Mandatory Cancer Risk Warnings on Alcoholic Beverages: What Are the Ethical Issues?

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring “informed choice” about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions (either with or without labels) and consider the implications if the autonomy of drinking behavior is substantially compromised. Our discussion demonstrates the need for the various ethical issues to be considered and addressed in any decision to mandate cancer warning labels.     

Micro- and macrodevelopmental changes in language acquisition and other representational systems

In this paper, it will be argued that each time a procedure in a representational system is functioning adequately and automatically, the child steps up to a metaprocedural level and considers the procedure as a unit in its own right. Data will be drawn from microdevelopment in children's creation of external memory devices (i.e., changes in representation of a spatial task during a one hour's session) as well as from macrodevelopment in language acquisition (i.e., changes occurring over age in a study of nominal determiners, pronouns and gender markers). These two aspects of development of representational systems are examined with respect to the spontaneous passage from concrete reference to abstract systems, from idiosyncratic to conventional notations, from redundant to economic marking, from unifunctional to plurifunctional meaningful units. These micro- and manodevelopmental changes take place in a spontaneous fashion despite the fact that the child's earlier system is adequate for successfully conveying the information required. A discussion will be made of the way in which children tend to indicate externally, by unifunctional markers, information which was implicit in their earlier use of an adult-like system. They appear to be striving for the delicate balance between encoding and decoding efforts, ultimately leading to a felicitous representational system. Metaprocedural behavior is hypothesized to act as a control mechanism in the striving for this delicate balance of information content and information processing effort. It also appears to act as a control mechanism for the interprocedural organizotion of what was previously a plethora of juxtaposed, unconnected procedures yielding superficially analogous behavior. The stepping-up to a metaprocedural level seems to occur each time the child has a handle on his currently functioning, goal-oriented system. This enables the child to treat the system, or procedures which are part thereof, as units functioning in their own right. Thus there appears to be a deep-rooted psychological tendency for a representational tool which functions well procedurally to become subsequently a problem-space per se.     

Are Residents Willing to Discuss Spirituality with Patients?

Family medicine is redefining itself in the wake of the Future of Family Medicine Project, the move to the Patient-Centered Medical Home, and the 2010 Patient Protection and Affordable Care Act’s emphasis on primary care. This effort has included representing family doctors as physicians who “care for the whole person” and who “specialize in you.” Many patients believe that whole person care involves attention to spirituality and wish to share their beliefs in the medical encounter. This national survey investigated whether a random sample of family medicine residents were willing to address spirituality upon patient request. With varying degrees of willingness, most doctors said that they would discuss patient beliefs if asked. Denominational preference, residency training in addressing spirituality, and self-rated spirituality were all predictive of the strength of reported willingness. These results indicate that training in addressing spirituality may create residents more likely to discuss the topic in clinical practice.     

Special People? An Exploratory Study into Re-entering Missionaries’ Identity and Resilience

Home country re-entry from cross-cultural missionary work abroad may be associated with psychological distress. Re-entrants experience multiple losses including loss of identity which may be associated with personal/relational identity gaps and depersonalization/dehumanization. However, research suggests that some re-entrants are resilient with good mental health, while others are fragile with poor mental health. The aims of this paper are to explore the nature and frequency of re-entering missionaries’ identity gaps and their depersonalization/dehumanization in resilient and fragile re-entrants. Fifteen re-entering adult Australian cross-cultural missionary workers from four interdenominational Australian mission organizations completed semi-structured interviews. Results were analysed using modified Consensual Qualitative Research methods. Links were established between personal/relational identity gaps, depersonalization/dehumanization and resilience on re-entry. Implications for re-entrants’ care are discussed with suggestions for further research.     

Mechanisms of developmental regression in autism and the broader phenotype: a neural network modeling approach

Loss of previously established behaviors in early childhood constitutes a markedly atypical developmental trajectory. It is found almost uniquely in autism and its cause is currently unknown (Baird et al., 2008). We present an artificial neural network model of developmental regression, exploring the hypothesis that regression is caused by overaggressive synaptic pruning and identifying the mechanisms involved. We used a novel population-modeling technique to investigate developmental deficits, in which both neurocomputational parameters and the learning environment were varied across a large number of simulated individuals. Regression was generated by the atypical setting of a single pruning-related parameter. We observed a probabilistic relationship between the atypical pruning parameter and the presence of regression, as well as variability in the onset, severity, behavioral specificity, and recovery from regression. Other neurocomputational parameters that varied across the population modulated the risk that an individual would show regression. We considered a further hypothesis that behavioral regression may index an underlying anomaly characterizing the broader autism phenotype. If this is the case, we show how the model also accounts for several additional findings: shared gene variants between autism and language impairment (Vernes et al., 2008); larger brain size in autism but only in early development (Redcay & Courchesne, 2005); and the possibility of quasi-autism, caused by extreme environmental deprivation (Rutter et al., 1999). We make a novel prediction that the earliest developmental symptoms in the emergence of autism should be sensory and motor rather than social and review empirical data offering preliminary support for this prediction.     

A longitudinal examination of couples' coping strategies as predictors of adjustment to breast cancer

This study's goals were to examine coping strategies of women and their male partners as predictors of change in women's adjustment over the year following breast cancer treatment and to test whether partners' coping processes interact to predict adjustment. In a sample of women who had recently completed breast cancer treatment and were taking part in a psychoeducational intervention trial, the patients' and partners' cancer-specific coping strategies were assessed at study entry (average of 10 months after diagnosis). Assessed at study entry and 20 months after diagnosis (n = 139 couples), dependent variables were women's general (i.e., vitality, depressive symptoms, relationship satisfaction) and cancer-specific adjustment (i.e., cancer-specific distress, perceived benefits). Both patients' and partners' coping strategies at study entry predicted change in women's adjustment at 20 months. Women's use of approach-oriented coping strategies predicted improvement in their vitality and depressive symptoms, men's use of avoidant coping predicted declining marital satisfaction for wives, and men's approach-oriented strategies predicted an increase in women's perception of cancer-related benefits. Patients' and partners' coping strategies also interacted to predict adjustment, such that congruent coping strategy use generally predicted better adaptation than did dissimilar coping. Findings highlight the utility of examining patients' and partners' coping strategies simultaneously.     

Recognition without awareness: An elusive phenomenon

Two recent studies described conditions under which recognition memory performance appeared to be driven by nondeclarative memory. Specifically, participants successfully discriminated old images from highly similar new images even when no conscious memory for the images could be retrieved. Paradoxically, recognition performance was better when images were studied with divided attention than when images were studied with full attention. Furthermore, recognition performance was better when decisions were rated as guesses than when decisions were associated with low or high confidence. In three experiments, we adopted the paradigm used in the earlier studies in an attempt to repeat this intriguing work. Our attempts were unsuccessful. In all experiments, recognition was better when images were studied with full attention than when images were studied with divided attention. Recognition was also better when participants indicated high or low confidence in their decision than when they indicated that their decision was a guess. Thus, our results conformed to what typically has been reported in studies of recognition memory, and we were unable to demonstrate recognition without awareness. We encourage others to explore this paradigm, and to try to identify conditions under which the phenomenon might be demonstrated.Declarative memory refers to the capacity to recollect facts and events, and can be contrasted with a collection of nondeclarative memory abilities, including skills, habits, and the phenomenon of priming, which are expressed through performance rather than recollection (Squire et al. 2004). Declarative memory depends on the integrity of medial temporal lobe structures, while the various forms of nondeclarative memory depend on other brain systems (Schacter and Tulving 1994; Eichenbaum and Cohen 2001; Squire 2004). The best-studied example of declarative memory is recognition memory—the ability to judge items as having been encountered previously. Successful recognition is ordinarily accompanied by a conscious experience of familiarity, and sometimes by conscious memory of the prior encounter itself (Gabrieli 1998).One interesting idea that has been explored in some detail is that recognition memory decisions based on familiarity might also benefit from priming. Priming refers to an improved ability to produce or identify an item on the basis of a recent encounter with the same item or a related item, but without a requirement that there be conscious knowledge of the prior encounter (Tulving and Schacter 1990; Schacter and Buckner 1998). In early studies, it was suggested that previously encountered items might be processed more fluently (e.g., with greater speed and with more ease), and that improved fluency might influence familiarity judgments. Specifically, items perceived with greater fluency might tend to be identified as familiar (Mandler 1980; Jacoby and Dallas 1981; Johnston et al. 1991).This idea encountered difficulty when it was found that severely amnesic patients can perform at chance on conventional recognition tests despite exhibiting intact perceptual priming (Hamann and Squire 1997; Stark and Squire 2000). If fluency facilitates recognition, severely amnesic patients who exhibit intact perceptual priming should perform better than chance on recognition memory tests. Thus, it has seemed that the perceptual fluency that mediates priming does not also support familiarity-based recognition judgments, at least not to a measurable degree. Indeed, the contribution of perceptual fluency appears to be too weak to drive recognition performance noticeably above chance (Conroy et al. 2005).Nonetheless, it remains possible that conditions might be found under which recognition decisions can benefit from perceptual fluency, and in this way be linked to nondeclarative memory. Two recent studies (Voss et al. 2008; Voss and Paller 2009) described conditions under which recognition memory appeared to be significantly driven by nondeclarative memory. Participants studied difficult-to-verbalize images (Fig. 1) with either full attention or divided attention. At test, each image was paired with a highly similar new image, and participants made a speeded forced-choice decision. The striking finding was that, under these conditions, accurate recognition memory performance occurred, but without the awareness that ordinarily accompanies successful recognition. Specifically (and paradoxically), performance was better under divided-attention conditions (which ordinarily degrade memory performance) than under full-attention conditions (Fig. 2A). Furthermore, in one study (Voss et al. 2008), recognition was better when participants reported that they were guessing than when they reported conscious memory of the images (combined high- and low-confidence trials) (Fig. 2B). Notably, this phenomenon occurred only when the test was given in a forced-choice format, and not in a yes/no format. The other study (Voss and Paller 2009) reported a similar advantage for guessing in the divided-attention condition. These two reports appear to demonstrate recognition without awareness and a significant contribution of nondeclarative memory to recognition performance.Open in a separate windowFigure 1.In the full-attention condition, participants studied 14 images for 2 sec each (1.5-sec intertrial interval). Alternatively, in the divided-attention condition, participants studied the images while deciding whether a digit heard during the previous trial was odd or even. The forced-choice recognition test probed memory for the middle 10 images presented in the study sequence. Each studied item was presented together with a highly similar new item, and participants selected the old item by responding “left” or “right.” After each response, participants indicated how confident they were in their recognition decision (G, guess; L, low confidence; H, high confidence).Open in a separate windowFigure 2.Data from Experiment 2 in Voss et al. (2008), estimated from their Figure 2. (A) When recognition was probed using a forced-choice format, performance was more accurate in the divided-attention condition than in the full-attention condition. (B) In both conditions, forced-choice recognition was more accurate in trials where participants indicated that their recognition decision was a guess (G) than in trials where participants indicated low or high confidence (L/H) in their decision. Asterisks indicate performance significantly above chance (P < 0.05). Error bars indicate SEM.These findings challenge the conventional view that recognition memory is more effective when full attention is given to a task than when attention is divided (Anderson 1980), that recognition memory is associated with a conscious experience of familiarity (Gabrieli 1998), and that recognition memory accuracy is positively correlated with ratings of confidence (Reed et al. 1997; Mickes et al. 2007). Because the reported findings are exceptional, we explored the phenomenon further in three separate experiments in an attempt to replicate it and identify its boundary conditions. We adopted the same paradigm as was used in the original study (Voss et al. 2008).     

Empowering youth to change their world: Identifying key components of a community service program to promote positive development

Prior to graduating from high school, the vast majority of youth in the United States will take part in at least one community service activity. Although it is frequently assumed that community service is inherently beneficial to those that take part, the activities and processes of youth service programs tend to be unsystematic and vary widely. In addition, empirical assessment of youth service programs is inconsistent and often lacks methodological rigor. The present paper addresses these concerns in a preliminary evaluation of both the process experience and the outcomes of a theoretically grounded school-based community service program for urban adolescents. The evaluation focuses on identifying key components of a youth community service program, assessing whether the program was experienced as it was intended, and providing preliminary data on participant outcomes. Findings indicate that the program was experienced as both empowering (i.e., guided by student initiative, preferences, and strengths) and promoting a sense of community (i.e., encouraged cooperation and collective decision making). Results also suggest that taking part in the community service program increased youths' self-reported empathy and intent to be involved in future community action, as compared to a group of matched controls. Implications and recommendations for developing and evaluating service-learning or community service programs in the schools are discussed.