Conscientious objection and person-centered care

Person-centered care offers a promising way to manage clinicians’ conscientious objection to providing services they consider morally wrong. Health care centered on persons, rather than patients, recognizes clinicians and patients on the same stratum. The moral interests of clinicians, as persons, thus warrant as much consideration as those of other persons, including patients. Interconnected moral interests of clinicians, patients, and society construct the clinician as a socially embedded and integrated self, transcending the simplistic duality of private conscience versus public role expectations. In this milieu of blurred boundaries, person-centered care offers a constructive way to accommodate conscientious objection by clinicians. The constitutionally social nature of clinicians commits and enables them, through care mechanisms such as self-care, to optimize the quality of health care and protect the welfare of patients. To advance these conditions, it is recommended that the medical profession develop a person-centered culture of care, along with clinician virtues and skills for person-centered communication.     

Sexual risk behaviour among HIV-infected women in the first twelve months after delivery in South Africa

This study aimed to assess sexual risk behaviour and its social correlates in HIV-infected women living in rural South Africa at six and twelve months post-partum. Participants were 699 HIV-positive women recruited prenatally by systematic sampling from twelve community health centres in Mpumalanga province, South Africa (mean age = 28.4 years, SD = 5.7; married =41.1%; serodiscordant or unknown partner status = 74.9%). They self-reported on their sexual activity six to twelve months after delivery; including use of condoms and partner involvement. Generalised linear mixed models were utilised to estimate unsafe sex outcomes from a prevention of mother to child transmission (PMTCT) intervention, socio-demographic factors, disclosure, and male involvement. About 20% of sexually active women in the past week had used condoms inconsistently at six and twelve months after delivery. Moreover, 16% and 18% of the women had not used a condom at last sex and 11% and 13% had unprotected sex with HIV-uninfected or unknown-status partners following delivery at six and twelve months, respectively. Higher inconsistent condom use was likely with lower male involvement. Promotion of condom use post-partum, as well as male involvement in sexual decisions, are important for safer sex post-partum by seropositive women.     

A daytime nap enhances visual working memory performance and alters event-related delay activity

Working memory (WM) is impaired following sleep loss and may be improved after a nap. The goal of the current study was to better understand sleep-related WM enhancement by: (1) employing a WM task that assesses the ability to hold and report visual representations as well as the fidelity of the reports on a fine scale, (2) investigating neurophysiological properties of sleep and WM capacity as potential predictors or moderators of sleep-related enhancement, and (3) exploring frontal and occipital event-related delay activity to index the neural processing of stimuli in WM. In a within-subjects design, 36 young adults (M_age = 20, 20 men, 16 women) completed a 300-trial, continuous-report task of visual WM following a 90-min nap opportunity and an equivalent period of wakefulness. Mixed-effect models were used to estimate the odds of successful WM reports and the fidelity of those reports. The odds of a successful report were approximately equal between nap and wake conditions for the start of the task, but by the end, the odds of success were 1.26 times greater in the nap condition. Successful WM reports were more accurate after a nap, independent of the time on task. Neither WM capacity nor any of the sleep variables measured were found to significantly moderate the nap effect on WM. Lastly, napping resulted in amplitude changes for frontal and occipital delay activity relative to the wake condition. The findings are discussed in relation to contemporary models of visual WM and the role of sleep in sustained attention.     

An automated approach to measuring child movement and location in the early childhood classroom

Children’s movement is an important issue in child development and outcome in early childhood research, intervention, and practice. Digital sensor technologies offer improvements in naturalistic movement measurement and analysis. We conducted validity and feasibility testing of a real-time, indoor mapping and location system (Ubisense, Inc.) within a preschool classroom. Real-time indoor mapping has several implications with respect to efficiently and conveniently: (a) determining the activity areas where children are spending the most and least time per day (e.g., music); and (b) mapping a focal child’s atypical real-time movements (e.g., lapping behavior). We calibrated the accuracy of Ubisense point-by-point location estimates (i.e., X and Y coordinates) against laser rangefinder measurements using several stationary points and atypical movement patterns as reference standards. Our results indicate that activity areas occupied and atypical movement patterns could be plotted with an accuracy of 30.48 cm (1 ft) using a Ubisense transponder tag attached to the participating child’s shirt. The accuracy parallels findings of other researchers employing Ubisense to study atypical movement patterns in individuals at risk for dementia in an assisted living facility. The feasibility of Ubisense was tested in an approximately 90-min assessment of two children, one typically developing and one with Down syndrome, during natural classroom activities, and the results proved positive. Implications for employing Ubisense in early childhood classrooms as a data-based decision-making tool to support children’s development and its potential integration with other wearable sensor technologies are discussed.     

The bed nucleus of the stria terminalis is required for the expression of contextual but not auditory freezing in rats with basolateral amygdala lesions

Previous data suggest that overtraining can overcome fear conditioning deficits in rats with lesions of the basolateral complex of the amygdala (BLA). We have previously shown that the central nucleus of the amygdala (CEA) is essential for the acquisition and expression of conditional fear to both contextual and auditory conditioned stimuli (CSs) after overtraining. This provides strong evidence that the CEA can compensate for the loss of the BLA. Another brain area that may compensate for the loss of the BLA is the bed nucleus of the stria terminalis (BNST). We explored this possibility by examining the consequences of lesions or reversible inactivation of the BNST on the expression of overtrained fear in rats with BLA lesions. We demonstrate that lesions or inactivation of the BNST block the expression of freezing to the conditioning context, but not to an auditory conditional stimulus. These results reveal that the BNST has a critical role in the expression of contextual fear, but not fear to an auditory CS, and is therefore not the essential locus of compensation for fear learning in the absence of the BLA.     

Medial prefrontal cortex activation facilitates re-extinction of fear in rats

It has been suggested that reduced infralimbic (IL) cortical activity contributes to impairments of fear extinction. We therefore explored whether pharmacological activation of the IL would facilitate extinction under conditions it normally fails (i.e., immediate extinction). Rats received auditory fear conditioning 1 h before extinction training. Immediately prior to extinction, rats received microinfusions into the IL of the GABA(A) receptor antagonist, picrotoxin, or the NMDA receptor partial agonist, D-cycloserine. Although neither drug facilitated extinction, they both facilitated the subsequent re-extinction of fear when animals were trained in a drug-free state, suggesting that activating the IL primes behavioral extinction.     

Labeling and family resemblance in the discrimination of polymorphous categories by pigeons

Two experiments examined whether pigeons discriminate polymorphous categories on the basis of a single highly predictive feature or overall similarity. In the first experiment, pigeons were trained to discriminate between categories of photographs of complex real objects. Within these pictures, single features had been manipulated to produce a highly salient texture cue. Either the picture or the texture provided a reliable cue for discrimination during training, but in probe tests, the picture and texture cues were put into conflict. Some pigeons showed a significant tendency to discriminate on the basis of the picture cue (overall similarity or family resemblance), whereas others appeared to rely on the manipulated texture cue. The second experiment used artificial polymorphous categories in which one dimension of the stimulus provided a completely reliable cue to category membership, whereas three other dimensions provided cues that were individually unreliable but collectively provided a completely reliable basis for discrimination. Most pigeons came under the control of the reliable cue rather than the unreliable cues. A minority, however, came under the control of single dimensions from the unreliable set. We conclude that cue salience can be more important than cue reliability in determining what features will control behavior when multiple cues are available.     

The effects of valence and arousal on the emotional modulation of time perception: evidence for multiple stages of processing

Previous research has demonstrated that both emotional valence and arousal can influence the subjective experience of time. The current research extends this work by (1) identifying how quickly this emotional modulation of time perception can occur and (2) examining whether valence and arousal have different effects at different stages of perception. These questions were addressed using a temporal bisection task. In each block of this task, participants are trained to distinguish between two different exposure durations. Participants are then shown stimuli presented at a number of durations that fall between the two learned times, and are asked to indicate whether the test stimulus was closer in duration to the shorter or longer learned item. In the current study, participants completed blocks of trials in which the durations were "Short" (100-300 ms) or "Long" (400-1600 ms). Stimuli consisted of neutral photographs as well as four categories of emotional images: high-arousal negative, high-arousal positive, low-arousal negative, and low-arousal positive. In Short blocks, arousing and nonarousing negative images were judged to have been shown for shorter durations than they actually were (i.e., the duration was underestimated); this effect occurred at durations as brief as 133 ms. In Long blocks, the display time for highly arousing negative items was overestimated, whereas durations were underestimated for highly arousing positive items and less arousing negative items. These data suggest that arousal and valence have different effects at different stages of perception, possibly due to the different neural structures involved at each stage of the emotional modulation of time perception.     

Electrophysiological responses to evaluative priming: the LPP is sensitive to incongruity

Previous studies examining event-related potentials and evaluative priming have been mixed; some find evidence that evaluative priming influences the N400, whereas others find evidence that it affects the late positive potential (LPP). Three experiments were conducted using either affective pictures (Experiments 1 and 2) or words (Experiment 3) in a sequential evaluative priming paradigm. In line with previous behavioral findings, participants responded slower to targets that were evaluatively incongruent with the preceding prime (e.g., negative preceded by positive) compared to evaluatively congruent targets (e.g., negative preceded by negative). In all three studies, the LPP was larger to evaluatively incongruent targets compared to evaluatively congruent ones, and there was no evidence that evaluative incongruity influenced the N400 component. Thus, the present results provide additional support for the notion that evaluative priming influences the LPP and not the N400. We discuss possible reasons for the inconsistent findings in prior research and the theoretical implications of the findings for both evaluative and semantic priming.