Discretionary power,lies, and broken trust: Justification and discomfort

This paper explores the relationship between the bonds of practitioner/patient trust and the notion of a justified lie. The intersection of moral theories on lying which prioritize right action with institutional discretionary power allows practitioners to dismiss, or at least not take seriously enough, the harm done when a patient's trust is betrayed. Even when a lie can be shown to be justified, the trustworthiness of the practitioner may be called into question in ways that neither theories of right action nor contemporary discourse in health care attends to adequately. I set out features of full trustworthiness along Aristotelian lines.     

The Severed Head and Existential Dread: The Classroom as Epistemic Community and Student Survivors of Incest

I discuss pedagogical issues that concern incest survivors. As teachers, we need to understand the ways in which the legacy of incest variously affects survivors' educational experiences and to be aware that the interplay of trust, knowledge, and power may be particularly complex for survivors. I emphasize the responsibility teachers have to create classrooms that are inclusive of survivors, while raising concerns about the practice of personal disclosure and assumptions about trust and safety in the classroom.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

Using image analysis techniques to analyze figure-copying performance of patients with visuospatial neglect and control groups

Figure copying is often used to detect visuospatial neglect (VSN) in brain-damaged patients. We describe algorithms that enable the computation of parameters for describing figure-copying performance. The researcher can readily implement these algorithms on a computer using image analysis software, and they provide information on goodness-of-fit, relative to a standard model, as well as on dynamic aspects of subjects’ performance in completing figure copies. To demonstrate the clinical utility of these algorithms, preliminary results from a group of right-hemisphere brain-damaged patients, some of whom have VSN, are compared with those for age-matched controls.     

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.     

Incremental exercise, plasma concentrations of catecholamines, reaction time, and motor time during performance of a noncompatible choice response time task

The primary purpose was to examine the effect of incremental exercise on a noncompatible response time task. Participants (N=9) undertook a 4-choice noncompatible response time task under 3 conditions, following rest and during exercise at 70% and 100% of their maximum power output. Reaction and movement times were the dependent variables. Maximum power output had been previously established on an incremental test to exhaustion. A repeated-measures multivariate analysis of variance yielded a significant effect of exercise intensity on the task, observation of the separate univariate repeated-measures analyses of variance showed that only movement time was significantly affected. Post hoc Tukey tests indicated movement time during maximal intensity exercise was significantly faster than in the other two conditions. The secondary purpose of the study was to assess whether increases in plasma concentrations of adrenaline and nor-adrenaline during exercise and power output would act as predictor variables of reaction and movement times during exercise. Catecholamine concentrations were based on venous blood samples taken during the maximum power output test. None of the variables were significant predictors of reaction time. Only power output was a significant predictor of movement time (R2 = .24). There was little support for the notion that peripheral concentrations of catecholamines directly induce a central nervous system response.