Confidentiality: a survey in a research hospital

Despite the many justifications for protecting patient confidentiality, we recognize that confidentiality cannot be absolute. Our world of automated information and easy access and storage poses many threats to confidentiality. This paper has described a survey conducted at the NIH Clinical Center to assess the knowledge, attitudes, and behaviors of clinical physicians and nurses about confidentiality of patient information. The survey findings demonstrate the need for reminders and increased awareness about confidentiality in our setting. Most of the survey respondents had a good knowledge of what was expected of them, and they believed that confidentiality was important and maintaining it was their responsibility. Of interest was that in several simulated clinical situations, there was a discrepancy between what respondents indicated they should do and what they thought they would do. The biggest discrepancies appeared in situations that involved overhearing a patient conversation on the elevator, approaching an unfamiliar person who is reading a medical record in the nurses' station, and answering a patient's inquiry about the status of another patient. The findings support the speculation that this difference may be attributed to discomfort or decreased awareness, and not necessarily to lack of knowledge. Results indicate that policies and administrative expectations should be frequently communicated and enforced, and that educational programs that address issues of confidentiality should be provided. The results of this survey have been influential in guiding educational strategies and administrative activities at the clinical center. The clinical center initiated a confidentiality awareness campaign, displaying a new poster every three months in strategic locations and distributing other tangible reminders (such as pens, magnets, and buttons) containing the same confidentiality message.(ABSTRACT TRUNCATED AT 250 WORDS)     

Human classical conditioning

Recent reports of failure to obtain blocking in human galvanic skin response (GSR) conditioning, together with our own equivocal results with eyelid conditioning, have motivated us to re-examine the status of the conditioned stimulus (CS) in human conditioning studies. The issues raised by compound stimuli, by contextual cues and occasion setting stimuli, and by cross-modal transfer are considered in the light of data from our laboratories. These data include observations on the interchangeability of stimulus modalities during acquisition, the use of varying information loads embedded in occasion setting displays, the comparison of alternative blocking designs and the analysis of response topography in relation to stimulus variability. They suggested that an adequate account of the CS in human conditioning studies must recognize that it is dynamically processed and reprocessed both during and after acquisition.     

The acquisition of observing.

Pigeons were exposed to stimuli correlated with the presence or absence of a variable-interval 60-second schedule of reinforcement only while they depressed a crossbar or "perch." In the first experiment, the stimuli were different tilts of a line displayed on the key. When the difference in brightness between the line and the background (salience) was maximal, seven of eight birds acquired the discrimination, but when the difference was reduced by 50%, only one succeeded. In the second experiment, wavelength of chamber illumination served as the relevant dimension. Neither experiment showed a large effect attributable to the magnitude of the difference (disparity) between the positive and the negative stimulus. Individual differences in time spent observing were positively correlated with level of discrimination in the presence of the stimuli. All birds produced the positive stimulus for a greater proportion of the available time than they did the negative stimulus. This may be the mechanism that provides selective reinforcement of observing. Finally, the formation of a discrimination was analyzed in terms of changes in the proportion of time spent in contact with the discriminative stimuli.     

Vocal changes in stutterers and nonstutterers when speaking to children

Within the last few years, considerable attention has been devoted to the possibility that the amelioration of stuttering in many novel speaking conditions is a function of vocal changes with or without accompanying modifications in prosodic expression. These formulations have made reference primarily to conditions in which stutterers were induced into one or another novel speech pattern by an external stimulus such as masking noise, a rhythmic cue, or by instructions to sing, or read in unison with another speaker. In contrast, far less attention has been paid to other ameliorative conditions that lack a novel external stimulus or special instructions that direct the stutterer to speak in some unique manner. Speaking or reading to a child is an example of this latter type of condition. The present study was conducted to see if nine adult stutterers and a matched group of nonstutterers would evince vocal changes as they read aloud to another adult, a child, and a child and adult together. There was also a fourth control condition wherein the subjects read to one of the experimenters. Dependent measures of disfluency and stuttering, fundamental frequency, fundamental frequency deviation, fluent reading rate, and peak vocal sound pressure level were made and treated statistically. The major findings of this study indicated that, relative to the control condition, both subject groups exhibited several vocal changes when reading to a child alone and to a child and adult together. In addition, the stutterers experienced a reduction in disfluency, but only when reading to the child alone. The normal speakers exhibited too few disfluencies in the control condition for any meaningful change to occur in that dependent variable. The fact that the stutterers evinced vocal changes in both experimental conditions but a significant drop in disfluency in just one bears importantly on hypotheses that emphasize vocal changes in conditions that ameliorate stuttering.     

Madness as religious experience: The case of Allen Ginsberg

Various writers have considered madness to be a religious experience. On the basis of the literature in the area and conversations with psychiatric patients, it is argued that madness as a religious experience can be viewed as a four-stage developmental process. The four stages are: 1) The hurt-and-be-hurt state of being, 2) The self-induced psychedelic experience, 3) The confusion-and-dread reaction, and 4) The reconstruction-with-insight world view. To clarify how these four stages make up a religious experience, the poet Allen Ginsberg's so-called psychotic episode is organized around each of the stages.     

Negative recency and measurement of primary memory.

The technique of Waugh & Norman (1965) is widely used in measuring the capacity of primary memory. Watkins (1974) has proposed a modification of the technique which takes into account registration failure. A further modification is proposed which takes into account findings of negative recency in delayed recall.     

Taste aversions to mother's milk: the age-related role of nursing in acquisition and expression of a learned association.

The development of taste aversion learning to novel cues contained in mother's milk was examined in rat pups. Pups receiving distinctive mild by experimenter-delivered oral infusions followed by toxicosis formed an aversion to the dam's diet. Robust aversions were learned as early as Day 10 and were retained for at least 11 days. When the same distinctive milk was obtained directly from a foster mother through nursing, however, only weanling-age pups (over 20 days) formed an aversion. X-ray analysis of nipple location in the mouths of suckling pups suggested that pups between the ages of 10 and 21 days receive milk at a similar tongue locus. Flavored milk was then delivered at specific time intervals in controlled quantities through tongue cannulas implanted at loci corresponding to the nipple position shown by the X-rays. Cannulated preweanling pups that were attached to a nipple during milk delivery failed to associate the taste cue with illness, whereas both preweanlings off the nipple and weanlings on the nipple acquired aversions to the taste cue in the milk. The evidence obtained in these experiments suggests that pups of all ages are incapable of expressing a taste aversion in a nursing situation and that preweanling pups in particular are also dificient in acquiring aversions within a suckling context. The inability of preweanling pups to acquire taste aversions in a nursing situation appears to result from a failure to associate taste cues with illness rather than a failure to detect taste cues obtained from a nipple.     

Generalized and specific expectancies: Sequential mediators of interpersonal behavior1

Two experiments confirmed sequential mediation of social interaction by investigating the effects of generalized expectancies on specific expectancies and the effects of specific expectancies on performance. Both experiments used a simulated tutoring task in which the subject took the role of tutor while a confederate took the role of student. In Experiment 1 subjects combined generalized expectancies about the effectiveness of certain tutoring responses with specific situational information to produce specific expectancies about the results of the tutoring responses under the experimental circumstances. Experiment 2 replicated this finding and showed that specific expectancies of the relative effectiveness of different responses influenced which response was performed more. Results were discussed in terms of cognitive motivation theory and social learning theory.