Limiting the role of the family in discontinuation of life sustaining treatment

In matters of discontinuation of life-sustaining treatment, traditional role of the family to speak on behalf of the incompetent patient is questionable. We explore the reasons why physicians perceive patient autonomy to be transferrable to family members. Principle of patient autonomy may not suffice when futile treatment is demanded and may serve to erode the ethical integrity of medical profession. An enhanced role for bioethics committees is proposed when physicians propose to discontinue life-sustaining treatment against the wishes of the patient or their families.     

A computerized system for monitoring and controlling intracranial electrical self-stimulation behavior

An automated system for measuring intracranial self-stimulation behavior is described. The system consists of two Commodore 6502 microcomputers interfaced with a constant-current generator and a standard operant chamber. The system hardware allows sine- and square-wave stimulation. Stimulus intensity can be varied in 256 steps between 0 and 100, 0 and 500, or 0 and 1,000 /µA. The system programs, which are written in machine language, allow the control of various schedules of reinforcement, the counting of operant responses and reinforcements, the measurement of interresponse intervals, and the storage of the data on disk. The software is designed for the determination of the threshold of reinforcement, on the basis of the titration of postreinforcement pauses caused by changeover in schedule control between concurrent continuous reinforcement and fixed ratio schedules.     

Taking visual disability into account: Explaining failure to experts and non-experts

The present study was designed to investigate visually handicapped students' explanations for failure when the motive to maintain or enhance self-esteem was in conflict with the motive to present a favorable social image. Subjects experienced manipulated failure in a text comprehension task and were subsequently asked to give causal and responsibility attributions in the presence of either a visually handicapped or a non-handicapped experimenter. It was expected that visually disabled participants would claim a handicap-bonus from the non-handicapped experimenter by explicitly presenting non-defensive attributions and accounts as well as handicap-related responses, while defensive explanations should be more pronounced when faced with a blind experimenter. The data provide support for the existence of presumed social expectations as determinants of individuals' verbal self-presentations.     

Endogenous and symptomatic schizophrenia. Wherein lies the difference?

It is the opinion of the present writer that endogenous and symptomatic schizophrenia are two completely different matters. By classical symptomatology it is impossible to establish the distinction in every individual case. Nevertheless, in not one of the published cases known to us did Bonhoeffer err in his diagnosis of the one or the other. Evidently he made use of additional characteristica gathered in practice, about which he himself may not always have been quite clear.     

A kinematic analysis of anticipatory coarticulation in the speech of anterior aphasic subjects using electromagnetic articulography

An investigation was made into the extent and time course of anticipatory coarticulation in the speech of two normal and two anterior aphasic, German-speaking subjects. Both labial and velar coarticulation gestures were investigated. Subjects produced sentences containing target words contrasting in postconsonantal vowel rounding (e.g., [geli:ge]/[gely:gel]) and in nasality (e.g., [ti:de]/[ti:ne]). Speech kinematics were monitored by means of electromagnetic articulography. The data revealed that for correct productions, aphasic speakers' coarticulatory patterns were more highly variable than those of control subjects. These differences, however, were found chiefly for spatial displacement characteristics, while the temporal aspects of articulator movement necessary for anticipatory coarticulation appeared largely intact. Articulator mistiming did not appear to explain a small corpus of stop/nasal substitution errors produced by one of the aphasic speakers.     

Saccadic reaction times of dyslexic and age-matched normal subjects

Saccadic reaction times (SRT) were measured in a simple task: subjects had to make saccades from a central fixation point to peripheral targets, which appeared randomly 4 deg to the left or to the right. In the first test the fixation point went off before the target appeared (gap trials); in the second test it remained on the screen (overlap trials). The distribution of SRTs for trained normal adults (N = 4), untrained normal adults (N = 11), untrained normal children (aged 9-11 years, N = 9), untrained normal teenagers (aged 15-17 years, N = 8), dyslexic children (aged 9-11 years, N = 15), and dyslexic teenagers (aged 15-17 years, N = 5) were compared, with special emphasis on the number of express saccades, ie saccades with extremely short reaction times (100-120 ms, under the present conditions). In normal adults with the gap paradigm, the distribution of reaction times typically exhibits two or three modes (express saccades, fast regular saccades, and very few slow regular saccades), whereas in the overlap paradigm only one or two modes (few fast regular saccades and many slow regular saccades) are obtained. On average, normal children produce more express saccades than naive normal adults. Dyslexic children produce more express saccades than the normal age-matched controls. Among the dyslexic children, four different types of abnormalities in their reaction times were encountered. The group of dyslexic teenagers was characterized by a larger number of express saccades at the expense of fast regular saccades in gap trials and by fewer express saccades and fewer fast regular saccades in overlap trials when compared to the age-matched control group. It is concluded that the abnormal patterns of saccadic reaction times reflect defects in the system of visual attention and/or in its control over the oculomotor system, rather than indicating a defect in the oculomotor system itself. In this context, symptoms of dyslexia appear as a combination of attentional deficits and irregular timing of saccadic eye movements.     

The neurocognitive basis of autism

The cognitive study of the underlying mental abnormalities in autism has advanced rapidly, while the biological study of the underlying brain abnormalities and of putative genetic mechanisms is lagging somewhat behind. However, the linking of cognitive and biological studies has become a real possibility. Developmental cognitive neuroscience has transformed our understanding of this enigmatic disorder, which was once misguidedly thought to be caused by maternal rejection. The hypothesis of a specific theory of mind deficit was a crucial step in this process. It explains the puzzle of the characteristic social and communication impairments of autism and allows for the fact that they can coexist with good general abilities. This hypothesis has been widely accepted and a start has been made at pinpointing the brain basis of theory of mind. The non-social impairments of autism have now become a major focus for cognitive research. One theory proposes dysfunction in executive processes, in an attempt to explain repetitive behaviour and inflexibility. Another theory proposes weak information integration, in an attempt to explain narrow interests and special talents. Autism research has thus stimulated ideas on important mind-brain systems that may be dedicated to the development of social awareness, executive functions and integrative processing.     

Procuring organs from a non-heart-beating cadaver: commentary on a case report

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed.