Non-heart-beating organ donation: a reply to Campbell and Weber.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure.     

Quantitative measurement of observed workload in the analysis of aircrew performance

A methodology for the quantitative evaluation of observed workload was proposed. The model was designed to provide point estimations of observed workload at any time during the performance of a set of tasks. The model was also designed to provide information about the task-scheduling strategies used to complete a set of tasks. The proposed model was then tested with data from a full mission flight simulation. The model predictions correlated significantly with expert ratings of workload management made during the flight simulation. The model was also able to distinguish between low- and high-performing aircrews when performance was based on the number of errors made during flight simulations.     

Parents, infants, and day-care teachers: Interrelations and implications for better child care

Many young children are reared today in both family and child-care settings. The relation that exists between these two settings has important implications for child care. Bronfenbrenner's (1979) ecological model is used as a way to view the interrelations among children, families, and child-care programs. Data from a study of infants in day care provide information on the time infants spend in family and day-care contexts, how parents and caregivers view children's behavior in these two settings, and rates of otitis media (ear infections) and other illnesses for these children. Results show that infants spend about twice as many hours per day awake with parents as in day care. Regarding child behaviors, parents and caregivers seem to have similar behaviors they like and dislike, but they each see particular children quite differently with respect to these behaviors. Finally, infants in this sample were diagnosed with illnesses 60% to 70% of the time. Findings are discussed in terms of the ecological model with particular attention given to relations between parents and caregivers.     

Factor analytic structure of theScale to Asses World View

This article reports on the factor structure of theScale to Assess World View ^(c) (SAWV). Alpha reliabilities for the factors are presented. Gender differences in world views are also explored to understand how men and women in this sample viewed the world. Recommendations for client assessment, therapy, education and training, and scale revision are discussed. The research reported here is based on a paper presented at the annual meeting of the American Psychological Association, Washington, DC, August 17, 1992.     

Authenticity as a foundational principle of medical ethics

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.     

The calibration and resolution of confidence in perceptual judgments

Carleton University, Ottawa, Ontariot Canada Confidence rating based calibration and resolution indices were obtained in two experiments requiring perceptual comparisons and in a third with visual gap detection. Four important results were obtained. First, as in the general knowledge domain, subjects were underconfident when judgments were easy and overconfident when they were difficult. Second, paralleling the clear dependence of calibration on decisional difficulty, resolution decreased with increases in decision difficulty arising either from decreases in discriminability or from increasing demands for speed at the expense of accuracy. Third, providing trial-by-trial response feedback on difficult tasks improved resolution but had no effect on calibration. Fourth, subjects can accurately reportsubjective errors (i.e., trials in which they have indicated that they made an error) with their confidence ratings. It is also shown that the properties of decision time, conditionalized on confidence category, impose a rigorous set of constraints on theories of confidence calibration.     

Human Signal-detection Performance: Effects Of Signal Presentation Probabilities And Reinforcer Distributions

University students participated in one of four standard two-choice signal-detection experiments in which signal presentation probability was varied and the reinforcement distribution was held constant and equal. In Experiments 1, 3 and 4, subjects' performance showed a systematic response bias for reporting the stimulus presented least often. Experiments 1 and 4 showed that this effect was reliable with extended training and monetary, rather than point, reinforcement. In Experiment 2, all correct responses were signaled in some way, and this produced the opposite relationship between signal presentation probability and response bias. Experiments 1 and 3 found that explicitly deducting money (intended as punishment) for equal numbers of incorrect responses on each alternative, or varying the obtained overall rate of reinforcement, produced no clear change in response bias. The bias, shown by humans, for reporting the stimulus presented least often remains a challenge for theories of stimulus detection.     

The conversion of Paul

This essay extrapolates from recent psychological data on the phenomena of guilt and splitting to possible implications for the understanding of the experience of the Apostle Paul.     

A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD

Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.