Case vignette: premature surrender

Three commentaries are offered on the following case: George, age 57, is a previously healthy man who recently underwent surgery for removal of a low-grade malignant thymoma. At the time of admission to the hospital, George stressed to the staff that he had long ago signed a "living will," which he renewed immediately after he learned of his cancer diagnosis. At the time of surgery, the tumor was found to extend into his mediastinum; although it was removable, this required revision of part of the sternum and grafting of the vessels feeding the heart chambers. Because of the resultant tissue damage and neuronal hyperactivity, George experienced postoperative episodes of cardiac arrhythmia and bronchospasm. Unanimous medical opinion was that this situation was a temporary problem that would resolve itself as the tissues healed. Until that time, however, it will be difficult to wean him from ventilatory support. When his stay in the intensive care unit became prolonged, George and his family began to insist that his status be changed to "do not resuscitate" and reminded the staff about his longstanding living will. All of this is happening despite the fact that the patient and family seemingly comprehend that although the short-term interventions are invasive, there is a high probability of a successful outcome. George's cancer prognosis is excellent, and, although he may well have an episode of life-threatening arrhythmia, he is likely to respond to resuscitation interventions. Once the immediate postoperative period is over, his potential for a long and productive life with full capacities is excellent. Consider the following questions: (a) Should George's expressed wishes be respected, or should the staff take additional steps to help him survive the postoperative period, even if that means violating his stated wishes? and (b) What steps might the staff follow in sorting through this problem?     

The effect of unilateral stellectomy on the regulation of heart rate during behavioral stress

Changes in heart rate were examined during classical aversive conditioning before and after either left (n=10) or right stellectomy (n=8). Heart rate (HR) significantly (p<0.01) increased in response to the conditional stimulus with a further increase noted during the unconditional stimulus. After right stellectomy (RSGx) the aversive stress elicited a significantly (p<0.01) smaller increase in heart rate (peak HR change: control 66.8 +/- 6.0; RSGx 36.1 +/- 6.8 beats/min). In contrast left stellectomy did not significantly alter the heart rate conditional response. Cardioselective beta-adrenergic receptor blockade, metoprolol HCl (BB, 1.0 mg/kg, n=8), significantly (p<0.01) reduced the heart-rate conditional response (peak HR change: control 66.8 +/- 6; BB 25.1 +/- 3.8 beats/min) to the same extent as noted during RSGx. These data suggest that the heart-rate increases elicited by aversive stress are mediated in part by sympathetic nerves that originate or pass through the right stellate ganglion. The residual HR increase noted after RSGx or BB probably results from the withdrawal of cardiac parasympathetic activity.     

Orientation-contingent color aftereffects mediated by subjective transparent structures

We examined whether the orientation-contingent color aftereffect (the McCollough effect) could be mediated by subjective horizontal and vertical structure induced by the perception of transparency. In our experiments, red vertical bars and green horizontal bars were alternated as an adapting stimulus. After adaptation, subjects (n=6) were asked to adjust the green and red saturation of a test pattern until they obtained a neutral gray. Horizontal and vertical stripes were combined in the test pattern in three different ways: (1) overlapping with a luminance combination that gave rise to a perception of transparent overlays of horizontal and vertical stripes (valid transparency condition), (2) overlapping with luminance combinations that did not induce a perception of transparency (invalid transparency condition) and that appeased more as a patchwork of checks, and (3) presented in adjacent, nonoverlapping areas. Our results showed that the McCollough effect was significantly greater in the valid transparency condition than in the invalid transparency conditions. The effect in the valid transparency condition was nevertheless less strong than was the effect seen with the standard test stimulus made up of nonoverlapping vertical and horizontal stripes, Our results suggest that the McCollough effect can be mediated by the subjective spatial organization (inner representation of vertical and horizontal stripes) that accompanies the perception of transparency in our stimulus.     

Attention deficit disorder with hyperactivity and methylphenidate: The effects of dose and mastery level on children's learning performance

This investigation examined the relationship between methylphenidate (MPH) and the learning and recall of paired associations by children with attention deficit disorder with hyperactivity (ADDH). Forty-five children with ADDH were randomly assigned to one of three groups (novel, partial mastery, and mastery learning) that varied in the amount of previous learning of paired associations and participated in a double-blind, placebo-control, repeated-measures-across-dose (crossover) design. Each child received four doses of MPH (5 mg, 10 mg, 15 mg, and 20 mg) and a placebo in a random, counterbalanced sequence. The results indicated that both the rate of acquisition and accuracy in learning paired associations were significantly, but differentially, affected by MPH dose and the degree of learning mastery. The implications of these results for psychopharmacological research and the monitoring of psychostimulant effects on children's learning performance in academic settings are discussed.The authors wish to acknowledge and express their sincere appreciation to the graduate and undergraduate student members of the Children's Learning Clinic.     

Interfacing Apple and IBM computers for the analysis of clinical biofeedback

This paper demonstrates a method of transferring research data from a remote clinic to a large university mainframe for data manipulation and statistical analysis. Data collected by an Apple //e computer were transferred to an IBM 3031 mainframe by sending data files to an IBM PC by telephone modem or by direct hardwire connection to the PC. The IMB PC performed data-formatting routines and then uploaded the files to the mainframe for storage. Advantages and disadvantages of sending data over telephone lines via a modem are discussed.     

Single-subject statistical analysis of computer-assisted biofeedback

Single-subject statistics were used to analyze physiological data [electromyographic (EMG) temperature] recorded from two patients receiving computer-assisted biofeedback treatment in a clinic. When the data were analyzed by an ANOVA method or a regression technique, the results demonstrated that both patients learned to significantly reduce EMG levels. The rationale of using single-subject statistics is discussed, and the applicability of the statistical technique to the clinic population is illustrated.     

A Psychoneuroimmunologic Perspective on AIDS Research: Questions,Preliminary Findings,and Suggestions1

Starting with the premise that research questions emanating from the fields of psychoneuroimmunology and behavioral medicine may provide critical information for understanding and treating acquired immune deficiency syndrome (AIDS), we provide brief backgrounds on psychoneuroimmunology and on AIDS. Previously, Solomon had generated 25 hypotheses based on the thesis that the immune and central nervous systems are intimately linked. Eight hypotheses from his list are presented as particularly relevant to AIDS. From these hypotheses, we derived a set of 12 new questions to be addressed in research on AIDS. Evidence and illustrations from studies in the literature, from our own research on psychoimmunologic relationships and psychosocial factors related to outcome, and from clinical examples is discussed for each question. Finally, suggestions are offered to address some of the problems in conducting psychoneurologic research.     

The effect of subject's gender on judgments of similarity and choice of a comparison other

This study examined the implications for social comparison theory of the proposition that women have lower self-confidence than men when there is a socially defined standard of performance. To this end, it was hypothesized that women would judge themselves to be similar to a lower ranked person, whereas men would judge themselves to be similar to a higher ranked person. Furthermore, it was hypothesized that women would choose to see a score lower than their own, whereas men would choose to see a score higher than their own. The results on the measure of similarity indicated that men did judge themselves to be similar to a higher ranked person, whereas women showed no consistent preferences in their judgments of similarity. The results on the choice of a comparison other were not as clear-cut.