Values interpretation: A new model for hospital ministry

The importance of values in clinical settings is a topic of increasing discussion in the medical literature, but the nature of values and the process of interpreting them have received little attention. The hospital chaplain or religious professional is an underused resource in addressing values issues. This paper summarizes the current models of the hospital chaplaincy in historical context, and then develops a new model drawn from the disciplines of pastoral care and clinical medical ethics in order to address problems involving values in clinical settings. The model construes the chaplain as values interpreter who provides both consultation and liaison functions in clinical situations. We present a clinical case to illustrate the role of the values interpreter. We conclude that the religious professional can make an important contribution to both clinical decision making and medical education through such a model.The authors thank Don S. Browning, Ph.D., and Thomas H. Jobe, M.D., for their critical readings of earlier versions of this paper.     

Developmental perspectives on the localization and detection of auditory signals

Responsiveness of 1-, 3-, and 5-year-old children and adults to octave-band noises at .4 and 10 kHz was assessed with a go/no-go version of visual reinforcement audiometry (VRA) (Moore, Thompson, & Thompson, 1975) and a two-alternative, forced-choice version (Suzuki & Ogiba, 1961; Trehub, Schneider, & Endman, 1980). Infants performed better on the two-alternative, forced-choice version in quiet and in noisy backgrounds, and adults performed better on the two-alternative, forced-choice version in quiet but not in noisy backgrounds. Performance on the two tasks was essentially equivalent for 3- and 5-year-old children. Superior performance on two-alternative VRA over go/no-go may be due to lesser cognitive demands in the case of infants and to the engagement of superior decision strategies in the case of adults.     

Spatial and conjoint models based on pairwise comparisons of dissimilarities and combined effects: Complete and incomplete designs

In pairwise multidimensional scaling, a spatial representation for a set of objects is determined from comparisons of the dissimilarity of any two objects drawn from the set to the dissimilarity of other pairs of objects drawn from that set. In pairwise conjoint scaling, comparisons among the joint effects produced by pairs of objects, where the objects in a pair are drawn from separate sets, are used to determine numerical representations for the objects in each set. Monte Carlo simulations of both pairwise dissimilarities and pairwise conjoint effects show that Johnson's algorithm can provide good metric recovery in the presence of high levels of error even when only a small percentage of the complete set of pairwise comparisons are tested.     

A comparative evaluation of parent-training interventions for families of chronic delinquents

Fifty-five families of chronically offending delinquents were randomly assigned to parent-training treatment or to service traditionally provided by the juvenile court and community. The families in the parent-training group received an average of 44.8 hours of professional contact (23.3 hours of which were phone contacts), and each control group family received treatment estimated at more than 50 hours on the average. Comparisons of police contact data at baseline and subsequent years for the two groups showed that subjects in both groups demonstrated reduced rates of offending during the followup years. The finding most relevant was significant treatment-by-time effect for offense rates, with most of this effect accounted for by a greater reduction in serious crimes for the experimental group during the treatment year, and a similar reduction of the community control group occurring in the first of three followup years. These early decrements in offense rates persisted during followup for both groups. Throughout the study, boys in the experimental group spent significantly less time in institutional settings than did boys in the control group. Parent training had a significant impact, but the reduction in offending was produced at very high emotional cost to staff. Although it is clear that this population requires substantial treatment resources, this study underscores the need for more work on prevention.Research for this paper was supported by grant MH 37938 from the Center for Studies of Antisocial and Violent Behavior, National Institute of Mental Health (NIMH), U.S. Public Health Service (PHS). The writing was supported in part by grants MH 17126 and MH 37940 from the same Center, grant DA 05304 from the National Institute of Drug Abuse, U.S. PHS., and grant MH 38730 from the Child and Adolescent Disorders Research Branch, NIMH, U.S. PHS. The authors gratefully acknowledge the enduring commitment of the treatment staff that made this study possible: Patricia Chamberlain, Marion Forgatch, and Kate Kavanagh.     

Use of the family adaptability and cohesion evaluation scales in child clinical research

Although the FACES has become a widely used instrument for assessing children's family relations, the possible linearity vs. curvilinearity of its cohesion and adaptability scales has been treated inconsistently by investigators. This study evaluated whether samples of adolescent repeat offenders, young adult prisoners, and adolescent nonoffenders were discriminated better by a linear or curvilinear treatment of the FACES scores. Between-groups comparisons showed that significant effects were observed for each of the three curvilinear measures (cohesion-curvilinear, adaptability-curvilinear, distance-from-center) and only one of the two linear measures (cohesionlinear). These findings support the superiority of a curvilinear treatment of the FACES. In light of these findings, it is suggested that investigators who use FACES evaluate the linearity of the scales and determine whether a linear or curvilinear treatment of the data produces more meaningful results.     

A developmental study of the relationship between geometry and kinematics in drawing movements.

Trajectory and kinematics of drawing movements are mutually constrained by functional relationships that reduce the degrees of freedom of the hand-arm system. Previous investigations of these relationships are extended here by considering their development in children between 5 and 12 years of age. Performances in a simple motor task--the continuous tracing of elliptic trajectories--demonstrate that both the phenomenon of isochrony (increase of the average movement velocity with the linear extent of the trajectory) and the so-called two-thirds power law (relation between tangential velocity and curvature) are qualitatively present already at the age of 5. The quantitative aspects of these regularities evolve with age, however, and steady-state adult performance is not attained even by the oldest children. The power-law formalism developed in previous reports is generalized to encompass these developmental aspects of the control of movement.     

Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.     

AIDS-related factors predictive of suicidal ideation of low and high intent among gay and bisexual men.

AIDS-related stressors were studied in relationship to suicidal ideation and suicide intent among 778 gay and bisexual men (none with AIDS). Over the previous six months, 27% (n = 212) reported suicidal ideation. Subjects who reported suicidal ideation (compared to those who did not) were more likely to report recent (last 6 months) bereavement of partner, recent ARC diagnosis, and multiple close friends with ARC. Suicide ideators were divided by a median split on a self-report scale of suicide intent into low (n = 105) and high (n = 107) intent suicide ideators. News of HIV seropositivity was specifically related to low intent suicidal ideation. High intent suicidal ideation was associated with having a partner with AIDS or ARC, or multiple close friends with AIDS, or having ARC. Generally speaking, while temporally discrete AIDS-related events were associated the report of suicidal ideation, ongoing stressors which may more greatly challenge adaptational capacities were more associated with high intent suicidal ideation.