Testing for equality of distributions using the concept of (niche) overlap.

In this paper, we propose a new non-parametric test for equality of distributions. The test is based on the recently introduced measure of (niche) overlap and its rank-based estimator. As the estimator makes only one basic assumption on the underlying distribution, namely continuity, the test is universal applicable in contrast to many tests that are restricted to only specific scenarios. By construction, the new test is capable of detecting differences in location and scale. It thus complements the large class of rank-based tests that are constructed based on the non-parametric relative effect. In simulations this new test procedure obtained higher power and lower type I error compared to two common tests in several settings. The new procedure shows overall good performance. Together with its simplicity, this test can be used broadly. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00362-021-01239-y.

[Cognition in children with social anxiety disorder experiencing stress]. / Kognitionen von Kindern mit sozialer Angststörung unter Stress.

Cognition in children with social anxiety disorder experiencing stress Abstract. Empirical data on cognitions of children with social anxiety disorder (SAD) are inconclusive. Objective: The present study examines the significance of cognition in children with SAD. Method: Thirty children suffering from SAD and 30 control children free of diagnosis (HC) aged between 9 and 15 years took part in an experiment. Their cognition was assessed before, during, and after a stress-inducing social situation. The assessment method was a self-report measurement. Coping perception was also assessed. Results: Children with SAD did not report a higher level of negative or coping cognition than those in the HC group. An interaction was apparent on the positive cognition scale: Older children (11-12 or 13-15 years) with SAD reported less positive cognition than those in the HC group, and younger children with SAD (9-10 years) reported more than those in the HC group. No group differences were found for perceived coping. Conclusions: The findings are important to the cognitive model and for the psychological treatment of SAD in children.

Caring When Curing is Not an Option.

These narratives provide intimate descriptions of the challenges, frustrations, and sometimes, the satisfaction of caring for a family member with dementia. They are presented by twelve individuals who want us to understand and possibly learn from their lived experiences. At the beginning of their journey, most describe a slow awareness that "something is seriously wrong." During the middle stage, their narratives are filled with examples of conflict and frustration as the authors try to respond with patience to behavior that "makes no sense." Finally, most learn to forgive themselves and accept 'the new normal' of this person, or their death. For some, the end of their journey is filled with regret and guilt, while others find acceptance and peace. We are privileged to be immersed in these stories, as such honest descriptions are rarely shared with 'outsiders.'

Assisted Suicide/Aid in Dying: What Is the Nurse's Role?

: This article presents the discussion that occurred during a policy dialogue on aid in dying (AID) presented at the American Academy of Nursing's annual conference in October 2016. Panelists explored the arguments for and against the growing state expansion of AID legislation, and the role for nurses in assisting patients who request AID. Recommendations are offered and four expert commentaries respond to the points raised.

Exploring the option of voluntarily stopping eating and drinking within the context of a suffering patient's request for a hastened death.

There is an acknowledged difficulty in distinguishing between some morally and legally accepted acts that hasten dying, such as refusing life-sustaining treatment, and other acts that also hasten dying that are labeled as acts of "suicide." Recent empirical findings suggest that most terminally ill and suffering patients who voluntarily chose to stop eating and drinking as a means to hasten their dying generally experienced a "good" death. This paper explores the moral and legal status of a decision to stop eating and drinking as a means to hasten dying that is voluntarily chosen by a competent, terminally ill and suffering patient. The option of voluntarily forgoing food and fluid will be compared to other end-of-life clinical practices known to hasten dying, with emphasis on the issue of whether such practices can or should be distinguished from suicide.

Responding to persistent requests for assistance in dying: a phenomenological inquiry.

Little is known about how American nurses understand and respond to requests made by decisionally capable patients for assistance in dying. This article is based on a broader qualitative study first reported elsewhere (Schwarz, 2003). The study used phenomenological interpretation and analysis of stories told by 10 nurses who worked in home hospice, critical care, and HIV/AIDS care settings. Persistent requests for assistance in dying were relatively uncommon, but when heard, participants provided the following responses: refusing assistance, administering palliative drugs that might secondarily hasten dying, tacitly permitting and not interfering with patient or family plans to hasten death, and actively providing direct assistance in dying. Nurses' responses were context-driven; they did not seek guidance from professional codes of ethics or colleagues. Secrecy and collusion were routinely practised. Few participants unequivocally agreed or refused to help patients die; most struggled to find morally and legally acceptable ways to help patients die well. Regardless of how they responded, nurses who believed they had hastened death described feelings of guilt and moral distress. Healthcare professionals who provide care for symptomatic dying patients need opportunities to meet with supportive colleagues, to share the experience of troubling cases and of moral conflict, and to be supported and heard in a 'safe' environment.

Stopping eating and drinking.

Voluntarily stopping eating and drinking, in which death occurs within one to three weeks of beginning the fast, is increasingly explored in the literature and mainstream media as an option to be discussed with "decisionally capable," suffering patients who want to hasten their dying. The author uses an example from her experience to describe stopping eating and drinking, as well as other clinical practices associated with hastening dying; explores whether this practice can or should be distinguished from suicide; and discusses the ethical and legal implications for nurses.

'I can't help you with that': when terminally ill patients wish to hasten their dying,nurses can--and should--help.

When terminally ill patients wish to hasten their dying, nurses can-and should-help.

Can we know what Terri Schiavo would have wanted?

What would Terri Schiavo have wanted? That remains an unanswered question for many who followed the media frenzy that attended the extraordinary court and legislative battles that preceded her death 13 days after her feeding tube was removed for the last time. What would she have directed her physicians to do if she had "miraculously" regained capacity and awareness of the consequences of her cardiac arrest that left her in a persistent vegetative state? Who would she have wanted to make that decision for her if she were unable to do so? How are we to understand the meaning of statements that she purportedly made about life-sustaining treatments approximately 20 years ago, and how can we apply them to the current situation? This article reflects on those questions from the perspective of two small exploratory studies. These studies considered the meanings and interpretation of statements by terminally ill patients concerning desire for hastened death and the relevance of previously made statements to their current clinical situation.

Understanding and responding to patients' requests for assistance in dying.

PURPOSE: To explore how nurses experience and respond to patients' requests for assistance in dying (AID). DESIGN AND METHODS: A phenomenological study of 10 self-selected nurses. FINDINGS: Four major themes: Being Open to Hear and Hearing; Interpreting and Responding to the Meaning; Responding to Persistent Requests for AID, and Reflections. When faced with persistent requests for AID, participants provided a continuum of interventions: refusal, providing palliative care that might secondarily hasten dying, respecting and not interfering with patients' or families' plans to hasten dying, and providing varying types and degrees of direct AID. Their responses were context-driven rather than rule-mandated, and they drew a distinction between secondarily hastening and directly causing death. CONCLUSIONS: Few nurses in this study unequivocally agreed or refused to directly help a patient die. Most struggled alone and in silence to find a morally and legally acceptable way to help patients who persisted in requesting AID. Regardless of how they responded, many described feelings of conflict, guilt, and moral distress.