Sources of variability in sequelae of very low birth weight.

Few investigations have examined the specificity of sequelae of very low birth weight (VLBW, <1500 g) or sources of variability in outcome. To better understand the nature and determinants of outcome, we assessed neuropsychological and achievement skills at mean age 11 years in 62 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Distinct cognitive constructs were identified by factor analysis, and the three birthweight groups were compared on these constructs and on composite measures of achievement. Although the group with <750 g birth weight performed less well on all tests than term-born controls, group differences in a perceptual planning factor and in mathematics remained even when IQ was controlled, and deficits were more pronounced in mathematics than in reading. Results from structural equation modeling were consistent with the hypothesis that neuropsychological skills mediated the relationship between birth weight and achievement. The findings confirm the differential deficit hypothesis, support the need to consider multiple sources of variability in VLBW outcomes, and highlight the importance of neuropsychological constructs in developing an explanatory framework.     

Improving Health Care Utilization, Improving Chronic Disease Utilization, Health Status, and Adjustment in Adolescents and Young Adults with Cystic Fibrosis: A Preliminary Report

We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.     

Cloninger's Temperament and Character Inventory Correlates with Personality Characteristics of Organ Donation Advocates

Temperament and Character Inventory (TCI) and background questionnaire data were collected from a sample of men and women organ donation advocates (N = 362) as part of a national study to investigate their personality characteristics, temperaments, and attitudes about organ donation advocacy. Goals included identifying unique traits for advocates, and response consistency between the TCI and questionnaire. The TCI results included high scores on Cooperativeness and Self-Directedness, and low on Harm Avoidance dimensions. The questionnaire results indicated that most advocates were White, married, college-educated females, who typically spent less than 2 hr with potential donor families, were satisfied with life and job, and believed they would be in a donation position 2 years from the time surveyed. TCI and questionnaire measures were correlated for Self-Transcendence and Spirituality, Helpfulness and Job Satisfaction, and Compassion and Identification variables.     

Impact of health beliefs, quality of life, and the physician-patient relationship on the treatment intentions of inflammatory bowel disease patients.

The research tested a model of treatment decision making in chronic illness that includes health beliefs, quality of life, and relationship with the physician (shared or not). Inflammatory bowel disease patients (N = 218) reported on their physician-patient relationship, general and disease-specific quality of life, and intentions to take a drug, for which perceived benefits and costs were manipulated. For more symptomatic patients, both costs and benefits predicted intentions; however, for less symptomatic patients, costs played a more important role. Physician recommendation predicted intention primarily among those who shared a decision-making relationship with their physician. Overall, the model accounted for 57.8% of the variance in medication-taking intention. Findings suggest that an integrative consideration of relationship factors, health beliefs, and health status may help explain treatment intentions among the chronically ill.     

Can Robert Adams Survive Moral Twin Earth?

Richard Boyd and Robert Adams have both developed semantic accounts of moral terms based on Hilary Putnam's causal regulation theory for natural kind terms, according to which the terms in question refer to the properties which predominantly causally regulated the terms. However, Terence Horgan and Mark Timmons have mounted an objection to Boyd's semantics—their Moral Twin Earth argument. If this argument is successful against Boyd then it might be thought that it should also be successful against Adams, given the similarity between their semantic accounts. I will argue in this essay that Adams's semantics is sufficiently different from Boyd's to enable him to survive Moral Twin Earth, but that he is vulnerable to a modified version of Moral Twin Earth that I describe.     

Heidegger’s Nietzsche

ABSTRACT

Heidegger maintained that Nietzsche was a metaphysical thinker. What did he mean by that? Not that Nietzsche advanced purely theoretical doctrines that might be perfected or refuted by rational argument. Instead, he meant that Nietzsche’s thinking is a ‘representational thinking’ (vorstellendes Denken) that preserves a commitment to a conception of truth as correctness (Richtigkeit). Nietzsche’s apparent denials of the intelligibility of truth, Heidegger argues, are in fact expressions of our growing insensitivity to truth understood as unconcealment (Unverborgenheit). Nietzsche’s thinking is thus deeply attuned to metaphysics as Heidegger came to understand it in the late 1930s, namely as a forgetting of being (Seinsvergessnheit), beginning with Plato. His interpretation of Nietzsche’s thought, particularly the idea of eternal recurrence, changed less because he changed his mind about Nietzsche than because he reconceived the philosophical tradition since Plato as metaphysical, and so reframed his own project as an attempt to think beyond metaphysics.