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S. Malir, M.B.A., M.D.

Associate Professor, Montana College of Osteopathic Medicine

In addition to economic opportunities, for the useful caucus politician, there are the opportunities to satisfy his vanity. The highest goal is, of course, a peerage, especially for the great financial Maecenases. About 50 per cent of the finances of the party depend on contributions of donors who remained anonymous. Such gestures are not demanded in England; the member of Parliament must only vote, not commit party treason. He must appear when the whips call him, and do what the cabinet or the leader of the opposition orders. The caucus machine in the open country is almost completely unprincipled if a strong leader exists who has the machine absolutely in hand. He brings the masses behind him by means of the machine and the members of Parliament are for him merely political spoilsmen enrolled in his following. Next to the qualities of will- decisive all over the world-naturally the force of demagogic speech is above all decisive. All important ministers of recent decades have this very real and effective work-training as a background. The practice of committee reports and public criticism of these deliberations is a condition for training, for really selecting leaders and eliminating mere demagogues. The caucus system there, however, has been a weak form, compared with the American party organization, which brought the plebiscitarian principle to an especially early and an especially pure expression. In the beginning, when parties began to organize, the members of the House of Representatives 17 claimed to be leaders, just as in England at the time when notables ruled. In some communities, where modern development first took place, the party machine was in the making even before the eighteen-twenties. Formal party leadership by leading members of Congress came to an end soon after 1840, when the great parliamentarians, Calhoun and Webster, retired from political life because Congress had lost almost all of its power to the party machine in the open country. Hence, as the price of victory, the true booty object of the office-prebend was held out precisely at the presidential election. What does this spoils system, the turning over of federal offices to the following of the victorious candidate, mean for the party formations of today? It means that quite unprincipled parties oppose one another; they are purely organizations of job hunters drafting their changing platforms according to the chances of vote-grabbing, changing their colors to a degree which, despite all analogies, is not yet to be found elsewhere. The parties are simply and absolutely fashioned for the election campaign that is most important for office patronage: the fight for the presidency and for the governorships of the separate states. Platforms and candidates are selected at the national conventions of the parties without intervention by congressmen. Hence they emerge from party conventions, the delegates of which are formally, very democratically elected. By comparison, however, the House of Representatives is, politically, quite impotent, because patronage of office is removed from it and because the cabinet members, simply assistants to the President, can conduct office apart from the confidence or lack of confidence of the people. With 300,000 to 400,000 such party men who have no qualifications to their credit other than the fact of having performed good services for their party, this state of affairs of course could not exist without enormous evils. A corruption and wastefulness second to none could be tolerated only by a country with as yet unlimited economic opportunities. Now then, the boss is the figure who appears in the picture of this system of the plebiscitarian party machine. He is a political capitalist entrepreneur who on his own account and at his own risk provides votes. He may have established his first relations as a lawyer or a saloon-keeper or as a proprietor of similar establishments, or perhaps as a creditor. When he has come this far he establishes contact with the neighboring bosses, and through zeal, skill, and above all discretion, he attracts the attention of those who have already further advanced in the career, and then he climbs. The boss is indispensable to the organization of the party and the organization is centralized in his hands. Well, partly by the contributions of the members, and especially by taxing the salaries of those officials who came into office through him and his party. But this alone is not enough to accumulate the necessary capital for political enterprises. The boss is indispensable as the direct recipient of the money of great financial magnates, who would not entrust their money for election purposes to a paid party official, or to anyone else giving public account of his affairs. The boss, with his judicious discretion in financial matters, is the natural man for those capitalist circles who finance the election.

If healthcare providers, like college students, are less likely to appreciate the presence of an eating disorder when it occurs in a non-White or Hispanic woman, this could contribute to a difference in referral for treatment of the disorder. Among 5,787 college students who participated in the National Eating Disorders Screen and subsequently met with a counselor, those who were Latino or Native American were significantly less likely to receive a referral for eating disorders treatment than were White students, and these differences were not explained by differences in symptom severity (Becker, Franko, Speck, & Herzog, 2003). In addition, among students in the same study who were concerned about their eating, doctors were approximately half as likely to ask ethnic minority students about their eating as they were White students. Given these data, it seems clear that treatment samples may better reflect who we expect to suffer from eating disorders than who actually suffers from those disorders. Because ethnic minority groups cannot be assumed to be alike on eating pathology the following sections examine evidence of eating disorders from community-based epidemiological studies separately for three ethnic minority groups: African American/Black, Asian, and Hispanic­Latino. Differences among people with specific cultural backgrounds within these groups are examined where possible, as well as information on whether acculturation to dominant White culture is linked to eating disorder prevalence in these groups. Indeed, Lawlor, Burket, and Hodgin (1987) described a Black male adolescent hospitalized for an eating disorder over 25 years ago. In the National Survey of American Life, Taylor, Caldwell, Baser, Faison, and Jackson (2007) interviewed 5,191 Black adults: 3,570 African Americans and 1,621 Black Americans of Caribbean origin. Combined with the lower likelihood of African Americans being asked about problems with eating or being referred for eating disorder treatment (Becker et al. Eating Disorders in Asian Samples the National Latino and Asian American Study evaluated eating disorder prevalence in 2,095 Asian American adults, including participants of Chinese, Filipino, Vietnamese, and "other" Asian (Japanese, Korean, and Asian Indian) descent (Nicdao, Hong, & Takeuchi, 2007). Comparing findings for non-Hispanic White and Asian American participants from the National Comorbidity Survey-Replication and the National Latino and Asian American Study, respectively, Marques et al. However, Asian individuals with a lifetime eating disorder were significantly less likely to have ever sought mental health treatment than were non-Hispanic White participants. Several studies have failed to find a significant association between acculturation to Western culture and body dissatisfaction or disordered eating among Asian American women (Gowen, Hayward, Killen, Robinson, & Taylor, 1999; Haudek, Rorty, & Henker, 1999; Jackson, Keel, & Lee, 2006; Marques et al. Rieger, Touyz, Swain, and Beumont (2001) have argued that traditional values and practices in some Asian cultures idealize thinness. The virtues of fasting to the point of emaciation are included in the Taoist text Sandong Zhunang (Rieger et al. Asian cultures may emphasize the importance of gaining approval from family members and friends (Mukai, Kambara, & Sasaki, 1998; Mukai & McCloskey, 1996), who may encourage dieting even among underweight girls (Mukai, Crago, & Shisslak, 1994). She would warn Jean that if she did not lose weight, she would never receive a wedding proposal. If a conflict between traditional Korean and American cultural values, referred to as acculturative stress, increased risk for eating disorders, then disordered eating should be highest in Korean immigrants. In contrast to both these hypotheses, disordered eating levels were lowest in Korean women who had been born in the United States and highest in native Korean and Korean immigrant women-that is, in women who had been born in Korea, regardless of whether they had remained there. Furthermore, there was no association between acculturation to Western culture and disordered eating levels among the Korean women living in the United States, whether they had been born there or immigrated. Eating Disorders in Hispanic­ Latino Samples A key limitation of the National Comorbidity Survey-Replication study was its requirement that all participants speak English, because not all Hispanic­Latino individuals in 36 36 e at i n g D i s o r D e r s the United States are English speakers. The National Latino and Asian American Study addressed this limitation by interviewing 2,554 English- and Spanish-speaking Latino adults in the United States (Alegria et al. Of these, 868 were of Mexican descent, 495 Puerto Rican, 577 Cuban, and 614 "other" Latino. Lifetime prevalence of eating disorders did not differ across the Latino subgroups. No other differences were found in eating disorder prevalence between Latino and non-Latino White adults. Even though Latino individuals were as or more likely to suffer from an eating disorder over their lifetimes than were non-Latino White participants, they were significantly less likely to have ever sought mental health treatment (Marques et al. For Latino individuals, increasing representation of Latino women among female pop artists such as Selena Gomez, Demi Lovato, and Christina Aguilera may provide a bridge between ethnic identity and dominant Western ideals of beauty, fame, and wealth. Summary of Eating Disorders in Racial/Ethnic Minorities the belief that White individuals are at particularly high risk for developing eating disorders appears to reflect a stereotype rather than reality. The apparent underrepresentation of ethnic or racial minorities among individuals with eating disorders seems to be related more to biases in who seeks and receives treatment for these disorders than to any protection from eating pathology afforded by ethnic or racial minority status.

The routine practice of such drills fosters a calm, competent Chapter 9: Administration 370 Caring for Our Children: National Health and Safety Performance Standards response to a natural or human generated disaster when it occurs (1). The extensive turnover of both staff and children, in addition to the changing developmental abilities of the children to participant in evacuation procedures in child care, necessitates frequent practice of the exercises. It also provides a means to contact visitors if needed (such as a disease outbreak) or to ensure all individuals in the building are evacuated in case of an emergency. The legal guardian(s) of the child should be established and documented at this time. The telephone authorization should be confirmed by a return call to the parents/guardians. If a previously unauthorized individual drops off the child, he or she will not be authorized to pick up the child without first being added to the authorization record. Policies should address how the facility will handle the situation if a parent/ guardian arrives who is intoxicated or otherwise incapable of bringing the child home safely, or if a non-custodial parent attempts to claim the child without the consent of the custodial parent. In centers caring for more than thirty children enrolled, the center director should assign one caregiver per classroom, the responsibility of bringing the class roster on evacuation drills and accounting for every child and classroom staff at the onset of the evacuation, at the evacuation site and upon return to a safe place. Small and large family home child caregivers/teachers should count or use a daily roster to be sure that all children and staff are safely evacuated and returned to a safe space for ongoing care during an evacuation drill. Assigning responsibility to use a roster(s) in a center, or count the children and adults in a large or small family child care home, ensures that all children and adults are accounted for. Practice accounting for children and adults during evacuation drills makes it easier to do in an emergency situation. If the information provided by the parent/ guardian does not match the information and identification of the unauthorized individual, the child will not be permitted to leave the child care facility. If the individual does not leave and his or her behavior is concerning to the child care staff or if the child is abducted by force, then the police should be contacted immediately with a detailed description of the individual and any other obtainable information such as a license plate number. Caregivers/teachers should consider having a child car seat policy stating all authorized persons that pick-up a child have an age-appropriate car seat to transport a child from the child care program. Many child care facilities have extra car seats on hand to lend in case a parent/guardian forgets one (1). Caregivers/teachers should consult local police or the local child protection agency about their recommendations for how staff can obtain support from law enforcement authorities to avoid incurring increased liability by releasing a child into an unsafe situation or by improperly refusing to release a child. The plan should be developed in consultation with the child care health consultant and child protective services. If these efforts fail, the facility should immediately implement the written policy on actions to be followed when no authorized person arrives to pick up a child. If an authorized person does not come to pick up a child, and one cannot be reached, the caregiver/teacher must know what authority to call and to whom they can legally and safely release the child. This standard ensures that the facility knows which children are receiving care at any given time including evacuation. It aids in the surveillance of child:staff ratios, knowledge of potentially infectious diseases. Accurate record keeping also aids in tracking the amount (and date) of service for reimbursement and allows for documentation in the event of child abuse allegations or legal action involving the facility. Furthermore, each year, twenty to forty children die from hyperthermia after being left/locked in a car or van. Some of these unfortunate deaths include children whose parents/ guardians meant to drop their child off at a child care program or preschool; thus, timely communication with these parents/guardians could prevent death from hyperthermia (1,2). Some notification system should be used to alert the caregiver/teacher whenever the responsibility for the care of the child is being transferred to or from the caregiver/teacher to another person. Heat related deaths to young children in parked cars: An analysis of 171 fatalities in the United States, 1995-2002. It is necessary for the safety of children to require that the caregiver/teacher comply with requirements governing the transportation of children in care, in the absence of the parent/guardian. Not all vehicles are designed to safely transport children, especially young children. It is necessary for the safety of children to require that the caregiver comply with minimum requirements governing the transportation of children in care, in the absence of the parent/guardian. Others have died or been injured when left outside the vehicle when thought to have been loaded into the vehicle.