Eye- and mouth-opening movements replacing head and hand responses in a microswitch program for an adolescent with deteriorating motor condition

This study assessed the possibility of replacing head and hand responses (no longer feasible) with minimal movements within the microswitch-based program of an adolescent with deteriorating motor condition and multiple disabilities. The new movements, i.e., eye- and mouth-opening, were introduced individually and then combined through the simultaneous availability of the related microswitches. Data showed the participant acquired the new movements (responses) successfully and retained them at a 2-mo. postintervention check. Mood improvements, i.e., increases in indices of happiness, also occurred through the program. The conclusion was that a person with deteriorating motor conditions may be able to revitalize a microswitch-based occupational program and retain a constructive engagement if new, feasible responses are identified.     

Trotter G: The Ethics of Coercion in Mass Casualty Medicine The Johns Hopkins University Press; 2007

Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters.     

Variable Neighborhood Search Heuristics for Selecting a Subset of Variables in Principal Component Analysis

The selection of a subset of variables from a pool of candidates is an important problem in several areas of multivariate statistics. Within the context of principal component analysis (PCA), a number of authors have argued that subset selection is crucial for identifying those variables that are required for correct interpretation of the components. In this paper, we adapt the variable neighborhood search (VNS) paradigm to develop two heuristics for variable selection in PCA. The performances of these heuristics were compared to those obtained by a branch-and-bound algorithm, as well as forward stepwise, backward stepwise, and tabu search heuristics. In the first experiment, which considered candidate pools of 18 to 30 variables, the VNS heuristics matched the optimal subset obtained by the branch-and-bound algorithm more frequently than their competitors. In the second experiment, which considered candidate pools of 54 to 90 variables, the VNS heuristics provided better solutions than their competitors for a large percentage of the test problems. An application to a real-world data set is provided to demonstrate the importance of variable selection in the context of PCA.     

Learning as a possible sign of non-reflective consciousness in persons with a diagnosis of vegetative state and pervasive motor impairment

A diagnosis of vegetative state represents a serious predicament, which basically precludes/minimizes rehabilitation perspectives. Reliability of the assessment approach in these situations is of paramount importance, but not easy to achieve. In recent studies, a learning assessment procedure has been suggested as a supplement in the diagnostic process and assessed with eight patients. The procedure involves an ABABCB sequence in which A represents baseline phases with no stimulation available, B intervention phases with stimuli delivered contingently on target responses, and C a control condition. This condition involves stimulation presented non-contingently. The patients’ ability to associate responding with environmental stimuli and thus increase such responding during the B phases, and reduce it during the A and C phases, may be considered a sign of learning. Learning might be viewed as representative of forms of concrete knowledge and presumably basic levels of consciousness. Preliminary results indicate that (a) signs of learning may appear in patients with a previous diagnosis of vegetative state and (b) the presence of those signs may require a revision of their diagnostic label and a reappraisal of their rehabilitation perspectives.     

Parents’ Autobiographical Narratives: Setting Events for Their Contemplation of Mindful Changes

The ability to tell a coherent and rich story about one’s personal life is an important marker of an individual’s capacity and willingness to contemplate personal change. We review research on correlations between the coherence of parents’ narrative accounts of life experiences and their responsiveness during interactions with their children. Based on this review, we explore ideas about the nature of narrative coherence, how parents might be taught to improve this structural feature when telling their stories, and why a well constructed story might enhance the parents’ objective study of the here and now. We discuss how the effects of narrative restructuring may enable parents to be more cognitively mindful of their interactions with their children. We present our speculations in the spirit of promoting discussion of new clinical strategies for parents and new research strategies aimed at experimental analyses of observed connections between parent narratives and their willingness to contemplate personal change.