Nonunique solutions to the likelihood equation for the three-parameter logistic model

Samejima identified the possibility of multiple solutions to the likelihood equation (multiple maxima in the likelihood function) for estimating an examinee's trait value for the three-parameter logistic model. In the practical applications that Lord studied, he found that multiple solutions did not occur when the number of items was 20. In the present paper, fourteen multiple-choice achievement tests with from 20 to 50 items were examined to see if it was possible for them to produce item response vectors with multiple maxima; such vectors were found for all the tests. Examination of response vectors for large groups of real examinees found that from 0 to 3.1% of them had response vectors with multiple maxima. The implications of these results for multiple-choice tests are discussed.     

Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the "high" on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.     

Collective Apologies and Their Effects on Forgiveness: Pessimistic Evidence but Constructive Implications

In the last three decades, there has been an explosion in the frequency with which leaders of groups have issued official apologies for collective transgressions. These apologies are commonly assumed to lay a pathway to forgiveness and reconciliation, but empirical examination of the downstream consequences of collective apologies is still in its infancy. In this article, we review a series of studies—including interview studies, survey studies, and experiments—that question the assumed wisdom that collective apologies lead to intergroup forgiveness. Reasons for the muted evidence of an apology–forgiveness link at the intergroup level are elaborated, and implications for how best to issue gestures of reconciliation and remorse are discussed.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.