The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.     

Using reflective practice to explore the origins and consequences of cultural and faith perspectives

The intention of the symposium is to allow individual voices to speak for themselves and to display their unmediated autobiographical narratives, albeit within a theoretical framework suggested by Part 2 of the Editorial. However, this snowball sample has thrown up some commonalties. So, the third and final part of the Editorial will attempt to point out some of these similarities. From a variety of viewpoints and positions and expressed in different styles of autobiographical narratives, the voices record a sophisticated awareness of the religious traditions discussed; a questioning of substance and loyalty that in one case resulted in a moving from one faith to another; and a display of religious and social values that travel with the individual to be tried and tested in a number of demanding contexts. Impotantly, it would seem that the individuals themselves selected what they would use in the formation of their own personal and professional identities.     

Me, myself, and lie: The role of self-awareness in deception

Deception has been studied extensively but still little is known about individual differences in deception ability. We investigated the relationship between self-awareness and deception ability. We enlisted novice actors to portray varying levels of deception. Forty-two undergraduates viewed the videotaped portrayals and rated the actors’ believability. Actors with high private self-awareness were more effective deceivers, suggesting that high self-monitors are more effective at deceiving. Self-awareness may lead to knowledge of another’s mental state (i.e., Theory of Mind), which may improve an individual’s deception ability.     

Married Women’s Situational Use of Last Names: An Empirical Study

Situational last name use was examined in a sample of 600 married women who responded to a mail survey. The sample was selected from the faculty and staff of a state university in the Midwest with over-sampling of women whose last name differed from their husband’s last name. Overall, 12% of married women reported situational last name use. Women from all last name choices (e.g., changed to husband’s, kept birth surname) reported situational surname use, but the most common occurrence of this practice was among hyphenators. Situational users were most likely to use their husband’s last name in family situations and their birth surname in professional situations. Factors that increase situational last name use included full-time employment, higher levels of educational attainment, and an older age at marriage. Situational last name use by married women can be seen as a manifestation of ambiguity over identity with family and non-family roles.     

CULTIVATING LOVING KINDNESS: A TWO‐STAGE MODEL OF THE EFFECTS OF MEDITATION ON EMPATHY,COMPASSION, AND ALTRUISM

Abstract. We explore the role of meditative practice in cultivating experiences of compassion, empathy, and altruism and address an apparent paradox: Meditation often is associated with solitary retreat, if not preoccupation with one's own concerns. How, then, does such a practice promote compassion for others? We propose a two‐stage model. The first stage involves disengagement from usual preoccupation with self‐reinforcing, self‐defeating, or self‐indulgent behaviors and reactions; the second involves a focused engagement with a universal human capacity for altruistic experience, love, and compassion. Reference is made to the limited research literature and to clinical applications of loving kindness (metta) meditation in cultivating these processes.     

The Impact of Having Children on the Lives of Women: The Effects of Children Questionnaire

The current study uses a newly developed questionnaire, the Effects of Children Questionnaire, to examine the impact of having children on women's lives. Participants were lower- and lower-middle-class women. The questionnaire assessed women's perceptions of their own change and other women's experiences of change as a result of having children in a number of life domains. Exploratory analyses, repeated-measures analyses, factor analyses, and regression analyses were used to test hypotheses. Results suggested that women do compare themselves with other women, that there are two primary factors underlying perceptions of change, and that there are significant changes from having children in various life domains. Results are discussed in terms of the costs and benefits of having children.     

The Relationship Between Facial Contact With a Pillow and Mood

Three studies examined the relationship between facial contact with a pillow and mood. In the first, 414 undergraduates described their face and body positions when sleeping and upon awakening, and their moods upon awakening. Results indicated that more negative moods were associated with increased facial contact with pillows. Then, 2 experiments manipulated participants' face and body positions while they lay down and listened to affectively neutral prose passages and musical selections. Participants evaluated the passages and music. Results of both experiments showed that increased facial contact with a pillow led to more negative evaluations. It is argued that these findings reflect effects of facial contact on mood, and are consistent with the facial feedback hypothesis. Possible alternative explanations are considered.     

Nonparametric Estimation of Item and Respondent Locations from Unfolding-type Items

Unlike their monotone counterparts, nonparametric unfolding response models, which assume the item response function is unimodal, have seen little attention in the psychometric literature. This paper studies the nonparametric behavior of unfolding models by building on the work of Post (1992). The paper provides rigorous justification for a class of nonparametric estimators of respondents’ latent attitudes by proving that the estimators consistently rank order the respondents. The paper also suggests an algorithm for the rank ordering of items along the attitudes scale. Finally, the methods are evaluated using simulated data. This research was supported in part by an Educational Testing Service Gulliksen Fellowship, and by the National Science Foundation, Grant DMS-97.05032. The author would like to thank Brian Junker for his help and support on this paper and Paul Holland, Steve Fienberg, and Jay Kadane for their helpful comments.     

After-School Supervision, Psychosocial Impact, and Adolescent Smoking and Alcohol Use in China

We examined effects of self-care after school hours and psychosocial factors on cigarette smoking and alcohol use among adolescents in China. Survey data were obtained from 4734 7th and 11th grade students from seven cities across China. Students were queried about the frequency and quantity of unsupervised self-care after school in an average week. Tobacco and alcohol usage were also obtained. Odds ratios were calculated to determine the strength of association between unsupervised self-care after school and substance use. Results indicated that the amount of self-care after-school (how many days and how many hours per week) was significantly associated with increased risk for smoking and alcohol use among Chinese adolescents. These associations remained significant even after controlling for anxiety, depressive symptoms, and peer influence. The interaction between unsupervised self-care after school and peer influence indicated that unsupervised self-care after school is a stronger risk factor for smoking among adolescents with pro-smoking friends. The findings suggest that substance use prevention programs for youth in China should try to enhance parental monitoring. As it may not be feasible for families to revert to a lifestyle that includes supervision by relatives, other approaches such as organized after-school care are worthy of consideration.