Effects of immediacy of feedback and level of aspiration statements on learning tasks for delinquent youngsters

The performance of institutionalized delinquent youngsters on paired associate learning tasks was investigated to determine whether level of aspiration (LOA) statements were associated with improved performance under varying feedback conditions. The effects of the feedback conditions were also examined. Forty-eight male adolescents were randomly assigned to the following six treatment conditions: (1) Delayed Feedback, (2) Delayed Feedback with LOA, (3) Immediate Feedback, (4) Immediate Feedback with LOA, (5) No Feedback, (6) No Feedback with LOA. The LOA conditions produced significantly better performance than did the no-LOA conditions. Implications for curricular intervention are discussed.     

Assessing the acceptability of staff management procedures to direct care and supervisory staff

Direct care and supervisory staff in five residential training programs for persons with mental retardation in North Dakota rated the acceptability of six staff management procedures. Overall, staff rated “Instructions”, “Instructions and Modeling”, “Feedback and Praise”, and “Instructions, Feedback, and Praise”, as significantly more acceptable than “Self-Management” and “Self-Management, Feedback and Praise”. There was a significant group by treatment interaction in which supervisors and direct care staff had significantly different acceptability rating for four of the six procedures. The results were further analyzed by group and implications and future research are discuessed.     

Five Components of a Basic Suicide Syndrome*

ABSTRACT: To the question “Why suicide?” a tentative framework is proposed, taking the form of a syndrome of five components: (a) commitment; (b) rigidity; (c) failure; (d) shame; and (e) isolation. These are quite similar to the conclusions of a study by Dorothy Miller. The syndrome is psychological as well as sociological, deals with the response of the suicider to crisis, and suggests mechanisms lacking in other theoretical frameworks. Quantitative and qualitative data taken from interviews with survivors of well over 100 suiciders support the framework. Also discussed are possible further refinements of the syndrome, its adequacy, and its applications to intervention with suicidal persons.     

关于证候定义的三点商榷

对证候定义研究中存在的问题进行剖析,提出三点商榷意见.首先,"证"是病理学概念,不是诊断学概念.其次,"证"发生在病人身上,并非由诊断"概括"出来.第三,应当把内在的病理改变与外在疾病征象区别开来.     

A case study of mediated learning, delayed auditory feedback, and motor repatterning to reduce stuttering

A case study of DW, an 11-yr. old monolingual, English-speaking boy who exhibits stuttering, language delay, and ADHD is presented. DW experienced only limited improvement during stuttering therapy received in public schools, according to parents and the public school clinician. The purpose of this case study was to assess whether fluency treatment which incorporated Mediated Learning, Delayed Auditory Feedback, and Speech Motor Repatterning would enhance progress. Therapy was delivered in two treatments, with each treatment being 5 wk. of intense therapy, separated by one year. Treatment 1 of combined Mediated Learning and Delayed Auditory Feedback yielded improvement in fluency, judged by parents and the teacher to be clinically significant. The improved fluency was maintained for one year when DW was pretested for participation in Treatment 2, which combined Mediated Learning, Delayed Auditory Feedback, and Speech Motor Repatterning Exercises. As no conclusions are possible, further study is needed.     

A Preliminary Study Using the Substance Abuse Subtle Screening Inventory—Adolescent Form as an Outcome Measure With Adolescent Offenders

The authors describe a preliminary study using the Substance Abuse Subtle Screening Inventory‐Adolescent Form (SASS‐A; E Miller, 1994) as an outcome measure with adolescent offenders. Results indicate that the SASSI‐A can be successfully used as a treatment planning tool as well as a measure to evaluate programs.     

Embracing the “Nation”

The idea of the “nation” has played only a small role in modern political philosophy because of its apparent irrationalism and amoralism. David Miller, however, sets out to show that these charges can be overcome: nationality is a rational element of one’s cultural identity, and nations are genuinely ethical communities. In this paper I argue that his project fails. The defence against the charge of irrationalism fails because Miller works within a framework of ethical particularism which leads to a position of metaethical relativism. A consequence of this relativism is that a community’s moral principles and boundaries of exclusion cannot be rationally justified to those constructed as “outsiders”. The defence against the charge of amoralism fails because Miller does not so much provide an argument to show that nations are ethical communities as assume they are; we are therefore left without resources to discriminate between ethical and unethical nations. I apply these problems to Miller’s treatment of the question of immigration, arguing that it shows that his version of “liberal” nationalism has a tendency to collapse towards a conservative position on such issues. This should not give us any great confidence that the nation, as Miller presents it, should be embraced by modern political philosophy. This revised version was published online in August 2006 with corrections to the Cover Date.     

Further evidence that the family assessment device should be reorganized: response to Miller and colleagues

Ridenour, Daley, and Reich's (1999) factor analyses of the Family Assessment Device (FAD) indicated that the FAD be reorganized. Miller and colleagues (2000) contend that the FAD be used in its original format based on the FAD's theoretical foundation; however, this does not preclude the importance of scientific scrutiny of an instrument's construct validity to determine how well an instrument represents its theoretical base. Subscale factor analyses (exploratory and confirmatory), item-level factor analysis, and the clinical and psychometric studies cited by Miller and colleagues suggest a more parsimonious FAD configuration and were consistent with Ridenour and colleagues' factor analyses.     

心肾贫血综合征的系统思维

心肾贫血综合征在慢性肾脏疾病患者和慢性心衰患者中大有人在,并日益受到医生重视,对其的正确认识及治疗直接影响患者的疾病预后.因此我们深入认识心肾贫血综合征及研究新的临床防治策略时,有必要着眼于心肾贫血综合征的内在特征并运用系统学方法原理分析其特点,为临床防治提供科学指导。     

Genetic Counseling for Fragile X Syndrome: Updated Recommendations of the National Society of Genetic Counselors

These recommendations describe the minimum standard criteria for genetic counseling and testing of individuals and families with fragile X syndrome, as well as carriers and potential carriers of a fragile X mutation. The original guidelines (published in 2000) have been revised, replacing a stratified pre- and full mutation model of fragile X syndrome with one based on a continuum of gene effects across the full spectrum of FMR1 CGG trinucleotide repeat expansion. This document reviews the molecular genetics of fragile X syndrome, clinical phenotype (including the spectrum of premature ovarian failure and fragile X-associated tremor-ataxia syndrome), indications for genetic testing and interpretation of results, risks of transmission, family planning options, psychosocial issues, and references for professional and patient resources. These recommendations are the opinions of a multicenter working group of genetic counselors with expertise in fragile X syndrome genetic counseling, and they are based on clinical experience, review of pertinent English language articles, and reports of expert committees. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

难治性肾病综合征典型病例的临床决策

难治性肾病综合征在肾内科临床实践中并不少见,其主要治疗是联合应用激素和细胞毒药物（如环磷酰胺、环孢素等）。少数患者,经以上联合治疗后仍不能达到临床缓解。而对于这些患者,长期使用激素及细胞毒药物不仅不能取得满意的效果,而且可能出现严重感染等并发症,甚至危及患者的生命,故在临床中应权衡利弊进行治疗决策。     

Contextualizing clinical research: the epistemological role of clinical equipoise

Since its introduction in 1987, Benjamin Freedman’s principle of clinical equipoise has enjoyed widespread uptake in bioethics discourse. Recent years, however, have witnessed a growing consensus that the principle is fundamentally flawed. One of the most vocal critics has undoubtedly been Franklin Miller. In a 2008 paper, Steven Joffe and Miller build on this critical work, offering a new conception of clinical research ethics based on science, taking what they call a “scientific orientation” toward the ethics of clinical research. Though there is much to recommend Joffe and Miller’s scientifically oriented conception of clinical research ethics, I believe that both the critical and constructive projects suffer from the same basic mistake: inattention to context. The internal norms of science cannot be fully specified, let alone satisfied, independently of contextual (external) factors that only come into view when we are attentive to the particular context of that form of inquiry.     

骨科急诊患者诊治中的决策问题

在骨科急诊患者的诊治过程中,骨科医师应该区分病情的轻重缓急,抓住重点进行处理。采集和分析临床资料时,应把病史、理学检查结果与检验及影象检查所见结合起来。这样才能作出准确的诊断。在诊断或/和治疗中选定任何一项措施,首先要从病人的情况出发,应尽可能减轻患者的经济负担。总之,为了提高临床决策的效率和准确性,减少或避免各种失误,需要建立起一套合理的临床思维方法和科学的处理程序。     

Wernicke-Korsakoff syndrome following small bowel obstruction

We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.     

Improving young drivers’ speed management behaviour through feedback: A cognitive training intervention

The aim of the present study was to examine which aspect of content-based feedback about drivers’ speed management behaviour (performance, financial infringements and safety implications for speeding) yielded positive changes in compliance with the speed limit. One hundred young drivers were randomly allocated to one of five groups (Control, Performance Feedback, Performance and Finance Feedback, Performance and Safety Feedback, Combined Feedback). Depending on group randomly allocated to, participants completed a baseline drive and received feedback about their speed management (except control). Immediately after, all groups completed a post-training drive, followed by a second drive one week later. A reduced sample (25 per cent dropout) completed a third test drive six month post-training. All drives were completed in a computer-based driving simulator. Feedback pertaining to their speed management behaviour was provided verbally immediately after the baseline drive by the researcher. Performance Feedback group received feedback about own speed-related performance (e.g., mean speed, time violated during the drive); Performance and Finance Feedback group received feedback about own performance and potential fines that could be received for exceeding the speed limit; Performance and Safety Feedback group received feedback about own performance and potential safety outcomes for them and other passengers; the Combined Feedback group received feedback about own performance, financial infringements and safety implications for speeding; and the Control group received no feedback. The results showed that all types of feedback are effective in modifying young drivers’ speed management behaviour, and these effects were present up to six months post-training in both low and high-speed zones. These findings have valuable implications in the development of a new training approach to improve young drivers’ speed management behaviour.     

Treatment of sleep problems in a toddler: a replication of the faded bedtime with response cost protocol.

Multiple sleep problems of a 2-year-old girl improved following treatment with a faded bedtime with response cost procedure (Piazza & Fisher, 1991). These results extend the literature by implementing treatment in a home setting with a nondisabled child using the parents as therapists.     

Fluent Reading as the Improvement of Stimulus Control: Additive Effects of Performance-Based Interventions to Repeated Reading on Students' Reading and Error Rates

The impact of adding performance-based interventions to a skill-based intervention on oral reading fluency was examined with 3 elementary students identified as having difficulty with reading. Two performance-based interventions were combined with the skill-based intervention Repeated Reading (RR) to create the three instructional packages investigated. The packages included Repeated Readings (RR), Repeated Readings with Performance Feedback (RR/FB), and Repeated Readings with Performance Feedback and Contingent Reward (RR/FB/REW). Results suggested that Repeated Reading (RR) alone led to the greatest increase in reading fluency for participants with the highest reading rates and lowest error rates at baseline. In contrast, the participant who exhibited the lowest reading rate and highest error rate benefited the most when Repeated Readings was offered in conjunction with Performance Feedback (RR/FB) or Performance Feedback plus Contingent Reward (RR/FB/RW). Implications for blending skill- and performance-based interventions to develop stimulus control over fluent reading and future research directions are discussed.     

Complementary and Symmetrical Interaction in the Present Day Mental Health Institute

Expanding an idea begun by Rosenhan (1973), ratings of communication from psychiatric aides to patients at a psychiatric hospital were obtained using Leather's Feedback Rating Instrument. As compared to a comparison group composed of aide to aide interactions, aide to patient interactions were characterised as more inflexible, withdrawn, concise, personal, irrelevant, and automatic. Implications were offered concerning the training of mental health workers.     

Reliability and Validity of Scores From the Inventory of Drug Use Consequences

Psychometric properties of the Inventory of Drug Use Consequences (InDUC; W. M. Miller, J. S. Tonigan, & R. Longabaugh, 1995), a self‐report assessment of negative consequences associated with alcohol and other drug use, were investigated. The InDUC demonstrated sound psychometric characteristics and can be a valuable clinical tool for chemical dependency counselors.     

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.