Doctors,Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.     

The Jerusalem TeleRehabilitation System, a new low-cost, haptic rehabilitation approach.

Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises. The Jerusalem TeleRehabilitation System (JTRS) consists of patient and therapist systems plus a central server and database connected via the internet. The system can work in two modes: (1) a cooperative mode in which the therapist and patient are online at the same time, and (2) a stand-alone mode in which the patient uses the system on his own. In both cases, the system will monitor the status and progress of the patient and various parameters of his movement abilities, and prepare reports for the patient and for the therapist. From the clinic, the therapist will be able to change the screen seen by the patient and change the level and types of tasks, as needed. Compared to existing systems, our system will have the following advantages: (1) inexpensive and easy to use; (2) remote monitoring and control of the patient's computer by the therapist in the clinic; (3) more detailed analysis of patient status and progress; (4) a "smart" system which self-adapts to the patient's capabilities in real time, increasing or decreasing the difficulty of the exercise as needed; and (5) a central, international database which, by gathering data on many patients over time, will provide the basis for "smart" therapy and will also facilitate coordinated multicenter research studies.     

Taxometric Investigation of PTSD: data from two nationally representative samples

Current psychiatric nosology depicts posttraumatic stress disorder (PTSD) as a discrete diagnostic category. However, only one study has examined the latent structure of PTSD, and this study suggested that PTSD may be more accurately conceptualized as an extreme reaction to traumatic life events rather than a discrete clinical syndrome. To build on the existing literature base, the present research examined the latent structure of posttraumatic stress reactions by applying three taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from large nationally representative samples of women (ns = 2684 and 3033) and adolescents (n = 3775). Results consistently provided evidence for a dimensional PTSD solution across samples and statistical procedures. These findings have important implications for the theory, assessment, and investigation of posttraumatic stress reactions.     

Which cues are available to 24-month-olds? Evidence from point-of-gaze measures during search

In previous research 2-year-olds have failed to show knowledge of solidity in a search task in which a ball rolled behind a screen and was stopped by a barrier. The screen had four doors and the barrier was visible above the door hiding the ball. To establish what cues 2-year-olds might be using, precise point-of-gaze measures were taken during the hiding event. A transparent screen with opaque doors provided two cues: (1) the ball could be tracked until it failed to emerge, and (2) the barrier's position could indicate the correct door. Point-of-gaze measures revealed that children failed to use the more indirect cue of the barrier, which requires reasoning and spatial integration. Their search success was predicted only by the more immediate cue of actively tracking the ball. These findings support the claim that children use best those cues directly related to the object's disappearance, while failing to use cues that entail higher cognitive demands.     

The possible benefits of difficulty: how stress can increase and decrease subjective well-being

This study explores the effects of stress, trauma, coping and growth orientation on subjective well-being. Based on cognitive stress theory, it was hypothesized that adversity may contribute to increased or decreased well-being, depending on the subsequent meaning these experiences are given. Survey data from Norwegian UN/NATO veterans (N= 142) showed that stress and well-being were negatively associated (r=-0.20, p < 0.05) at the level of zero-order correlations. However, a full structural equation model revealed that the effect of stress on well-being was mediated positively through a problem-focused coping process combined with a growth component. Stress was negatively mediated through an avoidant-focused coping process and a distress component. The effect from stress was fully mediated in the model. The hypothesis that stress can produce both increased and decreased subjective well-being was confirmed.     

Episodic chasing in pathological gamblers using the Iowa gambling task

"Chasing ones losses" is a key symptom among pathological gamblers (PGs). This study focuses on quantitative differences in episodic chasing (i.e., sequences of disadvantageous decisions within a single gambling session) between PGs and non-pathological gamblers (NPGs). We compared 61 PGs and 39 NPGs on the Iowa Gambling Task (IGT) and the Zuckerman Sensation Seeking Scale (SSS). The PGs showed significantly more chasing and had significantly poorer decision-making strategies than NPGs, particularly among males (F = 4.52, p < 0.05). Random players were significantly less sensation seeking than advantageous and disadvantageous (i.e., chasing) players, but there was no interaction with group or gender. The results suggest that quantifiable within-session gambling behavior holds important implications for detecting underlying vulnerabilities to gambling pathology.     

Does a regional accent perturb speech processing?

The processing costs involved in regional accent normalization were evaluated by measuring differences in lexical decision latencies for targets placed at the end of sentences with different French regional accents. Over a series of 6 experiments, the authors examined the time course of comprehension disruption by manipulating the duration and presentation conditions of accented speech. Taken together, the findings of these experiments indicate that regional accent normalization involves a short-term adjustment mechanism that develops as a certain amount of accented signal is available, resulting in a temporary perturbation in speech processing.     

Experimenting with phenomenology

We review the use of introspective and phenomenological methods in experimental settings. We distinguish different senses of introspection, and further distinguish phenomenological method from introspectionist approaches. Two ways of using phenomenology in experimental procedures are identified: first, the neurophenomenological method, proposed by Varela, involves the training of experimental subjects. This approach has been directly and productively incorporated into the protocol of experiments on perception. A second approach may have wider application and does not involve training experimental subjects in phenomenological method. It requires front-loading phenomenological insights into experimental design. A number of experiments employing this approach are reviewed. We conclude with a discussion of the implications for both the cognitive sciences and phenomenology.     

Sources of variability in children’s language growth

The present longitudinal study examines the role of caregiver speech in language development, especially syntactic development, using 47 parent–child pairs of diverse SES background from 14 to 46 months. We assess the diversity (variety) of words and syntactic structures produced by caregivers and children. We use lagged correlations to examine language growth and its relation to caregiver speech. Results show substantial individual differences among children, and indicate that diversity of earlier caregiver speech significantly predicts corresponding diversity in later child speech. For vocabulary, earlier child speech also predicts later caregiver speech, suggesting mutual influence. However, for syntax, earlier child speech does not significantly predict later caregiver speech, suggesting a causal flow from caregiver to child. Finally, demographic factors, notably SES, are related to language growth, and are, at least partially, mediated by differences in caregiver speech, showing the pervasive influence of caregiver speech on language growth.