Ethical issues in discharge planning for vulnerable infants and children

Discharge planning for vulnerable infants and children is a collaborative, interdisciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process may be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations.     

Discrimination of Facial Identity and Facial Affect by Temporal and Frontal Lobectomy Patients

The purpose of this study was to determine the extent to which lobectomy affects ability to discriminate facial identity or facial expression. Fifteen right temporal, 15 left temporal, 5 right frontal, and 4 left frontal lobectomy patients, pair-matched for age, sex, and education to normal control subjects, participated in this study. Tasks included a Facial Identity Matching Task and a Facial Affect Matching task. The lobectomized patients as a whole were significantly impaired on both tasks (22% decrement in performance). The patients made twice as many errors resulting from perseveration of response-set of the first condition (identity or emotion matching) into the second condition. The site of lobectomy did not influence general performance on any one task or selective performance on any subset of affective categories. It was concluded that all four brain regions play a significant and equal role in face processing, and that circuits more specifically dedicated to visual face processing, which are responsible for hemispheric dominance affects and affect/identity dissociations, are probably located more posteriorly in the brain. Finally, it was concluded that perseveration of acquired habit may, under specific conditions, characterize temporal lobe dysfunction just as much as frontal lobe dysfunction.     

Rewards and organizational commitment across structural characteristics: A meta-analysis

This article uses meta-analysis to summarize previous empirical studies which examine the relationship between actual income/pay satisfaction and organizational commitment (OC) across different structural settings. Twenty-one studies with correlational data on the relationship between OC and income, and 27 studies dealing with OC and pay satisfaction are examined; these studies include 23 and 31 independent samples, respectively. The findings reveal a moderator effect related to type of occupation in the OC-income relationship, and to sector in the OC-pay satisfaction relationship. The findings also show the moderating effect of measurement of OC on pay satisfaction. Theoretical and methodological considerations pertaining to the OC-rewards relationship are discussed. Directions for future research and practical implications are indicated.The authors would like to thank HelenJane Shawyer and Marion Lupu for their editorial assistance.     

A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD

Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

Reduction of the elevator illusion from continued hypergravity exposure and visual error-corrective feedback

Ten subjects served as their own controls in two conditions of continuous, centrifugally produced hypergravity (+2 Gz) and a 1-G control condition. Before and after exposure, open-loop measures were obtained of (1) motor control, (2) visual localization, and (3) hand-eye coordination. During exposure in the visual feedback/hypergravity condition, subjects received terminal visual error-corrective feedback from their target pointing, and in the no-visual feedback/hypergravity condition they pointed open loop. As expected, the motor control measures for both experimental conditions revealed very short lived underreaching (the muscle-loading effect) at the outset of hypergravity and an equally transient negative aftereffect on returning to 1 G. The substantial (approximately 17°) initial elevator illusion experienced in both hypergravity conditions declined over the course of the exposure period, whether or not visual feedback was provided. This effect was tentatively attributed to habituation of the otoliths. Visual feedback produced a smaller additional decrement and a postexposure negative aftereffect, possible evidence for visual recalibration. Surprisingly, the target-pointing error made during hypergravity in the no-visual-feedback condition was substantially less than that predicted by subjects’ elevator illusion. This finding calls into question the neural outflow model as a complete explanation of this illusion.     

Folic acid and the prevention of neural tube defects: A position paper of the national society of genetic counselors

Considerable scientific evidence demonstrates the reduction in risk for neural tube defects (NTDs) associated with maternal preconceptional folic acid supplementation. The National Society of Genetic Counselors (NSGC) endorses the U.S. Public Health Service recommendations for folic acid supplementation at the 0.4 mg level for women in the general population and at the 4.0 mg level for women at high or increased risk for NTD pregnancies for at least 4 weeks prior to active pursuit of conception. We encourage targeted educational efforts and surveillance to assess results of this dietary supplementation. The NSGC further urges the Food and Drug Administration to fortify staple foodstuffs with folic acid for a population-based approach to minimize the number of NTD births.     

The impact of confederate responsivity on social skills assessment

The current investigation examined the degree to which judges' ratings of skill, anxiety, and attractiveness are influenced by the responsivity of the confederate. High-, medium-, and low-skilled subject-pool groupings, as well as self-referred clinical groups, were exposed to either a moderately or a minimally responsive confederate. Results indicated that subjects were rated as more skillful when interacting with a moderately responsive confederate than when interacting with a minimally responsive confederate. Further, there was a groups × condition interaction for anxiety ratings such that both the high- and the medium-skilled groups appeared more anxious under the minimal condition, whereas the low-skilled and self-referred groups did not. Self-referred subjects received significantly lower attractiveness ratings than did the high- or medium-skilled groups. Implications of these results and future directions for research are discussed.This research is based on a M.S. thesis carried out by the first author under direction of the second author.