Abuse and neglect of adults with mental retardation in different residential settings

Eighty-two per cent of all cases of abuse or neglect of an adult with mental retardation substantiated by the Abuse Investigation Division of the Connecticut Office of Protection and Advocacy for Persons with Disabilities over a five-year period occurred in the victim's residence. Chi square analyses revealed that there was significantly more abuse in institutions and group homes and significantly less in the individual's own home. Furthermore, analyses revealed that there was significantly more personal neglect in group homes and community training homes and significantly less in own homes. The results were discussed and recommendations made regarding ways of reducing abuse and neglect.     

The patient-physician relationship and the allocation of scarce resources: a law and economics approach

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance.     

Daniel levinson and his theory of adult development: A reminiscence and some clarifications

I offer some reminiscences occasioned by the death of Daniel Levinson, a modern pioneer in the study of the human life cycle. I clarify three controversial aspects of Levinson's theory—its universality, the role of critical life events, and the place of relationships—as well as briefly foreshadow findings from his forthcoming book on women. I show that relationships to people, enterprises, and social institutions are the stuff out of which the individual life structure—Levinson's central concept—is formed. Levinson's dream was of a society in which the developmental needs of adults were better understood and met so that they could more generatively fill their roles in the institutions upon which the young depend. He thought this essential to the evolution of a society that would be both more competent and more humane. In this dream, which was a product of his own difficult mid-life transition and a measure of the success he achieved in integrating its polarities, Levinson united a warm, scientific interest in others with an affectionate curiosity about nature.     

A selective and critical review of neuropsychological deficits and the frontal lobes

Presumptions about the functions of the frontal lobes, and the sensitivity and specificity of certain tests to measure frontal lobe functions, are having a substantial influence on both clinical and research conclusions. In this paper the authors examine the details of the studies that have contributed to these presumptions, and find that the evidence to support these conclusions is weak. A detailed evaluation of the evidence relating to the Wisconsin Card Sorting Test and the Thurstone Word Fluency Test is also presented. Finally, the development of the belief that frontal lobe functions can be specifically measured is reviewed. The authors of this paper conclude that the bewildering array of deficits attributed to frontal lesions still seems to prevail.     

Computing Cohen’s kappa coefficients using SPSS MATRIX

This short paper proposes a general computing strategy to compute Kappa coefficients using the SPSS MATRIX routine. The method is based on the following rationale. If the contingency table is considered as a square matrix, then the observed proportions of agreement lie in the main diagonal’s cells, and their sum equals the trace of the matrix, whereas the proportions of agreement expected by chance are the joint product of marginals. The generalization to weighted kappa, which requires an additional square matrix of disagreement weights, both matrices having the same order, becomes possible by the use of the Hadamard product-that is, the elementwise direct product of two matrices.     

Diaphragmatic spasm: A neglected cause of dyspnoea and chest pain

The study included 17 patients, 12 women and 5 men, with a recurrent symptom complex involving chest pain and dyspnoea characterized by inability to get a full breath. Some attacks had subsided spontaneously. Others had lasted hours or days. When examined by fluoroscopy during an attack, each subject was found to have a nearly maximally contracted (flat) diaphragm. In some of them the attack was promptly interrupted by a small intravenous injection of sodium amytal. In others it could be aborted by a conscious effort at full expiration. The syndrome associated with diaphragmatic spasm is discussed in comparison with other noncardiac sources of chest pain and dyspnoea.