastectomy 2 hematoma had to be removed, and twice colpectomy revision was needed because of hematoma. No complications occurred after ovariohysterectomy. Partial flap necrosis took place in 1 patient of the forearm group and total necrosis in 2 patients of the fibula group. Eleven patients presented urethral stricture, and 9 a fistula. In 7 patients an operative stricture expansion was required, and in 6 patients surgical closure of the fistula. Overall patients' satisfaction was excellent.

Conclusions: The applied results demonstrates the effectiveness of such a multistage and interdisciplinary approach for female-to-male transsexual and it shows, that the fibula flap is an equal routine method extending the therapeutical range of gender assignment operations in female-to-male transsexuals.     

Genetic Counselors’ Perceived Responsibilities Regarding Reproductive Issues for Patients at Risk for Huntington Disease

Research indicates that health care professionals’ attitudes may affect patients’ decisions regarding prenatal Huntington Disease testing, but few studies have sampled genetic counselors. In this qualitative study, genetic counselors described their experiences counseling individuals at risk for HD regarding reproductive decision-making. Five major research questions were investigated: 1) What are genetic counselor responsibilities? 2) What issues arise for patients and counselors? 3) How do counselors reconcile prenatal testing with presymptomatic testing? 4) To what extent are counselors’ initial expectations of at-risk patients’ beliefs and behaviors met? and 5) What advice would counselors offer to novice practitioners about working with this patient population? Fifteen genetic counselors experienced in counseling individuals at risk for HD participated in a semi-structured phone interview that yielded several themes. For example, participants identified their primary responsibility as information provision; less prevalent were psychosocial support and facilitating decision making. The most common ethical challenge was testing prenatally for HD which also results in presymptomatic testing of minors. Participants were divided about how directive to be in response to this ethical issue and about termination of a gene positive pregnancy.     

Connection‐based and object‐based grouping in multiple‐object tracking: A developmental study

Developmental research on Gestalt laws has previously revealed that, even as young as infancy, we are bound to group visual elements into unitary structures in accordance with a variety of organizational principles. Here, we focus on the developmental trajectory of both connection‐based and object‐based grouping, and investigate their impact on object formation in participants, aged 9–21 years old (N = 113), using a multiple‐object tracking paradigm. Results reveal a main effect of both age and grouping type, indicating that 9‐ to 21‐year‐olds are sensitive to both connection‐based and object‐based grouping interference, and tracking ability increases with age. In addition to its importance for typical development, these results provide an informative baseline to understand clinical aberrations in this regard.

Statement of contribution

What is already known on this subject?

• The origin of the Gestalt principles is still an ongoing debate: Are they innate, learned over time, or both?
• Developmental research has revealed how each Gestalt principle has its own trajectory and unique relationship to visual experience.
• Both connectedness and object‐based grouping play an important role in object formation during childhood.

What does this study add?

• The study identifies how sensitivity to connectedness and object‐based grouping evolves in individuals, aged 9–21 years old.
• Using multiple‐object tracking, results reveal that the ability to track multiple objects increases with age.
• These results provide an informative baseline to understand clinical aberrations in different types of grouping.

     

Children's reasoning with peers in cooperative and competitive contexts

We report two studies that demonstrate how five‐ and seven‐year‐olds adapt their production of arguments to either a cooperative or a competitive context. Two games elicited agreements from peer dyads about placing animals on either of two halves of a playing field owned by either child. Children had to produce arguments to justify these decisions. Played in a competitive context that encouraged placing animals on one's own half, children's arguments showed a bias that was the result of withholding known arguments. In a cooperative context, children produced not only more arguments, but also more ‘two‐sided’ arguments. Also, seven‐year‐olds demonstrated a more frequent and strategic use of arguments that specifically refuted decisions that would favour their peers. The results suggest that cooperative contexts provide a more motivating context for children to produce arguments.

Statement of contribution

What is already known on this subject ?

• Reasoning is a social skill that allows people to reach joint decisions.
• Preschoolers give reasons for their proposals in their peer conversations.
• By adolescence, children use sophisticated arguments (e.g., refutations and rebuttals).

What the present study adds?

• Cooperation offers a more motivating context for children's argument production.
• Seven‐year‐olds are more strategic than five‐year‐olds in their reasoning with peers.
• Children's reasoning with others becomes more sophisticated after preschool years.

     

Teaching Ethical Decision Making: Designing a Personal Value Portrait to Ignite Creativity and Promote Personal Engagement in Case Method Analysis

The case method approach to introducing ethical issues is a traditional tool for applying critical thinking skills to a specific dilemma (Beauchamp &; Childress, 2001 Beauchamp, T. L. and Childress, J. F. 2001. Principles of biomedical ethics, 5th, New York: Oxford University Press.  [Google Scholar]). It allows for personal reflection and clarification of an individual's conceptual framework for deciding what is and is not ethical behavior. However, it also affords the student distance from the story line and may, through providing a retrospective critique, prevent sufficient challenge to the student to articulate and defend personal value assessments in addressing the ethical dynamics reflected in the case. Providing teaching exercises that encourage the creation of language to form that conceptual framework and a comfort in using that language allows the student to not only identify ethical issues but also recognize and more effectively communicate the struggles with molding a personal values portrait to apply to such cases.     

Wu Song’s Killing of His Sister-in-law: An Ethical Analysis

The Water Margin is a great Chinese classical novel; Wu Song’s 武松 killing of his sister-in-law, Pan Jinlian 潘金蓮, is one of the most popular episodes of the novel. It depicts Wu as the hero and defender of traditional values, and Pan as the adulterous woman. In contemporary discussion, there has been a dearth of ethical analyses regarding Wu’s killing of Pan. How should we judge the moral status of his action? Does the killing signify Wu Song’s ethical achievement or his ethical failure? What does the killing tell us about Wu’s character or his virtues? Does our appraisal of Wu’s action square with our modern belief regarding the treatment of women? I will examine these questions in the article.     

Constructivism,Ethics, and Knowing What's Right: A Reply to McNamee,Burr, McWilliams,Osbeck, and Held

Five responses to Raskin and Debany's (this issue Raskin, J. D., &; Debany, A. E. (this issue). The inescapability of ethics and the impossibility of “anything goes”: A constructivist model of ethical meaning making. Journal of Constructivist Psychology. doi:10.1080/10720537.2017.1383954[Taylor &; Francis Online] , [Google Scholar]) original target article on a constructivist model of ethical meaning making are discussed. The authors responding to the article raise many important issues about constructivist approaches to ethics. Differences between social constructionism and constructivism, the importance of multiple modalities of knowing, and a continuing hope for rapprochement between constructivist and realist perspectives are briefly explored.