Development of a new fear of hypoglycemia scale: FH-15

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new measure that explores specific fear of hypoglycemia (FH) in adult patients with type 1 diabetes and to examine its psychometric properties. The instrument developed to assess FH was initially made up of 20 items, of which 18 were negative and 2 were positive, assessed on a 5-point Likert scale (1-5). This scale was completed by 229 patients with type 1 diabetes. Additionally, a structured interview and a closed question called subjective fear of hypoglycemia were included as diagnostic criteria. A factor analysis employing the principal-components method and promax rotation was carried out, resulting in a new scale composed of 15 items. Three factors (fear, avoidance, and interference) were obtained and explained 58.27% of the variance. The scale showed good internal consistency (Cronbach's α = .891) and test-retest reliability (r = .908, p < .001), as well as adequate concurrent and predictive validity. The cutoff score that provided the highest overall sensitivity and specificity was set at 28 points. The Fear of Hypoglycemia 15-item scale (FH-15) demonstrated good reliability and validity. This study suggests that the new instrument may serve as a valuable measure of specific FH for use in research and clinical practice.     

Young adults' knowledge of politics: evaluating the role of socio-cognitive variables using structural equations

The aim of this study was to create an explanatory model that allows analyzing the predictive power of a set of variables related to political knowledge; more specifically, to analyze the relationship between the education level of young adults and the variables, interest in politics and internal political efficacy. We also analyzed the combined relationship between these variables, together with age, and political knowledge. We worked with a sample group of 280 young adults between the ages of 18-30 from the city of Córdoba (Argentina). The data was subjected to a structural equation modelling SEM analysis, which allowed for the corroboration of the following hypotheses: the higher the education level, the more the interest in politics; the higher the education level, the better the perception of internal political efficacy; the higher the education level, the more the political knowledge; the more the interest in politics, the more the political knowledge; and the better the perception of internal political efficacy, the more interest in politics. Moreover, the following hypotheses could not be verified: the older an individual, the more the political knowledge; and the better the perception of internal political efficacy, the more the political knowledge. The model obtained allows for discussion of the explanatory value of these socio-cognitive variables.     

Errorless learning of a conditional temporal discrimination

In the present study we extended errorless learning to a conditional temporal discrimination. Pigeons' responses to a left-red key after a 2-s sample and to a right-green key after a 10-s sample were reinforced. There were two groups: One learned the discrimination through trial and error and the other through an errorless learning procedure. Then, both groups were presented with three types of tests. First, they were exposed to intermediate durations between 2 s and 10 s, and given a choice between both keys (stimulus generalization test). Second, a delay from 1 s to 16 s was included between the offset of the sample and the onset of the choice keys (delay test). Finally, pigeons learned a new discrimination in which the stimuli were switched (reversal test). Results showed that pigeons from the Errorless group made significantly fewer errors than those in the Trial-and-Error group. Both groups performed similarly during the stimulus generalization test and the reversal test, but results of the delay test suggested that, on long stimulus trials, responding in the errorless training group was less disrupted by delays.     

Peripheral pain enhances the effects of incentive downshifts

Physical pain (induced by tissue damage) and psychological pain (induced by surprising incentive loss) share a set of common neural substrates, but little is known about their interactions. The present research studied such interactions using the formalin test to induce physical pain and consummatory successive negative contrast (cSNC) to induce psychological pain. In the formalin test, animals receive an intradermal injection of formalin (1%) in a hind paw. In cSNC, rats with free access to 32% sucrose show a sharp suppression of drinking behavior after a downshift to 4% sucrose, compared to rats that always receive 4% sucrose. In Experiment 1, formalin administration before the first and second 32-to-4% sucrose downshift trials enhanced cSNC. In Experiment 2, a similar treatment before the first downshift trial after a 16-to-4% sucrose downshift, which normally produces little or no evidence of cSNC, significantly increased cSNC. In Experiment 3, using a 32-to-4% sucrose downshift procedure similar to that of Experiment 1, no effects were observed following formalin administration immediately after Trial 11. Thus, no evidence was found that the effects of physical pain on cSNC were caused by changes in memory consolidation. The procedures used in these experiments offer a new approach to study the neural substrates of interactions between physical and psychological pain.     

The Professional Autonomy of the Medical Doctor in Italy

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has tomake reference to the following fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice.     

On the Common Origin of Music and Philosophy: Plato,Nietzsche, and Benjamin

The essay shows the common ground between music and philosophy from the origin of Western philosophy to the crisis of metaphysical thinking, in particular with Nietzsche and Benjamin. At the beginning, the relationship between philosophy and music is marked by the hegemony of the word on the sound. This is the nature of the Platonic idea of music. With Nietzsche and Benjamin this hegemony is denied and a new vision of the relationship becomes possible. The sound is the origin both of language and of music. In thinking about this origin, philosophy shows that “thinking about music” is “thinking in music”, and that this thinking is the origin of philosophy itself.     

Small-sample characterization of stochastic approximation staircases in forced-choice adaptive threshold estimation

Despite the widespread use of up-down staircases in adaptive threshold estimation, their efficiency and usability in forced-choice experiments has been recently debated. In this study, simulation techniques were used to determine the small-sample convergence properties of stochastic approximation (SA) staircases as a function of several experimental parameters. We found that satisfying some general requirements (use of the accelerated SA algorithm, clear suprathreshold initial stimulus intensity, large initial step size) the convergence was accurate independently of the spread of the underlying psychometric function. SA staircases were also reliable for targeting percent-correct levels far from the midpoint of the psychometric function and performed better than classical up-down staircases with fixed step size. These results prompt the utilization of SA staircases in practical forced-choice estimation of sensory thresholds.     

The effects of bilateral presentations on lateralized lexical decision

We investigated how lateralized lexical decision is affected by the presence of distractors in the visual hemifield contralateral to the target. The study had three goals: first, to determine how the presence of a distractor (either a word or a pseudoword) affects visual field differences in the processing of the target; second, to identify the stage of the process in which the distractor is affecting the decision about the target; and third, to determine whether the interaction between the lexicality of the target and the lexicality of the distractor ("lexical redundancy effect") is due to facilitation or inhibition of lexical processing. Unilateral and bilateral trials were presented in separate blocks. Target stimuli were always underlined. Regarding our first goal, we found that bilateral presentations (a) increased the effect of visual hemifield of presentation (right visual field advantage) for words by slowing down the processing of word targets presented to the left visual field, and (b) produced an interaction between visual hemifield of presentation (VF) and target lexicality (TLex), which implies the use of different strategies by the two hemispheres in lexical processing. For our second goal of determining the processing stage that is affected by the distractor, we introduced a third condition in which targets were always accompanied by "perceptual" distractors consisting of sequences of the letter "x" (e.g., xxxx). Performance on these trials indicated that most of the interaction occurs during lexical access (after basic perceptual analysis but before response programming). Finally, a comparison between performance patterns on the trials containing perceptual and lexical distractors indicated that the lexical redundancy effect is mainly due to inhibition of word processing by pseudoword distractors.     

Neuroimaging Measures to Assess the Effectiveness of a Two-Day Marathon Group of Individuals with Early Developmental Trauma: A Pilot Study

Group therapy can be effective with individuals with developmental trauma who re-experience intense physiological traumatic distress and struggle with terror and despair. This modality can address the long-term ramifications of developmental trauma, including problems with perceptions, trust, emotional regulation, and loss of sense of self. Neuroimaging techniques can be combined with group therapy interventions as a way to empirically validate the effectiveness of group psychotherapy on brain structures and networks impacted by trauma. The neuroscience explaining overpowering traumatic responses and related emotions will be reviewed. Results of a pilot study combining group therapy with neuroimaging are presented.     

Clustering and switching in unconstrained,phonemic and semantic verbal fluency: the role of age and school type

We investigated the role of age and school type on clustering and switching in verbal fluency tasks (VFTs) with Brazilian children. The children were administered unconstrained, phonemic and semantic VFTs with a duration of 150 or 120 s, respectively. Both age and school type influenced all variables and in terms of performance over time. Older children and private school students outperformed the remainder of the sample, with the first 30 s of each VFT usually being the most productive. Although the size of the clusters produced did not differ between groups, the types of clusters did show some variations, with semantic clusters being the most frequent. Our results revealed strong correlations between switching ability and word production in all three VFTs. In conclusion, the executive functions known as planning and cognitive flexibility play a crucial role in word production by organising and facilitating the recall of lexical information from memory.