A Pilot Study to Assess the Feasibility of a Multicenter Cluster Randomized Trial for the Management of Asymptomatic Persons with a Thrombophilia

There is controversy whether asymptomatic first-degree relatives (FDRs) of patients with venous thromboembolism (VTE) and thrombophilia should be screened, followed, and prescribed prophylaxis during risk periods. We recruited consecutive probands with idiopathic VTE and thrombophilia from our thrombosis clinics. Those FDRs with thrombophilia were randomized in family clusters to receive one-time verbal counseling and no organized follow-up or counseling, educational material, reminder aids and follow-up. Only 203 of 1,129 FDRs were eligible and consented. Dropouts were common; 1 FDR (1.7%) developed VTE. VTE risk, ability to treat and prevent were underestimated by the participants. Patients with VTE and thrombophilia and their FDRs are often not interested in thrombophilia testing. Despite education to inform their knowledge, interest and follow-up were less than ideal. The question of the best educational approach in these patients remains unanswered. The value of testing and following asymptomatic carriers of probands with VTE and thrombophilia remains unknown.     

Clarifying the paradigm for the ethics of donation and transplantation: Was 'dead' really so clear before organ donation?

Recent commentaries by Verheijde et al, Evans and Potts suggesting that donation after cardiac death practices routinely violate the dead donor rule are based on flawed presumptions. Cell biology, cardiopulmonary resuscitation, critical care life support technologies, donation and transplantation continue to inform concepts of life and death. The impact of oxygen deprivation to cells, organs and the brain is discussed in relation to death as a biological transition. In the face of advancing organ support and replacement technologies, the reversibility of cardiac arrest is now purely related to the context in which it occurs, in association to the availability and application of support systems to maintain oxygenated circulation. The 'complete and irreversible' lexicon commonly used in death discussions and legal statutes are ambiguous, indefinable and should be replaced by accurate terms. Criticism of controlled DCD on the basis of violating the dead donor rule, where autoresuscitation has not been described beyond 2 minutes, in which life support is withdrawn and CPR is not provided, is not valid. However, any post mortem intervention that re-establishes brain blood flow should be prohibited. In comparison to traditional practice, organ donation has forced the clarification of the diagnostic criteria for death and improved the rigour of the determinations.     

Revisiting the Stanford prison experiment: could participant self-selection have led to the cruelty?

The authors investigated whether students who selectively volunteer for a study of prison life possess dispositions associated with behaving abusively. Students were recruited for a psychological study of prison life using a virtually identical newspaper ad as used in the Stanford Prison Experiment (SPE; Haney, Banks & Zimbardo, 1973) or for a psychological study, an identical ad minus the words of prison life. Volunteers for the prison study scored significantly higher on measures of the abuse-related dispositions of aggressiveness, authoritarianism, Machiavellianism, narcissism, and social dominance and lower on empathy and altruism, two qualities inversely related to aggressive abuse. Although implications for the SPE remain a matter of conjecture, an interpretation in terms of person-situation interactionism rather than a strict situationist account is indicated by these findings. Implications for interpreting the abusiveness of American military guards at Abu Ghraib Prison also are discussed.     

Tolerant (In)civility? A Longitudinal Analysis of White Conservative Protestants’ Willingness to Grant Civil Liberties

Past research has found conservative Protestants to be less willing than most Americans to grant civil liberties to unpopular groups. In light of evidence of high and growing civility by Smith (2000) and Hunter (1984), there is good reason to believe that conservative Protestants are becoming less distinctive with regard to granting civil freedoms. We update and expand previous research on conservative Protestants and civil liberties by examining the civil liberties measures in the General Social Survey over a 26-year period, with special attention to explaining conservative Protestantism's rejection of civil liberties. In comparison to mainline Protestants and Catholics, we find that conservative Protestants are still less willing to grant civil liberties to unpopular groups, though important qualifications apply. Various explanations are examined.     

Metacognitive Therapy in Major Depression: An Open Trial of Comorbid Cases

This open trial investigated the transdiagnostic effects of metacognitive therapy (MCT) in patients with severe major depressive disorder and comorbid psychiatric disorder. Ten patients were treated with MCT over 10 sessions and were assessed with measures of depression, anxiety, rumination, and metacognitions at pre- and posttreatment and at 6 months follow-up. None of the patients were diagnosed as depressed at posttreatment, and of the initial 21 total diagnoses at pretreatment only 3 diagnoses remained at postintervention. The effect sizes were large for symptoms of depression, rumination, and worry. At 6 months follow-up standardized recovery criteria on the BDI showed that 70% were recovered, 20% improved, and 10% unchanged. The results indicate that MCT was associated with high rates of transdiagnostic improvement.     

REJOINDER: WHITHER MARITAL THERAPY?

It is apparent that Gurman and Kniskern have greatly revised their original position in response to our critique. We believe that their revised position is more fully consonant with the available empirical evidence, although certain areas of disagreement between us are still evident. Overall, we believe that this dialogue has generated some promising lines for future research and clinical practice.