Development of the University of Pittsburgh Medical Center policy for the care of terminally ill patients who may become organ donors after death following the removal of life support

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation.     

The prediction of adjustment at age 7 from activity level at age 5

One-hundred and ninety-two children (equally split between boys and girls) were studied when they were 5 years old in two settings, school and home. The children were observed in playgroups and at home, and were rated on activity level by their parents on the Rothbart Child Behavior Questionnaire. At age 7, the children were tested in our laboratory on the Harter Test of Perceived Competence and on an achievement task, and parents filled out the Child Behavior Checklist, the Child Behavior Questionnaire, and the Conners Parent Rating Scale. Home observations of activity level were significantly related to parent ratings of activity level, but not to school observations. Activity level at age 5 was related to parents' ratings of aggression and hyperactivity and to girls' learning problems at age 7. Activity level was not related to the children's self-perceived competence, but mothers' rating of high activity level at age 5 was related to low reading comprehension at age 7.Preparation of this paper was supported in part by the Center for Research for Mothers and Children, NICHD, U.S. PHS grant HD 19739 to Beverly I. Fagot.     

Argument versus dialogue: a response to Luepnitz, Madigan and other argumentative authors

In the context of family therapy's task of serving families, the purpose of theorizing is ultimately practical. It is a prevailing cultural practice among intellectuals to use up a vast amount of 'space' in our brains and in the pages of our journals theorizing at a great distance from the practical. One of the reasons for this distance from the practical may be the sophistic habit of argumentativeness. An alternative is proposed in which priority is given to the practical and dialogue is focused on the co-creation of meanings.     

Cerebral Anesthetization for Localization of Speech: The Contribution of W. James Gardner

In 1949, the neurologist Juhn Wada reported the first use of a new procedure for determining the localization of speech and language in neurological patients: examination of the effects on speech and language after injecting a barbiturate, sodium amytal, into the internal carotid artery of each hemisphere in succession. By the 1960s, Wada'sIntracarotid Amobarbital Procedure,orIAP,had become the method of choice for identifying the speech-dominant side in one kind of neurological patient, persons with epilepsy who are candidates for surgical resection, and it remains so today. In 1941, however, an American neurosurgeon, W. James Gardner, reported his use of a different anesthetization procedure for speech localization in neurological patients. Instead of injecting sodium amytal through the blood supply, as in the IAP, Gardner injected procaine hydrochloride directly into cortical tissue. In this paper, we provide a brief biography of Gardner. We then discuss his method of cortical anesthetization, the theoretical and empirical background guiding his use of this method and his choice of patients, and, finally, the fate of Gardner's method within the scientific community.     

Gender differences in coping: A further test of socialization and role constraint theories

To further test role constraint and socialization theories of gender differences in coping, two studies were conducted to examine coping strategies in individuals occupying similar roles. The relations between coping strategy frequency and effectiveness and between coping strategy use and psychological functioning also were examined. Predominantly Caucasian female and male college students participated in the studies. Results indicated support for both socialization and role constraint theories. Effectiveness and frequency of coping strategy use were moderately correlated. Gender differences in cognitive appraisal varied with dispositional vs. situational assessment. The need for a more integrated model to explain gender differences in coping and implications for existing theories are discussed.     

Non-heart-beating organ donation: a reply to Campbell and Weber.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure.     

Applications of a computer algebra system in introductory statistics

Maple, a computer algebra system, is employed in introductory statistics courses to promote conceptual learning by students of statistical principles without direct use of mathematics. Maple’s symbolic computation, graphic display, and animation capabilities support an integrated set of procedures for active study of sampling distributions and concepts related to samples, populations, and statistical decision making, error, and power. Students select parameter values for one-line commands and examine the effects of alternatives on computer-generated graphical representations of distributions. The 20 procedures written to support active student exploration of basic statistical concepts are described, and examples of exercises to support their use are provided.     

Mid-career change in academia: The decision to become an administrator

This study explored the reasons why professors would leave their teaching/ research occupations to begin new careers as administrators. Valence-Instrumentality-Expectancy theory of occupational preference and choice was used as a framework to examine mid-career change among professors and department chairmen at a major university. Data showed that professors' intentions to change careers and become administrators could be explained by the theory. Analyses of job characteristics demonstrated that professors who want a mid-career change are primarily attracted by the power and formal authority vested in the administrative position, while professors who prefer to remain in their career paths do so because of the autonomy it offers.