Patient and Family Descriptions of Ethical Concerns

Abstract

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N?=?196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.     

Goal setting in acquisition of a volleyball skill late in motor learning

To examine the effects of different types of goal setting on motor skill acquisition during advanced stages of learning. 44 female volleyball players were tested in four experimental training groups with generic goals, specific long-term goals, specific short-term goals, and as a control group. This study's pretest, training, and retention test phases used performance of a volleyball dig/forearm pass oriented to a target. Analyses yielded no significant differences among groups, although performance increased from pre- to retention test.     

Use of temperature variations to combat drivers' drowsiness

The purpose of the present study was to evaluate the efficiency of temperature variations as a measure against drivers' drowsiness. A system for regulation of the air temperature in the cab was installed in two trucks. Irregular temperature reductions of about 8 degrees C were introduced. The periods between the temperature reductions varied among 5, 6, 7, and 8 min. The periods for the temperature reductions varied between 2, 4, 6, and 8 min. The system was tested with 6 drivers on 54 trips. The system was applied for periods varying between 30 to 300 min. Changes in wakefulness were analysed using subjective ratings by the lorry drivers. The application of the system significantly improved subjectively rated wakefulness. The wakefulness was rated with a questionnaire completed after 10 min. use of a cooling system and at the end of its use. Analysis showed individual differences in the usefulness of the system: 3 of the 6 truck drivers reported positive reactions to the use of the temperature cooling system.     

Implicit and explicit attitudes toward high-fat foods in obesity

This study examined implicit and explicit attitudes toward high-fat foods in obese (n = 30) and normal-weight controls (n = 31). The Implicit Association Test (A. G. Greenwald, D. E. McGee, & J. L. K. Schwartz, 1998) was used to measure the differential association of the 2 target categories--high-fat vs. low-fat food words--with an attribute dimension (positive vs. negative). Results suggest that obese people are characterized by a significantly stronger implicit negative attitude toward high-fat foods than are normal-weight controls. This implicit negative attitude is contradictory to their preferences and behavior: Several studies indicate that obese people prefer and consume high-fat foods. Apparently, obese people like the taste of high-fat foods but not the fat content itself, not only on the explicit but also on the implicit level.     

Object individuation using property/kind information in rhesus macaques (Macaca mulatta)

Around 1 year of age, infants develop the ability to individuate objects in the absence of spatiotemporal information. Some have proposed that this capacity relies on the emergence of language and, in particular, that comprehending an object's label is required to individuate it as a particular kind. One approach to testing this hypothesis is to conduct experiments on pre-linguistic human infants. A second is to test non-linguistic animals. We followed the second approach, exploring whether semi-free-ranging rhesus macaques can individuate objects using property/kind information. To make the results most directly comparable, we adapted a reaching paradigm used to examine property/kind individuation in infants. Results from three experiments demonstrate that, like 12-month-old infants, adult rhesus macaques can use both spatiotemporal and property/kind information to individuate food objects. In a fourth experiment designed to examine which properties are used to individuate food objects, results revealed that rhesus use color, but not shape. These results, together with experiments involving different procedures, provide support for the conclusion that in the absence of linguistic abilities, some non-human primates spontaneously use property/kind information to individuate objects.     

Characterizing the ADHD phenotype for genetic studies

The genetic study of ADHD has made considerable progress. Further developments in the field will be reliant in part on identifying the most appropriate phenotypes for genetic analysis. The use of both categorical and dimensional measures of symptoms related to ADHD has been productive. The use of multiple reporters is a valuable feature of the characterization of psychopathology in children. It is argued that the use of aggregated measures to characterize the ADHD phenotype, particularly to establish its pervasiveness, is desirable. The recognition of the multiple comorbidities of ADHD can help to isolate more specific genetic influences. In relation to both reading disability and conduct disorder there is evidence that genes may be involved in the comorbid condition that are different from pure ADHD. To date, progress with the investigation of endophenotypes for ADHD has been disappointing. It is suggested that extending such studies beyond cognitive underpinnings to include physiological and metabolic markers might facilitate progress.     

Motor development during the first year: a comparative study.

This investigation of the motor development characteristics of Brazilian infants during the 1st year of postnatal life compared the findings with those of a widely used U.S. sample (N. Bayley, 1993). Analysis of the 12 monthly assessments indicated that Brazilian infants' scores increased with age, with the greatest increase occurring over the first 8 months. As a general comparison, the results are similar to the U.S. patterns of development. However, the Brazilian sample exhibited mean scores significantly lower than the U.S. sample's in the 3rd, 4th, and 5th months. More specific analyses indicated that the difference within these months was on tasks of sitting and grasping. Possible explanations for the differences focus on variations in child-rearing practices and the influence of biological maturation in early movement behaviors.     

Visual-Motor Integration Problems in Low Birth Weight Infants

This paper represents a review of the research that focuses on a population of strong clinical interest on a national and international scale—infants born with low birth weight (LBW). Among the numerous developmental deficits commonly associated with this group, one of the most frequently cited problems is poor fine- and visual-motor integration. In addition to the direct perceptual-motor development concern, the literature provides a reasonable case that such deficits place this population at increased risk for subnormal academic performance and difficulties with specific daily living (self-help) activities. By assessing the infant at an early age and designing specific strategies for intervention, clinical psychologists can play a major role in improving fine- and visual-motor behavior in this population.     

Recognition and categorization of biologically significant objects by rhesus monkeys (Macaca mulatta): the domain of food.

To survive, organisms must be able to identify edible objects. However, we know relatively little about how humans and other species distinguish food items from non-food items. We tested the abilities of semi-free-ranging rhesus monkeys (Macaca mulatta) to learn rapidly that a novel object was edible, and to generalize their learning to other objects, in a spontaneous choice task. Adult monkeys watched as a human experimenter first pretended to eat one of two novel objects and then placed replicas of the objects at widely separated locations. Monkeys selectively approached the object that the experimenter had previously eaten, exhibiting a rapidly induced preference for the apparently edible object. In further experiments in which the same objects were used as tools or were manipulated at the face but not eaten, we fail to observe an approach bias, providing evidence that the monkeys' pattern of approach in the earlier experiments was specific to objects that were eaten. Subsequent experiments tested how monkeys generalized their preference for an edible object by first allowing them to watch a human experimenter eat one of two objects and then presenting them with new objects composed of the same substance but differing from the original, edible object in shape or color. Monkeys ignored changes in the shape of the object and generalized from one edible object to another on the basis of color in conjunction with other substance properties. Finally, we extended this work to infant rhesus monkeys and found that, like adults, they too used color to generalize to novel food objects. In contrast to adults, however, infants extended this pattern of generalization to objects that were acted on in other ways. These results suggest that infant monkeys form broader object categories than adults, and that food categories become sharpened as a function of maturational or experiential factors.     

Effect of prefrontal cortex damage on resolving lexical ambiguity in text

The function of suppression of context-inappropriate meanings during lexical ambiguity resolution was examined in 25 adults with prefrontal cortex damage (PFCD) localized to the left (N=8), right (N=6), or bilaterally (N=11); and 21 matched Controls. Results revealed unexpected inverse patterns of suppression between PFCD and Control groups, with measures suggesting decreased interference across time in the PFCD group and increased interference in the Control group. The PFCD group, however, had significantly lower accuracy rates for the context-inappropriate condition. Results suggest a loss of the control aspects of inhibitory processes in lexical ambiguity resolution following PFCD. An aging effect on suppression function is also suggested.