Patient autonomy and the challenge of clinical uncertainty

Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. Empirical studies suggest that physicians find it more difficult to adhere to norms of disclosure in situations where there is substantial uncertainty. They may be concerned that acknowledging their own uncertainty will undermine patient trust and create additional confusion and anxiety for the patient. We argue, in contrast, that effective disclosure will protect patient trust in the long run and that patients can manage information about uncertainty. In situations where there is substantial uncertainty, extra vigilance is required to ensure that patients are given the tools and information they need to participate in cooperative decision making about their care.     

Observing emotion in infants: facial expression,body behavior,and rater judgments of responses to an expectancy-violating event

Eleven-month-old European-American, Japanese, and Chinese infants (ns = 23, 21, and 15, respectively) were videotaped during baseline and stimulus episodes of a covert toy-switch procedure. Infants looked longer at the object during the expectancy-violating event (stimulus episode) but did not produce more surprise-related facial expressions. American and Japanese infants produced more bodily stilling during stimulus than baseline, and American infants also produced more facial sobering. Naive raters viewing both episodes could correctly identify the expectancy-violating event. Rater judgments of surprise were significantly related to infants' bodily stilling and facial sobering. Judgments of interest were related to cessation of fussing. Thus, observer judgments of infant emotions can be systematically related to behaviors other than prototypic emotional facial expressions.     

Emotion among women with psychopathy during picture perception

Emotional reactions in women with psychopathy were examined in a mixed-picture paradigm using psychophysiological measures. Startle probes were presented at 2.0 or 4.5 s following onset of a 6-s picture presentation. At 2.0 s, nonpsychopaths exhibited the typical pattern of eyeblink reflex magnitude: unpleasant > neutral > pleasant. Psychopaths with high general levels of anxiety also exhibited this pattern. Psychopaths with lower anxiety exhibited attenuated reflex magnitudes during unpleasant pictures. Similarly, when focusing on psychopathy components, only individuals expressing high antisocial behavior and high emotional detachment exhibited smaller reflex magnitudes during unpleasant pictures. At 4.5 s, all groups exhibited normal, potentiated reflex magnitudes during unpleasant pictures. Group differences were not observed for other measures.     

What the precedence effect tells us about room acoustics

Sound produced in a room is typically followed by numerous reflected sounds from nearby surfaces; yet we perceive a single sound source. This perceptual phenomenon, known as the precedence effect, has long been assumed to involve echo suppression, but the nature of this suppression remains unclear. In two experiments, we investigated whether information about the lagging sound's location was perceived. Our hypothesis was that such information is critical because reflected sound can function to inform the listener about objects and structures in the room. Listeners reported hearing more echoes under a stimulus situation that simulated sudden, unexpected changes in the location of the lagging sounds, as compared with stable stimulus conditions. Placement of lagging sounds' locations proved to be critical in that a sudden shift per se did not disrupt the fusion aspect of the precedence effect; the new location had to occupy a site that specified a new reflecting surface. Perception of echoes appears to be modulated by room acoustic information contained in reflected sound and listeners' expectations about this.     

The intoxicated witness: effects of alcohol on identification accuracy from showups

The effect of alcohol on identification accuracy is potentially an important topic. This study examined the effects of alcohol consumption on identification accuracy from showups, the identification procedure most likely to be used by police with intoxicated witnesses. The blood alcohol level of people exposed to a target was measured. In the target-present showup condition, blood alcohol level was not significantly related to correct identification rate. In the target-absent showup condition, the higher the blood alcohol level, the more people were likely to make a false identification. Implications for law enforcement and future research directions are discussed.     

Assessment of mand selection for functional communication training packages

We evaluated the effects of training novel and existing mands during functional communication training (FCT) to decrease problem behavior for 2 children. A functional analysis (Phase 1) identified mands for FCT. Phase 2 used distinct stimulus conditions to train novel and existing mands. Phase 3 evaluated allocation of responding within a concurrent-schedules design. When reinforcement for either mand was concurrently available, the children used existing mands more than novel mands, but higher levels of problem behavior occurred with existing mands.     

Alexithymia is not related to tolerance for cold pressor pain

To test the hypothesis that higher scores on alexithymia are associated with reduced tolerance for cold pressor pain, 116 college undergraduates completed the Toronto Alexithymia Scale-20 of Bagby, Parker and Taylor and engaged in the cold pressor test. Their alexithymia scores were not associated with tolerance for cold pressor pain, suggesting that individuals scoring high on alexithymia do not show a general hypersensitivity to a cold stimulus.     

Effects of orientation on Rey complex figure performance

An experiment was performed that examined the impact of stimulus orientation on performance on the Rey complex figure. A total of 48 undergraduates (24 men, 24 women) were randomly assigned to one of four Rey figure orientation groups (0 degrees, 90 degrees, 180 degrees, and 270 degrees ). Participants followed standard procedures for the Rey figure, initially copying it in whatever orientation group they were assigned to. Next, all participants performed a 15-20 min lexical decision experiment, used as a filler task. Finally, and unbeknownest to them, participants were asked to recall as much of the figure as they could. As expected, results revealed a main effect of Task (F = 83.92, p < .01), in which copy performance was superior to recall performance. However, the main effect for orientation was not significant, nor did orientation interact with task (Fs < .68, ps > .57). The results are important from an applied setting, especially if testing conditions are less than optimal and a fixed stimulus position is not possible (e.g., testing at the bedside).     

The nootropic properties of ginseng saponin Rb<Subscript>1</Subscript> are linked to effects on anxiety

Previous studies have shown that crude ginseng extracts enhance performance on shock-motivated tasks. Whether such performance enhancements are due to memory-enhancing (nootropic) properties of ginseng, or to other non-specific effects such as an influence on anxiety has not been determined. In the present study, we evaluated both the nootropic and anxiolytic effects of the ginseng saponin Rb₁. In the first experiment, 80 five-day-old male chicks received intraperitoneal injections of 0, 0.25, 2.5 or 5.0 mg/kg Rb₁. Performance on a visual discrimination task was uvaluted 15 minutes, 24 and 72 hours later. Acquisition of a visual discrimination task was unaffected by drug treatment, but the number of errors was significantly reduced in the 0.25 mg/kg group during retention trials completed 24 and 72 hours after injection. Animals receiving higher dosages showed trends towards enhancement initially, but demonstrated impaired performance when tested 72 hours later. Rb₁ had no effect on response rates or body weight. In the second experiment, 64 five-day-old male chicks received similar injections of Rb₁ (0, 0.25, 2.5 or 5.0 mg/kg) and separation distress was evaluated 15 minutes, 24 and 72 hours later. Rb₁ produced a change in separation distress that depended on the dose and environmental condition under which distress was recorded. These data suggest that Rb₁ can improve memory for a visual discrimination task and that the nootropic effect may be related to changes in anxiety.     

Can the Edinburgh Risk of Repetition Scale Predict Repetition of Deliberate Self‐poisoning in an Australian Clinical Setting?

This study tested the ability of the Edinburgh Risk of Repetition Scale (ERRS) to identify patients at high risk for repeat deliberate self-poisoning (DSP). Consecutive DSP patients (N= 1,317) over a 3-year period were followed-up for 12 months. A statistically significant relationship between ERRS scores and repetition was observed; however, sensitivity and specificity were low. Logistic regression analysis revealed only "previous parasuicide" contributed significantly to repetition. The ERRS had limited value in identifying patients at high risk of repeat DSP in this clinical population.