Unaltered ethical standards for individual physicians in the face of drastically reduced resources resulting from an improvised nuclear device event

When disaster disrupts healthcare and other systems, the ethical allocation of resources should follow principles of justice, defined as fairness, established for normal clinical practice. Standards of clinical practice may be altered during disaster, but ethical standards must remain centered on prioritizing the treatment of patients according to need and the effectiveness of treatment. Should resources become extremely limited, it is fair to restrict their use to patients who have the highest needs, provided that the intervention is effective. When resources become more available, patients with lower priority can be increasingly accommodated.     

A STIMULUS CONTROL PROCEDURE TO DECREASE MOTOR AND VOCAL STEREOTYPY

A changing criterion design was used to examine the effects of two stimuli (a green card and a red card), conditioned via discrimination training, on reducing motor and vocal stereotypy in a youngster with autism while he looked at books. During discrimination training, motor and vocal stereotypy was not interrupted in the presence of a green stimulus, but was interrupted in the presence of a red stimulus using manual guidance and appropriate behavior was reinforced. After the participant demonstrated successful discrimination of the stimuli (i.e., the absence of stereotypy in the presence of a red stimulus and the engagement in stereotypy in the presence of a green stimulus), intervention began. During intervention, upon meeting criterion for latency to engage in motor and vocal stereotypy in the presence of the red stimulus for a target duration, the participant was provided access to the green stimulus, which signaled that motor and vocal stereotypy would not be interrupted. The criterion latency to engage in stereotypy in the presence of the red stimulus was systematically increased. Simultaneously, the duration of access to the green stimulus was systematically decreased. The red and green stimuli were faded from poster boards to colored 10 × 10 cm cards, and stimulus control was generalized to the participant's classroom and to a community setting (i.e., public library). Results are discussed in terms of discrimination training as a useful intervention for reducing motor and vocal stereotypy. Copyright © 2011 John Wiley & Sons, Ltd.     

Body dysmorphic symptoms: phenomenology and ethnicity

Differences in the presentation of clinical features of body dysmorphic disorder (BDD) across ethnic groups have received little investigation. The current study assessed BDD symptoms in an ethnically diverse sample of adults (n=401) using an online survey. Participants completed self-report measures assessing BDD symptoms, body parts of concern and BDD behaviors. Compared to Caucasian participants, no significant differences were found in body parts or behaviors reported by Latino or African American participants. Significant group differences did emerge between Asian and Caucasian participants. Specifically, Asians reported more concern with straight hair and dark skin and fewer body shape concerns than Caucasians. Asians also endorsed lower rates of grooming, touching body parts, and camouflaging and higher rates of exercise compared to Caucasians. Although most clinical features of BDD appear similar across ethnic groups, results showed some differences in body parts and behaviors between Caucasians and Asian Americans with BDD symptoms.     

Crimes of obedience: "groupthink" at abu ghraib

Clear evidence of authorization at the highest levels belies administration statements to the effect that the torture at Abu Ghraib was an aberration and simply unauthorized actions by rogue soldiers. The administration reflected a "group mind," demonstrating many qualities of "groupthink." Whatever was necessary, including torture and violation of the Geneva accords, the system in effect authorized, because of the perceived danger to the system and the desperate requirement to get the information out of "them" by whatever means necessary, information that could save lives. The sanctioned violence demonstrated the qualities identified by Kelman and Hamilton (1989) in their study of the Mylai massacre as characteristic of sanctioned massacres: authorization, routinization, and dehumanization. It would seem that officials and participants exhibited all of these characteristics in the decision to conduct extreme interrogation on the "unlawful combatants" imprisoned at Abu Ghraib.     

The role of familiarity in daily well-being: developmental and cultural variation

The present study examined life stage and cultural differences in the degree to which familiarity of one's physical location and interaction partner is associated with daily well-being. Participants reported all the activities they engaged in and how they felt during these activities on a previous day using the Day Reconstruction Method (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004). Both Korean and American retirees were happier when in a familiar place than in an unfamiliar place, whereas the reverse was true for both Korean and American working adults. In addition, we found cultural differences in the role of familiarity of the interaction partner. Specifically, Koreans (both retirees and working adults) were substantially happier when they interacted with a familiar person than when they interacted with an unfamiliar person. In contrast, Americans (both retirees and working adults) were no happier with a familiar person than with an unfamiliar person.     

Biased lineup instructions and face identification from video images

Previous eyewitness memory research has shown that biased lineup instructions reduce identification accuracy, primarily by increasing false-positive identifications in target-absent lineups. Because some attempts at identification do not rely on a witness's memory of the perpetrator but instead involve matching photos to images on surveillance video, the authors investigated the effects of biased instructions on identification accuracy in a matching task. In Experiment 1, biased instructions did not affect the overall accuracy of participants who used video images as an identification aid, but nearly all correct decisions occurred with target-present photo spreads. Both biased and unbiased instructions resulted in high false-positive rates. In Experiment 2, which focused on video-photo matching accuracy with target-absent photo spreads, unbiased instructions led to more correct responses (i.e., fewer false positives). These findings suggest that investigators should not relax precautions against biased instructions when people attempt to match photos to an unfamiliar person recorded on video.     

Elucidating the neural correlates of egoistic and moralistic self-enhancement

Self-enhancement is the biasing of one’s view of oneself in a positive direction. The brain correlates of self-enhancement remain unclear though it has been reported that the medial prefrontal cortex (MPFC) may be important for producing self-enhancing responses. Previous studies have not examined whether the neural correlates of self-enhancement depend on the particular domain in which individuals are enhancing themselves. Both moralistic and egoistic words were presented to participants while transcranial magnetic stimulation (TMS) was applied to the MPFC, precuneus or in a sham orientation. Participants were asked to make decisions as to the words describing themselves, some of which were positive and some of which were negative. It was found the MPFC TMS significantly disrupted egoistic self-enhancement when TMS was delivered to the MPFC. Judgments involving moralistic words were not influenced by TMS. These data provide further evidence that MPFC is involved in self-enhancement, and that the role of MPFC may be selective in this regard.     

Cognitive performance and morning levels of salivary cortisol and alpha-amylase in children reporting high vs. low daily stress perception

The aim of the present study was to assess the effects of daily stress perception on cognitive performance and morning basal salivary cortisol and alpha-amylase levels in healthy children aged 9-12. Participants were classified by whether they had low daily perceived stress (LPS, n = 27) or a high daily perceived stress (HPS, n = 26) using the Children Daily Stress Inventory (CDSI). Salivary cortisol and alpha-amylase were measured at awakening and 30 minutes later. Cognitive performance was assessed using the Cognitive Drug Research assessment system. The HPS group exhibited significantly poorer scores on speed of memory (p < .05) and continuity of attention (p < .05) relative to the LPS group. The HPS group also showed significantly lower morning cortisol levels at awakening and at +30 minutes measures in comparison with the LPS group (p < .05), and mean morning cortisol levels were negatively correlated with speed of memory (p < .05) in the 53 participants. No significant differences were observed between both groups in alpha-amylase levels. These findings suggest that daily perceived stress in children may impoverish cognitive performance via its modulating effects on the HPA axis activity.