Ethical Research in Delirium: Arguments for Including Decisionally Incapacitated Subjects

Here we describe how more important findings were obtained in a delirium study by using an informal assessment of mental capacity, and, in those who lacked capacity, obtaining consent later when or if capacity returned or a proxy was found. From a total of 233 patients 23 patients lacked capacity as judged by our informal capacity judgment and 210 did not. Of those who lacked capacity, 13 agreed to enter in the study. Six of them regained capacity later. When these 13 participants were excluded from analysis, significant findings were no longer evident. These results show that by the inclusion of subjects who lacked capacity the results of analyses of the condition from whish they suffer are altered. We suggest that this approach to the study of delirium is more ethical than the usual system of strict exclusion of people who lack capacity to give consent and for whom assent is not available.     

More about linda or conjunctions in context

Abstract

Tversky and Kahneman (1982; 1983) reported that subjects rated the con junction of two events as more likely than one of the component events. This “conjunction effect” is an error in terms of formal probability, where the probability of more happening is always smaller than the probability of less. They explained this effect in terms of a “representativeness” heuristic. This paper focuses on the context of the problem and the suggestions implied by the questions in the task. The three studies reported here provide evidence that context effects and implicit suggestions alter subjects' judgements. Tvenky and Kahneman's models take no account of such factors. Two studies show that when implicit suggestions are reduced, subjects are much less prone to the conjunction “effect”. Subjects take being asked the question “Is person X a Y?”, as providing evidence that X may be Y.     

Risk for Suicide among Medicaid Beneficiaries

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow‐up care, training mental health providers in assessing suicide lethality, and providing adequate assessment time are all crucial to achieve these objectives.     

Decision criteria do not shift: Commentary on Mueller and Weidemann (2008)

The effects of base rates and payoffs on the shapes of rating receiver operating characteristic curves are inconsistent with the basic assumptions of signal detection theory (SDT), in particular the notion of a shifting decision criterion. Mueller and Weidemann (2008) propose that these unexpected phenomena are not due to problems with the decision- criterion construct but are instead due to two compounded effects: instability of the decision criterion across trials, and even greater instability in the flanking criteria that determine which confidence rating will be reported. There are several problems with the authors’ decision-noise hypothesis. First, even if their hypothesis about decision noise were taken for granted, the key feature of the ratings data that rejects the SDT model would remain a mystery. Second, the same violations of SDT that are exhibited in the ratings paradigm are also exhibited in the yes-no detection task when response time is substituted for confidence as a basis for analysis. Finally, the decision-noise hypothesis predicts that sensitivity will increase when one source of this variation-the response on a previous trial-is controlled for. This prediction was consistently violated in both the yes-no and ratings conditions of Mueller and Weidemann’s experiment. In an Addendum, we respond to Weidemann and Mueller’s (2008) reply to this Comment.     

Values in action scale and the Big 5: An empirical indication of structure

Within this study we used self-report measures completed by 123 undergraduate students from an Australian university to investigate the validity of Peterson and Seligman’s [Peterson, C., & Seligman, M. E. P (2004). Character strengths and virtues. New York: Oxford.] classification system of 24 character strengths and six virtues. We also looked at how the 24 character strengths relate to the Five Factor Model of personality and to a measure of social desirability. Using a second order factor analysis of the 24 character strengths, we found that these 24 character strengths did not produce a factor structure consistent with the six higher order virtues as proposed by Peterson and Seligman [Peterson, C., & Seligman, M. E. P (2004). Character strengths and virtues. New York: Oxford.]. Instead, the 24 character strengths were well represented by both a one and four factor solution. Patterns of significant relationships between each of the 24 character strengths, the one and four factor solutions and the Five Factor Model of personality were found. The results have implications for [Peterson, C., & Seligman, M. E. P (2004). Character strengths and virtues. New York: Oxford.] classification.     

Body satisfaction, eating disorders and suicide ideation in an Internet sample of self-harmers reporting and not reporting childhood sexual abuse

This study examined differences between self-harmers who had and who had not been sexually abused in childhood with regards to other risk factors and associated behaviours commonly identified in the research literature as being related to self-harm. Participants (N = 113, mean age = 19.92 years) were recruited via self-harm Internet discussion groups and message boards, and completed a web questionnaire assessing measures of body satisfaction, eating disorders, childhood trauma and suicide ideation. Self-harmers who reported a history of childhood sexual abuse scored higher on measures of body dissatisfaction, eating disorders, suicide ideation, physical abuse, physical neglect, emotional abuse and emotional neglect. These findings implicate sexual abuse as a powerful traumatic event that can have severe repercussions on an individual, not only in terms of self-harming behaviour but also in terms of developing a wide range of maladaptive behaviours in conjunction with self-harm.     

Qualitative Health Research and the IRB: Answering the “So What?” with Qualitative Inquiry

Qualitative inquiry is increasingly used to foster change in health policy and practice. Research ethics committees often misunderstand qualitative inquiry, assuming its design can be judged by criteria of quantitative science. Traditional health research uses scientific realist standards as a means-to-an-end, answering the question “So what?” to support the advancement of practice and policy. In contrast, qualitative inquiry often draws on constructivist paradigms, generating knowledge either as an end-in-itself or as a means to foster change. When reviewers inappropriately judge qualitative inquiry, it restricts the ways health phenomena can be understood. Qualitative inquiry is necessary because it enables an understanding not possible within scientific explanation. When such research illuminates, it can also shed light onto the “So what?” In order to ensure an appraisal of qualitative inquiry congruent with its paradigmatic premises, we suggest the “Illumination Test,” met when findings foster rich understanding of phenomena, resulting in a reflective “aha!”     

Praying for Courage: African Religious Leaders and Climate Change

Climate change has emerged as one of the major challenges facing Africa. This article argues that religious leaders in Africa must mobilize their communities to provide effective responses to climate change. Although prayer occupies a central place in the major religions found in Africa, this article maintains that religious leaders must invest in innovative strategies to address climate change. They must avoid escapist prayers. The article analyzes the strengths of religious leaders in Africa and identifies some of the areas where they can play an effective role. It calls upon African religious leaders to challenge triumphalist theologies, mobilize for local action, and convene multi‐religious meetings on climate change.