Subjective and physiological responses to the 35% carbon dioxide challenge in healthy and non-clinical control populations: a meta-analysis and systematic review

Background/Rationale: The carbon dioxide (CO₂) challenge has been reliably used in laboratory settings as a panicogen in clinical populations. However, the magnitude of these effects on healthy and non-clinical control populations are not clear. The aim of this meta-analysis and systematic review is to provide quantitative estimates of those effects. Specifically, the current paper will evaluate the relative efficacy of the CO₂ challenge in eliciting both subjective and physiological arousal in healthy and non-clinical control populations.

Method: A total of 16 articles with 35 independent samples were included in the meta-analysis, while 37 studies with 74 independent samples were included in the systematic review.

Results: Both the meta-analysis and systematic review found the CO₂ challenge to elicit an increase in subjective distress via self-reported anxiety and fear. Physiological responses via blood pressure and heart rate were heterogeneous in studies sampled, with no significant changes observed across studies. Moderator analyses revealed the variations in findings may be attributed to participant screening and invasive sampling.

Discussion: Findings highlight the CO₂ challenge as a useful tool in the provocation of subjective distress. Implications for both the use of the CO₂ challenge and its anticipated effects in healthy and non-clinical control populations are discussed.     

Marginally Represented Patients and the Moral Authority of Surrogates

Abstract

Incapacitated adult patients are commonly divided into two groups for purposes of decision making; those with a surrogate and those without. Respectively, these groups are often referred to as represented and unrepresented, and the relative ethics of decision making between them raises two particular issues. The first issue involves the differential application of the best interests standard between groups. Second is the prevailing notion that representedness and unrepresentedness are categorical phenomena, though it is more aptly understood as a multidimensional and continuous variable based on relational moral authority. This paper examines the nature of representedness as it relates to ethical norms of surrogate decision making.     

Dr. Susan W. Gray

While Susan W. Gray is known primarily for her work with the Early Training Project, a pioneering early intervention program with low-income black children, she has also influenced the development of school psychology and the creation of Early Childhood Education as a discipline. In addition, in her own quiet way, she has supported the career development of a number of professional women who have had impact on child development, early childhood education, and school psychology. Four major themes are used to present Susan Gray's biography: (1) being ahead of her time in terms of thinking which allowed her to take advantage of opportunities; (2) the role of serendipity versus long-range planning of career trajectories; (3) specific influences on her as a woman; and (4) a lifetime of courage and dedication. Examples of work which was in advance of psychology included work in early intervention with low-income children, an emphasis on the use of scientific experimental methodology in field research, an eclectic approach which crossed disciplinary boundaries, a consultative approach to school psychology, and the inclusion of affective and cognitive education in inter-