The Patient Self-Determination Act and Advance Directives: Snapshots of Activities in a Tertiary Health Care Center

This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.     

Client preferences for informed consent information

Thirty-five current therapy clients, 47 former clients, and 42 college students with no therapy experience rated 27 items in terms of importance for inclusion in informed consent discussions. The current and former client samples rated information about inappropriate therapeutic techniques, confidentiality, and the risks of alternative treatments as most important, and information about the personal characteristics of the therapist and the therapist's degree as least important. The results of this study provide evidence for differential informed consent disclosure practices.     

Minds and Bodies: Human and Divine

Does God have a mind? Western theism has traditionally construed God as an intentional agent who acts on creation and in relation to humankind. God loves, punishes, and redeems. God's intentionality has traditionally been construed in analogy to human intentionality, which in turn has often presumed a supernatural dualism. Developments in cognitive science, however, render supernatural dualism suspect for explaining the human mind. How, then, can we speak of the mind of God? Borrowing from Daniel Dennett's intentional stance, I suggest that analogical reasoning regarding the mind of God be abandoned in favor of an ontologically agnostic approach that treats God as an intentional system. In this approach, God's purposive action is an explanatory feature of the believer's universe, a real pattern that informs our values and beliefs about the world and our place in it.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

Variation of Isometric Response Force in the Rat

Hungry, unrestrained rats (N = 7) were rewarded for pressing a response beam in excess of 11 different force requirements. Changes in peak force production as a function of peak force requirement were examined by analyses of the first four moments of distributions of peak response forces: constant error, the within-subject standard deviation, skewness, and kurtosis. Results were similar to those previously obtained with human subjects: Constant error was positive at low and negative at high force requirements, the within-subject standard deviation increased as a negatively accelerating function of force requirement, and skewness and kurtosis were positive at low force requirements and decreased to negative values at the highest increments. Additional analyses of response kinetics indicated that rats, like humans, meet increasing force requirements by altering the rate of rise of force. The performance similarities suggest that common processes are engaged by the human and rat motor control systems to solve the problem of generating forces that are appropriate to the prevailing environmental constraints.     

Exposure-based models of human parsing: Evidence for the use of coarse-grained (nonlexical) statistical records

Several current models of human parsing maintain that initial structural decisions are influenced (or tuned) by the listener's or reader's prior contact with language. The precise workings of these models depend upon the grain, or level of detail, at which previous exposures to language are analyzed and used to influence parsing decisions. Some models are premised upon the use of fine-grained records (such as lexical cooccurrence statistics). Others use coarser measures. The present paper considers the viability of models based exclusively on the use of fine-grained lexical records. The results of several studies are reviewed and the evidence suggests that, if they are to account for the data, experience-based parsers must draw upon records or representations that capture statistical regularities beyond the lexical level. This poses problems for several parsing models in the literature.Aspects of this work were supported by ESRC grant No. R0023 4062 to Don Mitchell, by a Spanish Government grant DGICVT No. PB-92-0656-C04-02 to Fernando Cuetos, and by the Belgian National Fonds voor Wetenschappelijk Onderzoek, of which Marc Brysbaert is a Research Associate. We are grateful to Chuck Clifton, Barbara Hemforth, Martin Pickering, Matt Traxler, and an anonymous reviewer-all of whom made helpful comments on an earlier draft of the paper.     

Measures of feeling-of-knowing accuracy: A new look at an old problem

Two ordinal measures of feeling-of-knowing performance appropriate for n × n data arrays are reviewed. Goodman and Kruskal's gamma provides a measure of association between recognition performance and feeling-of-knowing judgements. The Hamann coefficient provides a measure of agreement accuracy. The relative strengths and weaknesses of each measure are compared at length. A proof is provided, which reveals a lack of one-to-one relation between the two and suggests that they may be independent under most circumstances. It is concluded that both measures should be reported together as complementary indices as each captures a different facet of feeling-of-knowing performance. Alternative measures for gamma and the Hamann coefficient are considered and a number of recommendations are made for future research.