The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process.     

Assessing the Effect of Language Demand in Bundles of Math Word Problems

Differential bundle functioning (DBF) analyses were conducted to determine whether seventh and eighth grade second language learners (SLLs) had lower probabilities of answering bundles of math word problems correctly that had heavy language demands, when compared to non-SLLs of equal math proficiency. Math word problems on each of four test forms (two at Grade 7 and two at Grade 8) were bundled together if they used the passive voice, conditional clause, relative clause, or a combination of any two. The results showed that the average total scores for SLLs was significantly lower than that for non-SLLs on each test form. However, only two bundles (passive voice and conditional clause at Grade 7 on Form 2) indicated statistically significant DBF against SLLs in favor of matched non-SLLs. An additional step was taken to determine whether the two bundles that showed statistically significant DBF against SLLs had biased the mean total scores for this group.The Walker, Zhang, Banks, and Cappaert (2012) procedure established for this purpose showed that this was not the case. Implications of the results are provided as well as suggestions for future research.     

Visual perspective in remembering and episodic future thought

According to the constructive episodic simulation hypothesis, remembering and episodic future thinking are supported by a common set of constructive processes. In the present study, we directly addressed this assertion in the context of third-person perspectives that arise during remembering and episodic future thought. Specifically, we examined the frequency with which participants remembered past events or imagined future events from third-person perspectives. We also examined the different viewpoints from which third-person perspective events were remembered or imagined. Although future events were somewhat more likely to be imagined from a third-person perspective, the spatial viewpoint distributions of third-person perspectives characterizing remembered and imagined events were highly similar. These results suggest that a similar constructive mechanism may be at work when people remember events from a perspective that could not have been experienced in the past and when they imagine events from a perspective that could not be experienced in the future. The findings are discussed in terms of their consistency with—and as extensions of—the constructive episodic simulation hypothesis.     

Adjusting the Religious Autobiography Course for the Postmodern Classroom

Religious autobiography as an introductory course is popular yet problematic. Often, it lacks methodological breadth and functions to ensconce Western notions of subjectivity which elide difference, locatedness, and the reality of multiple or shifting identifications. These problems can be addressed by incorporating into the course a community‐based learning exercise in which each student is paired with a local senior citizen, conducts a series of interviews with the elder, and then writes an (auto‐)biography based on the interviews. Students are thus given a real‐life situation in which to test the applicability of theories and definitions of religion, as well as a relationship to a subject whose locatedness and relatively unprivileged “I” allow for the problematization of autobiography as a genre as well as an appreciation for the contextual nature of religiosity. This exercise transforms the religious autobiography course into a pedagogically fruitful, intellectually defensible, and institutionally savvy introductory course.     

Adult Attachment,Self‐Efficacy,Perspective Taking,and Conflict Resolution

Parents (N= 124) completed surveys assessing their adult attachment style, conflict resolution style, social self‐efficacy, and perspective taking. Findings supported hypothesized relationships between secure attachment and mutual forms of conflict resolution. More equivocal support was obtained for hypothesized pairings of specific nonsecure attachment styles and nonmutual conflict styles. Findings suggested mediating effects for social competencies (social self‐efficacy and perspective taking), which accounted for some of the negative association between attachment avoidance and mutual conflict style. Follow‐up analyses identified mediating effects of social competencies on specific combinations of attachment and conflict styles–thus suggesting avenues for counseling interventions.     

Mothers' resolution of their children's diagnosis: Organized patterns of caregiving representations

In this paper we examine mothers' representations of one form of trauma to the caregiving system: the experience of receiving a diagnosis of a chronic illness or disability in their child. An interview and classification system was used with 91 mothers of children ages 15–50 months with cerebral palsy or epilepsy. Mothers were classified as Resolved or Unresolved with respect to their child's diagnosis and grouped into subcategories within these major groups. Roughly half of these mothers were classified as Unresolved with respect to their child's diagnosis. Diagnosis type, severity of condition, developmental age, and time since receiving diagnosis were all unrelated to the distribution of Resolved/Unresolved classifications. Patterns of resolution in which cognitive strategies predominated were the most frequent form within the Resolved classification. Findings provide support for the organizational nature of caregiving representations as well as a number of implications for clinical practice.     

Effects of Age on Dual-Task Walking While Listening

This study examined the effects of age on single- and dual-task listening and walking during virtual street crossing. Seventeen younger and 12 older adults participated. In each listening trial, three sentences were presented simultaneously from separate locations. Participants were instructed to report the target sentence. Predictability of the target sentence location was varied. Treadmill walking was measured using motion analysis. Measures included word recognition accuracy, head and trunk angles, and spatiotemporal gait parameters. Older adults exhibited a more upright head alignment and less variability in stride time during dual-tasking, particularly under less certain target sentence location conditions. Younger adults’ walking was unaffected by dual-task demands. Together, the results indicate greater postural prioritization in older adults than young.     

A Limited Information Estimator for Dynamic Factor Models

Structural equation modeling (SEM) is an increasingly popular method for examining multivariate time series data. As in cross-sectional data analysis, structural misspecification of time series models is inevitable, and further complicated by the fact that errors occur in both the time series and measurement components of the model. In this article, we introduce a new limited information estimator and local fit diagnostic for dynamic factor models within the SEM framework. We demonstrate the implementation of this estimator and examine its performance under both correct and incorrect model specifications via a small simulation study. The estimates from this estimator are compared to those from the most common system-wide estimators and are found to be more robust to the structural misspecifications considered.     

Socially Valued Roles,Self‐Determination,and Community Participation among Individuals Living with Serious Mental Illnesses

Decades after deinstitutionalization, individuals living with serious mental illnesses remain isolated, socially disengaged, and devalued members of communities. Burgeoning research and services need conceptual clarity to improve such social conditions. This qualitative inquiry used grounded theory and participatory approaches to conduct an in‐depth exploration of community participation for individuals living with serious mental illnesses based on key stakeholder perspectives (n = 45). Results revealed that community participation is a multifaceted construct with layers of meaning for individuals living with serious mental illnesses. Overarching themes are contextualized in Self‐Determination Theory and presented with deidentified illustrations. Implications for services, research, and policy are discussed.