Investigating medical decision‐making capacity in patients with cognitive impairment using a protocol based on linguistic features

A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision‐making capacity by use of a Swedish linguistic instrument for medical decision‐making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision‐making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision‐making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one‐dimensional instrument of medical decision‐making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.     

Linguistic and neuropsychological deficits in crossed conduction aphasia. Report of three cases

This study describes the linguistic and neuropsychological findings in three right-handed patients with crossed conduction aphasia. Despite the location of the lesion in the right hemisphere, all patients displayed a combination of linguistic deficits typically found in conduction aphasia following analogous damage to the left hemisphere. Associated cognitive deficits varied across the three patients. In addition, all cases showed deficits classically attributed to non-dominant hemisphere damage (visuoperceptual deficits and reduced figural memory). As a result, lesion-behaviour relationships in our study sample indicate both dominant and non-dominant qualities of the right hemisphere.     

Cross-cultural investigation of the Questionnaire of Smoking Urges in American and Spanish smokers

This study evaluated the factor structure of the Questionnaire of Smoking Urges (QSU) across American and Spanish smokers. Using confirmatory factor analyses, the fits of one-, two-, and four-factor models of smoking craving in American and Spanish data sets were compared. The two-factor model provided the best fit in both samples. However, negatively worded items confounded the interpretation of the two-factor structure in both the American and Spanish data. The first factor had positively and negatively worded items, whereas the second had only positively worded items. The two-factor structure was reexamined, removing either the positively or the negatively worded items. Using only positively worded items resulted in a loss of fit, whereas using only negatively worded items improved model fit substantially. Thus, the results supported the generalization of smoking craving across Spanish and American smokers and suggested that negatively worded items play a larger role in the two-factor structure of the QSU than originally thought.     

Temporal aspects of stimulus-driven attending in dynamic arrays

Auditory sequences of tones were used to examine a form of stimulus-driven attending that involves temporal expectancies and is influenced by stimulus rhythm. Three experiments examined the influence of sequence timing on comparative pitch judgments of two tones (standard, comparison) separated by interpolated pitches. In two of the experiments, interpolated tones were regularly timed, with onset times of comparison tones varied relative to this rhythm. Listeners were most accurate judging the pitch of rhythmically expected tones and least accurate with very unexpected ones. This effect persisted over time, but disappeared when the rhythm of interpolated tones was either missing or irregular.     

Fear of storms and hurricanes in Antillean and Belgian children

The present study assessed fear of hurricanes in children who had been confronted with this natural event (i.e., Antillean children, n=161). Their fear levels were compared to those of children who are unfamiliar with such an event (i.e., Belgian children, n=185). Antillean children reported significantly higher levels of fear of storms than Belgian children did, thus providing support for the notion that exposure to dangerous events promotes children's fears of those events. Surprisingly, however, Antillean children had lower scores on the 'Hurricanes' item than Belgian children. Plausibly, differences in how children interpreted this item may have accounted for this unexpected finding. That is, ratings of Antillean children were probably based on actual experiences with hurricanes, whereas scores of Belgian children presumably reflected appraisal of threat in case they would be confronted with such an event. Implications of this finding for the assessment of childhood fears are briefly discussed.     

A cross-linguistic data bank for oral picture naming in Dutch, English, German, French, Italian, Russian, Spanish, and Swedish (PEDOI)

The well established effect of word frequency on adult's picture naming performance is now called into question. This is particularly true for variables which are correlated with frequency, as is the case of age of word acquisition. Since the work of [Carrol and White, 1973] there is growing agreement among researchers to confer an important role in lexical access to this variable. Indeed, it has been shown ( [Hodgson and Ellis, 1998]) that for normal English-speaking adults only the variables 'age-of-acquisition' and 'name agreement' are independent predictors of naming success among the various variables considered. However, when brain-damaged subjects with and without degenerative pathologies are studied, word frequency and word length as well as concept familiarity all give significant effects ( [Hirsh and Funnell, 1995]; [Lambon Ralph et al., 1998]; [Nickels and Howard, 1995]). Finally, it has been suggested that the production of specific error types may be related to such variables. According to [Nickels and Howard, 1994] the production of semantic errors is specifically affected by 'imageability' and in the recent study by [Kremin et al., 2001] 'age of acquisition' predicts (frank) word finding difficulties.     

Wicked incarnations: Jesus,intra-action,climate change

To take incarnation seriously, Creation Care Christians, such as Douglas and Jonathan Moo, focus on Jesus’ divinity in incarnation. If the divine Jesus was fully flesh, then creation must be good. And if we do not take care of it, we are sinning, they reason. Laurel C. Schneider's promiscuous view of incarnation insists on a porous flesh, one that is materially entangled with the world. This is beyond Sallie McFague's model of the world as God's body. Applying Schneider's promiscuous incarnation, Mary-Jane Rubenstein claims that the world is God's body, and, as such, God does not transcend matter as Ernest Simmons suggests. For Catherine Keller, unknowable divine interdependence must move us to civic action. In the middle of this conversation, I offer the term wicked incarnations to make explicit the intra-action of divinity and the world in its incarnations. To take incarnation seriously is to acknowledge incarnations as a dynamism of divine and material forces, neither of which pre-exist their relationship. I join Keller in hoping that this moves us to care about and for the material world, its changing climate, and our intra-active relationship with nonhuman, divine presence.     

Social networks and social competence: Exploring the effects of early adolescent friendships

Conclusions Perhaps the main significance of this work was in its methodological contributions. Most noteworthy were its attempts to expand network analysis beyond the examination of supportive functions, the use of a more objective measure of social support, and the use of a multivariate hierarchical strategy of analysis.This study obtained correlations between social network variables and social competence indices that were highly suggestive. However, it is important to keep in mind that the sample under investigation was fairly small and relatively homogeneous with respect to ethnicity, social class, and even values. Whether the exact nature of these relationships will generalize to different samples remains an empirical question. In fact, one would suppose that some of the results would be quite different for a population that does not highly value school. Further research, ideally longitudinal in nature, is sorely needed to address some of the issues raised by this study, both in terms of the social support/network literature and the possibly changing characteristics of minority children and their social environments as they move from preadolescence to adolescence.The author was in part funded by the American Psychological Association Minority Fellowship Program and the Yale Bush Center of Child Development and Social Policy while this research was undertaken. The author thanks Edmund Gordon, Edward Zigler, Seymour Sarason, Roger Weissberg, Ron McMullen, and Lawrence Cohen for their helpfulness throughout this project.     

Important Goals,Meanings, and Relationships in Flourishing and Languishing States: Towards Patterns of Well-being

Qualitative studies of lay people’s perspectives on facets of well-being are scarce, and it is not known how the perspectives of people with high and low levels of well-being dovetail or differ. This research explored the experiences of people with high/flourishing versus low/languishing levels of positive mental health in three cross-sectional survey design studies. Languishing and flourishing participants were selected in each study based on quantitative data from the Mental Health Continuum - Short Form as reported by Keyes et al. (Journal of Health and Social Behavior 43:207–222, 2002). Qualitative content analyses were conducted on written responses to semistructured open-ended questions on the what and why of important meaningful things (study 1, n = 42), goals (study 2, n = 30), and relationships (study 3, n = 50). Results indicated that well-being is not only a matter of degree—manifestations differ qualitatively in flourishing and languishing states. Similar categories emerged for what flourishing and languishing people found important with regard to meaning, goals, and relationships, but the reasons for the importance thereof differed prominently. Languishing people manifested a self-focus and often motivated responses in terms of own needs and hedonic values such as own happiness, whereas flourishers were more other-focused and motivated responses in terms of eudaimonic values focusing on a greater good. We propose that positive mental health can be conceptualized in terms of dynamic quantitative and qualitative patterns of well-being. Interventions to promote well-being may need to take into account the patterns of well-being reflecting what people on various levels of well-being experience and value.