Development of an institutional policy on artificial hydration and nutrition

The issues involved in deciding whether to use artificial methods of delivering hydration and nutrition are often very difficult for patients, families, and health care providers. Once private and personal matters, these decisions now frequently involve the judicial system. Five years ago, Hospice of Washington recognized the need for a written policy and wrote the one published here. Its goal is to respect individual preferences and family concerns while addressing the nutrition and hydration needs of dying patients. The policy sets parameters on the issue, provides basic information, and encourages crafting the most fitting resolution to each situation.     

The role of the hospital in the evolution of elite cultures of medicine

Rosenberg argues that a culture of medicine articulates a unique medical vision reflecting scientific ideologies and perceptions, professional values and rewards, career patterns, and the work context of each generation of physicians (Rosenberg, 1987, p. 7) It might be more accurate, however, to recognize multiple cultures of medicine. This papers traces American hospitals' contributions to three specific aspects of certain elite cultures of medicine. Its first section introduces and explores these aspects transhistorically. They are: a stratified paradigm of the physician-patient relationship, the equation of competence with specialization, and a pattern within a stratified model of medicine called the “Lone Ranger syndrome.” A brief historical profile subsequently highlights changes in the structure and function of American hospitals in the 19th century. The three remaining sections chart the ebb and flow of the prominence and power of these specific aspects of elite cultures of medicine across three historical periods: the late 19th century, 1910–1930, and the post World War II era.     

Perfectionism and Sexual Satisfaction in Intimate Relationships

This study sought to provide information on the relations between trait perfectionism and perfectionistic self-presentation and sexual satisfaction in married couples. A sample of 74 married or cohabiting couples were recruited from the community to participate in the study. They completed measures of perfectionism, perfectionistic self-presentation, sexual satisfaction, dyadic adjustment, and depression. The results showed that the interpersonal dimensions of trait perfectionism were negatively related to general sexual satisfaction and sexual satisfaction with the partner for both husbands and wives. After partialing out marital satisfaction and depression, the husband's sexual satisfaction was significantly negatively correlated with his own socially prescribed perfectionism and with his wife's ratings of other-oriented perfectionism. The wife's satisfaction was significantly negatively correlated both with her husband's socially prescribed perfectionism and with her own socially prescribed perfectionism, other-oriented perfectionism, and perfectionistic self-presentation. Regression analyses suggest that the wife's other-oriented perfectionism is a unique predictor of her general lower sexual satisfaction and her husband's lower satisfaction with her contribution to the sexual relationship. Overall, the findings suggest that perfectionistic expectations have an important role to play in sexual satisfaction in married couples.     

Cultural Beliefs About Social Influence Strategies of Mexican Immigrant Women and Their Heterosexual Partners

The present study examined cultural beliefsregarding the use of influence strategies inheterosexual relationships of 40 Mexican immigrantcouples in stable relationships. Although over 75% ofparticipants had completed seven or more years of education,men were more likely to have completed high school thanwomen. Over half the sample (55%) reported familyincomes of $300 or less per week; 23% reported incomes in excess of $400 a week. During a structuredinterview respondents were asked to indicate their levelof agreement on a 4-point Likert scale with 24statements about influence tactics used by women and men in heterosexual relationships. Culturalconsensus analyses revealed a common cultural modelshared by the sample about which strategies men andwomen use to influence their partners. Results suggest that influence strategies are believed similarfor men and women. Direct and indirect strategies areperceived as used by both partners; bilateral strategiesare believed more likely to be used than unilateral strategies. These findings suggest that Mexicanimmigrant women in stable partnerships endorse normsthat support the use of relatively equivalent power inpartner relationships. The use of positive Mexican cultural norms to promote health protectivebehaviors such as condom use and other less risky sexualbehaviors is discussed.     

Inhibition of the Endothelial Isoform of Nitric Oxide Synthase Impairs Long-Term Memory Formation in the Chick

Previous studies with general inhibitors of nitric oxide synthase have yielded variable and contradictory results with respect to their effects on memory. This may have been due to differential effects of blocking the various isoforms of this enzyme. We show that day-old chicks trained on a single-trial passive-avoidance task suffered significant memory loss from ~40 min post-training following post-training intracranial administration of a potent inhibitor of eNOS. Administration of a specific nNOS or iNOS inhibitor at the same time had no effect on retention, although a role for either of these isoforms when administered at a different time after learning has yet to be fully investigated. The onset of memory loss following eNOS inhibition is the same as observed following general NOS inhibition, which suggests that amnestic effects observed in previous studies using nonspecific inhibitors may be attributable to blocking the function of eNOS. The findings indicate that eNOS may play a role in memory formation for this task, which is at least distinct from any role that may be played by nNOS.     

Comparison of the Effects of Formal and Informal Accountability on the Correct Performance of a Lifeguard Rescue

We compared instructional strategies used to train lifeguards. Fifteen undergraduates participated in the study during their twice weekly 90 minute lifeguard classes. A checklist of 15 steps was used to define correct performance of a lifeguard (water) rescue. The dependent variable was the percentage of steps completed correctly. Data were collected from videotapes of 32 sessions. A multi-treatment reversal design was used to assess the efficacy of typical peer instruction, a triad where students verbally supported one another, a triad where members used a checklist to prompt correct performance, and a instructor-mediated condition where for each 90% or better correct performance the participant received a bonus grade point. The significance of the rescue was not enough to produce competent performance, neither was peer support, nor peer-mediated instruction using a checklist, but all participants achieved 90% correct performance or better during the instructor-mediated condition. Our results suggest that the instructor-mediated condition is considerably more effective than informal accountability.     

Priesthood and the Epistle to the Hebrews

Current controversies about the ordination of women have shown the need for a re-examination of what the Christian Church means by priesthood. This article looks at the Epistle to the Hebrews' contribution to our understanding. To that end it focuses on the institution of priesthood in its first-century Jewish context and shows the use made of it by the author of Hebrews in his presentation of Christian faith.
Section 1 emphasizes some all-important differences between the NT's use of the language of priesthood and ours. Not least, it nowhere uses "priest" to designate Christian ministers. All the more striking, therefore, is Hebrews' depiction of Jesus as "high priest".
Section 2 discusses Judaism' Day of Atonement ceremonies – Hebrews' dominant cultic model. In the comparison drawn between Christ's death and exaltation with these rites, he becomes not only the high priest but also the expiatory victim.
As far as Judaism' cultic institutions are concerned, however, Jesus was not and never could be a priest, since he was of the tribe of Judah rather than Levi. Hence Hebrews appeals to Melchizedek. How this non-Israelite model is used by Hebrews to subvert the whole notion of priesthood as caste is discussed in section 3.
Finally, in section 4 Isaacs concludes that for Hebrews there is no longer a role for an ongoing priesthood, since Jesus has definitively achieved access to God, which was its raison d'être . Melchizedekian high priesthood is unique to Christ; neither inherited nor transmitted. Hence, unlike other NT authors, for Hebrews even the church as a corporate body is not a priesthood. As its closing chapters show, in this Epistle the cultic model gives way to the more inclusive one of pilgrimage.