Ethical issues in discharge planning for vulnerable infants and children

Discharge planning for vulnerable infants and children is a collaborative, interdisciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process may be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations.     

Discrimination of Facial Identity and Facial Affect by Temporal and Frontal Lobectomy Patients

The purpose of this study was to determine the extent to which lobectomy affects ability to discriminate facial identity or facial expression. Fifteen right temporal, 15 left temporal, 5 right frontal, and 4 left frontal lobectomy patients, pair-matched for age, sex, and education to normal control subjects, participated in this study. Tasks included a Facial Identity Matching Task and a Facial Affect Matching task. The lobectomized patients as a whole were significantly impaired on both tasks (22% decrement in performance). The patients made twice as many errors resulting from perseveration of response-set of the first condition (identity or emotion matching) into the second condition. The site of lobectomy did not influence general performance on any one task or selective performance on any subset of affective categories. It was concluded that all four brain regions play a significant and equal role in face processing, and that circuits more specifically dedicated to visual face processing, which are responsible for hemispheric dominance affects and affect/identity dissociations, are probably located more posteriorly in the brain. Finally, it was concluded that perseveration of acquired habit may, under specific conditions, characterize temporal lobe dysfunction just as much as frontal lobe dysfunction.     

Rewards and organizational commitment across structural characteristics: A meta-analysis

This article uses meta-analysis to summarize previous empirical studies which examine the relationship between actual income/pay satisfaction and organizational commitment (OC) across different structural settings. Twenty-one studies with correlational data on the relationship between OC and income, and 27 studies dealing with OC and pay satisfaction are examined; these studies include 23 and 31 independent samples, respectively. The findings reveal a moderator effect related to type of occupation in the OC-income relationship, and to sector in the OC-pay satisfaction relationship. The findings also show the moderating effect of measurement of OC on pay satisfaction. Theoretical and methodological considerations pertaining to the OC-rewards relationship are discussed. Directions for future research and practical implications are indicated.The authors would like to thank HelenJane Shawyer and Marion Lupu for their editorial assistance.     

Repetition blindness and bilingual memory: Token individuation for translation equivalents

The repetition blindness effect (RB) occurs when individuals are unable to recall a repeated word relative to a nonrepeated word in a sentence or string of words presented in a rapid serial visual presentation task. This effect was explored across languages (English and Spanish) in an attempt to provide evidence for RB at a conceptual level using noncognate translation equivalents (e.g.,nephew-sobrino). In the first experiment, RB was found when a word was repeated in an English sentence but not when the two repetitions were in different languages. In the second experiment, RB was found for identical repetitions in Spanish and in English using word lists. However, the crosslanguage condition produced significant facilitation in recall, suggesting that although conceptual processing had taken place, semantic overlap was not sufficient to produce RB. The results confirm Kanwisher’s (1987) token individuation hypothesis in the case of translation equivalents.     

Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

Reduction of the elevator illusion from continued hypergravity exposure and visual error-corrective feedback

Ten subjects served as their own controls in two conditions of continuous, centrifugally produced hypergravity (+2 Gz) and a 1-G control condition. Before and after exposure, open-loop measures were obtained of (1) motor control, (2) visual localization, and (3) hand-eye coordination. During exposure in the visual feedback/hypergravity condition, subjects received terminal visual error-corrective feedback from their target pointing, and in the no-visual feedback/hypergravity condition they pointed open loop. As expected, the motor control measures for both experimental conditions revealed very short lived underreaching (the muscle-loading effect) at the outset of hypergravity and an equally transient negative aftereffect on returning to 1 G. The substantial (approximately 17°) initial elevator illusion experienced in both hypergravity conditions declined over the course of the exposure period, whether or not visual feedback was provided. This effect was tentatively attributed to habituation of the otoliths. Visual feedback produced a smaller additional decrement and a postexposure negative aftereffect, possible evidence for visual recalibration. Surprisingly, the target-pointing error made during hypergravity in the no-visual-feedback condition was substantially less than that predicted by subjects’ elevator illusion. This finding calls into question the neural outflow model as a complete explanation of this illusion.     

Folic acid and the prevention of neural tube defects: A position paper of the national society of genetic counselors

Considerable scientific evidence demonstrates the reduction in risk for neural tube defects (NTDs) associated with maternal preconceptional folic acid supplementation. The National Society of Genetic Counselors (NSGC) endorses the U.S. Public Health Service recommendations for folic acid supplementation at the 0.4 mg level for women in the general population and at the 4.0 mg level for women at high or increased risk for NTD pregnancies for at least 4 weeks prior to active pursuit of conception. We encourage targeted educational efforts and surveillance to assess results of this dietary supplementation. The NSGC further urges the Food and Drug Administration to fortify staple foodstuffs with folic acid for a population-based approach to minimize the number of NTD births.     

Sexual responding of “nonrapists” to aggressive sexual themes: Normative data

The present study presents data relevant to the sexual responding to aggressive cues of a large sample of nonrapist males recruited from the community. Two hundred three subjects received physiological assessment of sexual arousal to heterosexual and rape stimuli. Results indicated that under instructions not to interfere with sexual responding, approximately 80% of the nonrapists would be correctly classified, which was significantly different from chance. However, under instructions to suppress arousal, classification was no better than chance. The rape index was not related to age, socioeconomic status, sexual experience, or amount of arousal shown in the laboratory. However, there was a small but significant relationship to IQ. Overall, the data suggest that for instructions not to interfere with responding, the error rate seen in this larger-scale sample was equivalent to that in previous studies using smaller normative samples and that classification in general is not biased by the subject characteristics measured in this study.Portions of this project were supported by USPHS Grant MH-34030-02 from the Center for the Studies of Crime and Delinquency and by Tennessee Department of Mental Health and Mental Retardation Research Contract ID-0783 to the Department of Psychiatry.