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What were the lived experiences of men on the frontiers of the British Empire? Using their journals, diaries and letters Robert Hogg examines the dreams, challenges and failures of men seeking their 'independence' on the margins of empire and demonstrates that life in colonial Queensland and British Columbia challenged preconceived ideas of manliness. Men were forced to sacrifice or modify elements of this ideal; some accepted that their manly aspirations were impossible to fulfil. In fact, this ideal of manliness contained a deep paradox. It was inherently contradictory, encompassing physical and mental prowess, caste hierarchies and egalitarianism, heterosexual dominance and the possibility of homoeroticism, Christian piety and the potential for violence and murder.

SummaryThe variability of three behavioural risk factors for heart disease—heavy alcohol and tobacco consumption and physical inactivity—was assessed in an Australian Aboriginal community, where heart disease death rates were high. Prevalence levels were assessed by comparison with those experienced by all adult Australians and by evaluating whether Aboriginal rates were influenced by underlying sociodemographic conditions. Relative risk ratios, odds ratios and logistic regression analysis were used.A total of 159 males and 114 females participated. Compared to all Australians, Aborigines are significantly more likely to drink five or more drinks on a drinking day, to be current smokers, and not to participate in vigorous exercise. In the Aboriginal community, univariate analysis indicates that: the odds of being a heavy drinker are significantly higher for those in unsatisfactory health; odds of being a current smoker are significantly higher for those in unsatisfactory health or unemployed; odds of not participating in vigorous exercise are significantly higher for those in unsatisfactory health, unemployed or without secondary education. Multivariate analysis shows that risk of being a heavy drinker is independently associated with sex, age, and health status; risk of being a current smoker is associated with health and employment status. The risk of not participating in vigorous exercise is significantly related to all sociodemographic variables examined. Reasons for these associations are discussed.

Prologue: Churchill's Congress: Four Driving Forces ; The Struggle for the Congress ; Negotiations and Decisions ; A Milestone -- 1. Foundation Years, 1948-1957:- The Struggle over the Council of Europe ; The Emergence of the Coal and Steel Community ; The Drama of the EDC ; The Difficult "Relance" ; The Negotiations on Euratom and the European Economic Community -- 2. Formative Years, 1958-1963: The European Commission ; The Struggle over the Free-Trade Area ; The Construction of the Common Market ; Fouchet Plans and British Membership Application ; Accession Negotiations and Franco-German Treaty ; The Success of the Economic Community -- 3. Crises of the Community of the Six, 1963-1969: Erhard's Relaunch ; Hallstein's Offensive ; The Crisis of the "Empty Chair" ; The Time of the Arrangements ; The Return of the British Question ; France on the Way to Turning -- 4. Expansion and New Perspectives, 1969-1975: Turning Point: The Summit in The Hague ; The Completion of the Common Market ; The First Enlargement ; The Project of Monetary Union ; Political Cooperation ; Crisis and New Beginning -- 5. Consolidation, 1976-1984: The Path to Direct Elections ; The European Monetary System ; Expansion to the South ; The Defense of Detente ; Thatcher, Genscher, and Colombo -- 6. The Era of Development, 1984-1992: The Single European Act ; The Internal-Market Project ; The Project for an Economic and Monetary Union ; European Security and German Unity ; The Path to Maastricht -- 7. From Maastricht to Nice, 1992-2001: Implementing the Monetary Union ; The Northern Expansion ; The Way to Amsterdam ; Security and Eastern Policy ; The Nice Complex -- 8. Constitutional Struggle and Euro Crisis, 2001-2012: The Eastward Enlargement ; The Constitutional Treaty ; From Prodi to Barroso ; The Constitutional Crisis ; The Euro Crisis -- Conclusion: The Future of the Union..

Devoted to the problem of fitting parametric probability distributions to data, this treatment uniquely unifies loss modeling in one book. Data sets used are related to the insurance industry, but can be applied to other distributions. Emphasis is on the distribution of single losses related to claims made against various types of insurance policies. Includes five sets of insurance data as examples.

BackgroundDespite not being collected for research purposes, linked administrative health data are increasingly being used to conduct observational epidemiologic analyses. In the field of HIV research in British Columbia (BC), Canada, the Comparative Outcomes And Service Utilization Trends (COAST) Study is based on a linkage between HIV-related clinical data and several provincial administrative health datasets. Specifically, the BC Centre for Excellence in HIV/AIDS Drug Treatment Program, which manages antiretroviral therapy (ART) dispensation for all known people living with HIV (PLWH) in BC, is linked with several Population Data BC data holdings. Population Data BC is a repository that houses longitudinal administrative data for all BC residents.
RationaleWhile the use of administrative data for research poses several challenges, bias due to confounding remains to be a key issue in this context. While randomized controlled trials of ART are common, an objective of COAST is to further examine the "real-world" impact of ART on health and clinical outcomes in a population-based sample of 13,907 PLWH in BC. Therefore, while longitudinal administrative data provide a unique opportunity to estimate the effect of ART on outcomes that are infrequently assessed in trials (e.g., chronic conditions), such data often lacks information on sociodemographic, socioeconomic, and behavioural confounders.
ApproachIt has been shown that adjustment for large numbers of covariates, in the form of administrative codes (e.g., diagnostic ICD codes, procedure codes, drug identification numbers), allows for better control of confounding bias. Therefore, relying on an established methodology in pharmacoepidemiology, we will use the high-dimensional propensity score algorithm to select and prioritize covariates (codes) that collectively act as proxies for unmeasured confounders. The use of this causal inference methodology in COAST will enhance our ability to generate stronger evidence to inform strategies that may improve the health and wellbeing of PLWH in this setting.

Background: Although the survival benefits of antiretroviral therapy (ART) for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU). Methods In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs) ART for patients with a CD4 cell count of 350 or less); Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less); Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI) for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL); Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment). Results Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5%) individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53%) in Era 1, 3 (12%) in Era 2, 22 (28%) in Era 3, and 23 (15%) in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5 – 20). Conclusion The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple-therapy era. As therapeutic guidelines continue to evolve, it is critical that mechanisms be put in place to ensure prescription of ART combinations for IDU that are consistent with current expert recommendations. ; Medicine, Department of ; Medicine, Faculty of ; Non UBC ; Reviewed ; Faculty

IntroductionDespite the tremendous improvements in survival, some groups of people living with HIV (PLHIV) continue to have lower survival rates than the overall HIV‐positive population. Here, we characterize the evolving pattern of mortality among PLHIV in British Columbia since the beginning of the expansion of antiretroviral treatment in 2003.MethodsThis retrospective cohort study included 3653 individuals ≥20 years old, who enrolled on treatment between January 1, 2003, and December 31, 2012, and were followed until December 31, 2013. All‐cause mortality rates and standardized mortality ratios (SMRs) were calculated to compare mortality outcomes of PLHIV to the general population. Abridged life tables were constructed to estimate the life expectancy at age 20 years for PLHIV.ResultsThe overall crude mortality rate was 28.57 per 1000 person‐years, the SMR was 3.22 and the life expectancy was 34.53 years. Interestingly, if we considered only individuals alive after the first year, the life expectancy increased to 48.70 years (41% increase). The SMRs for males and females decreased over time. Although females had higher SMRs in 2003 to 2008, this difference no longer existed in 2009 to 2011. There were also important differences in mortality outcomes for different clinical and demographical characteristics.ConclusionsMortality outcomes of PLHIV who initiated antiretroviral treatment have dramatically improved over the last decade. However, there is still room for improvement and multilateral efforts should continue to promote early, sustained engagement of PLHIV on treatment so that the impact of treatment can be fully realized.

Objective: Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. Methods: We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables as outlined by the World Health Organization. Results: Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66), and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00) were found to be a significant risk factor for MMR. Conclusion: Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities. ; Population and Public Health (SPPH), School of ; Medicine, Faculty of ; Reviewed ; Faculty

IntroductionIn 2012, the Supreme Court of Canada ruled that people living with HIV (PLWH) must disclose their HIV status to sexual partners prior to sexual activity that poses a "realistic possibility" of HIV transmission for consent to sex to be valid. The Supreme Court deemed that the duty to disclose could be averted if a person living with HIV both uses a condom and has a low plasma HIV‐1 RNA viral load during vaginal sex. This is one of the strictest legal standards criminalizing HIV non‐disclosure worldwide and has resulted in a high rate of prosecutions of PLWH in Canada. Public health advocates argue that the overly broad use of the criminal law against PLWH undermines efforts to engage individuals in healthcare and complicates gendered barriers to linkage and retention in care experienced by women living with HIV (WLWH).MethodsWe conducted a comprehensive review of peer‐reviewed and non‐peer‐reviewed evidence published between 1998 and 2015 evaluating the impact of the criminalization of HIV non‐disclosure on healthcare engagement of WLWH in Canada across key stages of the cascade of HIV care, specifically: HIV testing and diagnosis, linkage and retention in care, and adherence to antiretroviral therapy. Where available, evidence pertaining specifically to women was examined. Where these data were lacking, evidence relating to all PLWH in Canada or other international jurisdictions were included.Results and discussionEvidence suggests that criminalization of HIV non‐disclosure may create barriers to engagement and retention within the cascade of HIV care for PLWH in Canada, discouraging access to HIV testing for some people due to fears of legal implications following a positive diagnosis, and compromising linkage and retention in healthcare through concerns of exposure of confidential medical information. There is a lack of published empirical evidence focused specifically on women, which is a concern given the growing population of WLWH in Canada, among whom marginalized and vulnerable women are overrepresented.ConclusionsThe threat of HIV non‐disclosure prosecution combined with a heightened perception of surveillance may alter the environment within which women engage with healthcare services. Fully exploring the extent to which HIV criminalization represents a barrier to the healthcare engagement of WLWH is a public health priority.