An application of the empirical Bayes approach to directly adjusted rates: a note on suicide mapping in California

A simple, reliable, and comparable measure for suicide mapping and other health problems is needed. Because standardized mortality ratios (SMRs) may not indicate the relative meaning of their magnitudes when compared with one another, and statistical significance levels of tests for SMRs overlook the areas that have small populations, neither of these approaches provides a satisfactory index. The results using directly adjusted rates can be ordered directly according to their magnitudes. However, because of the lack of reliable estimates of local age-specific rates, the usefulness of directly adjusted rates in mapping suicide is also limited. To extend the usefulness of directly adjusted rates, an empirical Bayes approach whereby information from other areas is borrowed to improve the precision of the estimates of local age-specific rates in calculating directly adjusted rates--especially in the areas with small population sizes--is proposed. When an empirical Bayes approach was applied to the 1983 suicide data for California counties, a more reasonable conclusion than could be obtained by using directly adjusted rates was reached.     

On the Ethics of Facial Transplantation Research

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase.     

An Investigation of Teachers’ Growing Understandings of the Picture Book Format

This study investigated the impact of a graduate course that focused on picture books on teachers’ understandings of the picture book format and the ways in which these understandings influenced their self-reports of picture book use in the classroom. Findings of this qualitative investigation revealed that immersion in and analysis of the picture book format resulted in important changes in teachers’ understandings of and literary stance toward picture books. In addition, teachers reported changes in their instructional practices which, in turn, led to reported changes in their students’ construction of meaning as they interacted with picture books.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

Teachers’ reactions to experiences of violence: an attributional analysis

Violence perpetrated against teachers is prevalent and has the potential to adversely affect teachers’ well-being, efficacy, and longevity in the profession. In this study, we examined teachers’ reactions after having experienced violence, specifically examining the roles of attributional processes. In collaboration with the American Psychological Association, National Education Association, and American Federation of Teachers, data were collected via a survey instrument from teachers across the United States. We examined responses from 2505 participants who described the most upsetting incident of violence that had been perpetrated against them in their roles as teachers. We examined predictors of (1) communicating with others after the incident and (2) implementing intervention strategies with the perpetrators of violence. Emotions were tested as mediators of the relations between attributions and outcomes. Results indicated that characterological and behavioral self-blame were predictive of negative affect, which in turn predicted the majority of outcomes. Study limitations and implications for research and practice are discussed.     

Socrates’ Aversion to Being a Victim of Injustice

In the Gorgias, Plato has Polus ask Socrates if he would rather suffer injustice than perform it. Socrates’ response is justly famous, affirming a view that Polus himself finds incredible, and one that even contemporary readers find difficult to credit: “for my part, I would prefer neither, but if it had to be one or the other, I would choose to suffer rather than do what is unjust” (Gorgias 469c1-2). In this paper, we take up the part of Socrates’ response that Polus never engages and that has also been completely neglected by contemporary scholars, namely, Socrates’ explicit aversion to being a victim of injustice. We show that this same aversion—though one not nearly as strong as his aversion to doing injustice—appears in several texts, and we argue that the best explanation of such an aversion derives from two important features of Socratic philosophy, both of which have only recently been recognized in Socratic scholarship: (i) his virtue intellectualism, which conceives of virtue as a kind of craft that can be achieved in different degrees, and (ii) his conception of moral psychology, which allows for non-rational influences on how we perform the cognitive functions required for proper deliberation.