Death and organ procurement: public beliefs and attitudes

Although "brain death" and the dead donor rule--i.e., patients must not be killed by organ retrieval--have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents >18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs there were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation.     

Reconsidering evidence for the suppression model of the octave illusion

The octave illusion is elicited by a sequence of tones presented to each ear that continuously alternate in frequency by one octave, but with high and low frequencies always in different ears. The percept for most listeners is a high pitch in one ear, alternating with a low pitch in the other ear. The influentialsuppression model of the illusion proposed by Deutsch and Roll (1976) carries three postulates: first, that listeners perceive only the pitch of the tones presented to their dominant ear; second, that this pitch is heard in whichever ear received the higher frequency tone; and third, that this apparent dissociation betweenwhat andwhere mechanisms arises from sequential interactions between the tones. In the present article, we reappraise evidence for the suppression model and demonstrate (1) the incompatibility of the theory with the existing literature on pitch perception, sound localization, and ear dominance and (2) methodological limitations in studies that have claimed to provide support for the suppression model. We conclude by proposing an alternative theory of the octave illusion that is based on established principles of fusion, rather than suppression, between ears.     

Institutional culture and individual behavior: Creating an ethical environment

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate; i.e., it helps to define what are viable action options, what is the organization’s genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Using latent trait modeling to conceptualize an alcohol problems continuum

Recent research points toward the viability of conceptualizing alcohol problems as arrayed along a continuum. Nevertheless, modern statistical techniques designed to scale multiple problems along a continuum (latent trait modeling; LTM) have rarely been applied to alcohol problems. This study applies LTM methods to data on 110 problems reported during in-person interviews of 1,348 middle-aged men (mean age=43) from the general population. The results revealed a continuum of severity linking the 110 problems, ranging from heavy and abusive drinking, through tolerance and withdrawal, to serious complications of alcoholism. These results indicate that alcohol problems can be arrayed along a dimension of severity and emphasize the relevance of LTM to informing the conceptualization and assessment of alcohol problems.     

Efficiency of a strategy for detecting back random responding on the personality assessment inventory

The efficiency of a new strategy to identify back random responding (BRR) on the Personality Assessment Inventory (L. C. Morey, 1991) was studied using random manipulations of item responses from community (904 adult nonpatients) and clinical (1,079 adult patients) respondents. The strategy involved a comparison of short-form and full-instrument T scores on 2 scales found to be particularly sensitive to BRR in a recent study. This strategy was found to be reasonably sensitive and specific to even relatively low levels of BRR.     

Test modality affects source monitoring and event-related potentials

Two experiments investigated the effect of test modality (visual or auditory) on source memory and event-related potentials (ERPs). Test modality influenced source monitoring such that source memory was better when the source and test modalities were congruent. Test modality had less of an influence when alternative information (i.e., cognitive operations) could be used to inform source judgments in Experiment 2. Test modality also affected ERP activity. Variation in parietal ERPs suggested that this activity reflects activation of sensory information, which can be attenuated when the sensory information is misleading. Changes in frontal ERPs support the hypothesis that frontal systems are used to evaluate source-specifying information present in the memory trace.     

Deleterious effects of alcohol intoxication: diminished cognitive control and its behavioral consequences

The authors tested the hypothesis that impaired behavioral performance during intoxication results partly from alcohol's deleterious effects on cognitive control. The impact of alcohol on perseverative behavior was examined with an n-back working memory task that included manipulations of task complexity and prepotency of inclinations to respond or withhold responding. Thirty-two social drinkers (16 men) participated in either an alcohol (.075g/100ml) or a no-alcohol condition. Alcohol increased perseveration of prepotent, task-inappropriate response patterns only under cognitively demanding (heavy memory load) conditions. This effect was evident for both commission errors (response persistence despite contingencies altered to require restraint) and omission errors (failure to respond when contingencies were revised to encourage action). Findings suggested that alcohol-induced perseveration arises from impairments in cognitive control.     

Cognitive predictors of symptom return following depression treatment

This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N = 121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n = 53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms.     

Investigating the encoding and retrieval of intentions with event-related potentials

Strong evidence exists in the literature that remembering to complete intentions involves executive processing subserved by the frontal lobes. Event-related potentials were measured during the encoding of actions with the intention to perform versus more neutral material about which there was no such intentionality. Event-related potentials were also measured in a two-alternative discrimination task requiring identification of the to-be-performed actions and to-be-memorized actions. The results suggest that formation and retrieval of intentions differs from encoding and retrieval of similar material committed to memory. Additionally, the results suggest that right frontal areas may play an important role in the formation of prospective actions and that intentions are kept active in memory by processing mediated by the left frontal pole.