How clinical trials really work rethinking research ethics

Despite prevalent concerns about the ethical conduct of clinical trials, little is known about the day-to-day work of trials and the ethical challenges arising in them. This paper reports on a study designed to fill this gap and demonstrates a need to refine the oversight system for trials to reflect an understanding of this day-to-day work. It also illuminates ethical challenges that cannot be addressed by the oversight system and so necessitate a rethinking of the ethics of clinical trials.     

An introduction to the 2011 National Multicultural Conference & Summit keynote addresses

This article provides and introduction to the 2011 National Multicultural Conference & Summit Keynote Addresses. The authors explain that they chose to focus on the tension and possibilities within multicultural psychology at the seventh biennial National Multicultural Conference & Summit (NMCS), which was held on January 27-28, 2011, at The Westin-Seattle Hotel. During the 2-day conference, nearly 900 attendees engaged with one another and heard from experts in the field as we focused on the theme, "Unification through Diversity: Bridging Psychological Science & Practice in the Public Interest. Two key sets of presentations are highlighted.     

Resource allocation during spoken discourse processing: Effects of age and passage difficulty as revealed by self-paced listening

The allocation of processing resources during spoken discourse comprehension was studied in a manner analogous to self-paced reading using the auditory moving window technique (Ferreira, Henderson, Anes, Weeks, & McFarlane, 1996). Young and older participants listened to spoken passages in a self-paced segment-by-segment fashion. In Experiment 1, we examined the influence of speech rate and passage complexity on discourse encoding and recall performance. In Experiment 2, we examined the influence of speech rate and presentation mode (self-paced vs. full-passage presentation) on recall performance. Results suggest that diminished memory performance in the older adult group relative to the young adult group is attributable to age-related differences in how resources were allocated during the initial encoding of the spoken discourse.     

Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches

The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.     

A model for outpatient care

Chaplains have seriously discussed outpatient care for a number of years. This article describes a model of thorough and intentional outpatient care that is practiced in conjunction with an inpatient care to cancer populations. Rationales, values, institutional dynamics, and clinical care are discussed. Although the focus is on outpatient care where slightly more than 50% of personnel resources are invested, the care also occurs in the context of both inpatient care and follow-up care after discharge to home. A general model of spiritual and religious care and more specific models pertinent to hematopoietic stem cell transplant populations and general oncology populations are described. The models attend times of distress and times of "ordinary" and celebratory experiences, attend care of patient, caregiver, and staff.     

Anagram software for cognitive research that enables specification of psycholinguistic variables

Anagram tasks are frequently used in cognitive research, and the generation of new scrambled letter combinations is a task well suited to a software solution. Most available programs, however, do not allow experimenters to generate new anagrams flexibly or to characterize existing anagrams using psycholinguistic criteria. They also do not provide detailed information on their source dictionaries. We present anagram software that interfaces with CELEX2, an internationally recognized psycholinguistic database. This software allows users to capitalize on lexical variables and thus enables direct control of psycholinguistic features that may influence the cognitive processes involved in anagram solution.     

Studies of the vicarious traumatization of college students by the September 11th attacks: effects of proximity, exposure and connectedness

From mid-October 2001 through the end of November 2001, we collected fairly large sets of questionnaires from undergraduates at three public universities (Albany, NY, n = 507, Augusta, GA, n = 336, Fargo, ND, n = 526 ) to assess rate of acute stress disorder (ASD) and level of ASD symptoms following the September 11th attacks, rate of current posttraumatic stress disorder (PTSD) and level of PTSD symptoms, and current level of depressive symptoms resulting from the September 11th attacks. We also gathered information on exposure to media coverage of the attacks, connectedness to the World Trade Center (WTC) and personnel there, and degree of engagement in reparative acts such as giving blood, attending vigils. We found higher levels of ASD, ASD symptoms, PTSD and PTSD symptoms as a function of geographical proximity to New York City (and within the Albany site, proximity of students' homes) and gender. Exposure (hours of TV watched) was a predictor in some instances as was connectedness to WTC victims. ASD symptoms were the strongest predictor of subsequent PTSD symptoms. Path models accounted for over 60% of the variance in PTSD symptoms.     

Scientific misconduct and findings against graduate and medical students

Allegations of scientific misconduct against graduate students appear to have unique attributes in the detection, investigation, processes used and sanctions imposed vis-à-vis other populations against which misconduct is alleged and found. An examination of the cases closed by the Department of Health and Human Services' Office of Research Integrity and the National Science Foundation reveals that most of the allegations made against graduate and medical students are for falsification and fabrication. Further, additional processes are used in these cases, e.g., student judicial processes, more students are "set up" and more students admit misconduct. Finally, the sanctions imposed when a finding is made typically involve separation from the institution and the federal sanction ranges from none to debarment. Drawing upon the teachings and circumstances of cases involving graduate student peers is a good vehicle for illustrating the concepts and perils of misconduct to graduate students.     

Abusive relationships: Is a new category for traumatization needed?

The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS), which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.     

A longitudinal study of implicit and explicit memory in old persons

Decline in explicit memory with advancing age is a common finding, but it is unclear whether implicit memory (repetition priming) declines or remains stable. Meta-analyses of studies that examined differences between extreme groups (young-old), typically at a single point in time and on a single test, suggest that a mild reduction in priming occurs with advancing age. The authors examined explicit memory and priming, on multiple tests over 4 annual data-collection waves, in a large group of older persons without dementia at baseline. Explicit memory declined significantly, but priming remained stable. Findings indicate that explicit memory and priming are dissociable on the basis of age-related change and that mildly reduced priming is not an inevitable consequence of growing older.