Causal Responsibility and Rationing in Medicine

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age.     

Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

Immunity to functional fixedness in young children

In thecandle problem (Duncker, 1945), subjects must attach a candle to a vertical surface, using only a box of tacks and a book of matches. Subjects exhibitfunctional fixedness by failing, or being slow, to make use of one object (the tack box) as a support, rather than as a container, in their solutions. This failure to produce alternate functions is measured against improved performance when the tack box is presented empty rather than full of tacks (i.e., not preutilized as a container). Using an analogous task, we show that functional fixedness can be demonstrated in older children (6- and 7-year-olds); they are significantly slower to use a box as a support when its containment function has been demonstrated than when it has not. However, younger children (5-year-olds) are immune to this effect, showing no advantage when the standard function is not demonstrated. Moreover, their performance under conditions of preutilization is better than that of both older groups. These results are interpreted in terms of children’s developing intuitions about function and the effects of past experience on problem solving.     

The reverse Stroop effect

In classic Stroop interference, manual or oral identification of sensory colors presented as incongruent color words is delayed relative to simple color naming. In the experiment reported here, this effect was shown to all but disappear when the response was simply to point to a matching patch of color. Conversely, strong reverse Stroop interference occurred with the pointing task. That is, when the sensory color of a color word was incongruent with that word, responses to color words were delayed by an average of 69 msec relative to a word presented in gray. Thus, incongruently colored words interfere strongly with pointing to a color patch named by the words, but little interference from incongruent color words is found when the goal is to match the color of the word. These results suggest that Stroop effects arise from response compatibility of irrelevant information rather than automatic processing or habit strength.     

Is there a general factor in ratings of job performance? A meta-analytic framework for disentangling substantive and error influences

A database integrating 90 years of empirical studies reporting intercorrelations among rated job performance dimensions was used to test the hypothesis of a general factor in job performance. After controlling for halo error and 3 other sources of measurement error, there remained a general factor in job performance ratings at the construct level accounting for 60% of total variance. Construct-level correlations among rated dimensions of job performance were substantially inflated by halo for both supervisory (33%) and peer (63%) intrarater correlations. These findings have important implications for the measurement of job performance and for theories of job performance.     

The structure of goal contents across 15 cultures

The authors investigated the structure of goal contents in a group of 1,854 undergraduates from 15 cultures around the world. Results suggested that the 11 types of goals the authors assessed were consistently organized in a circumplex fashion across the 15 cultures. The circumplex was well described by positioning 2 primary dimensions underlying the goals: intrinsic (e.g., self-acceptance, affiliation) versus extrinsic (e.g., financial success, image) and self-transcendent (e.g., spirituality) versus physical (e.g., hedonism). The circumplex model of goal contents was also quite similar in both wealthier and poorer nations, although there were some slight cross-cultural variations. The relevance of these results for several theories of motivation and personality are discussed.     

An interval size illusion: the influence of timbre on the perceived size of melodic intervals

In four experiments, we investigated the influence of timbre on perceived interval size. In Experiment 1, musically untrained participants heard two successive tones and rated the pitch distance between them. Tones were separated by six or seven semitones and varied in timbre. Pitch changes were accompanied by a congruent timbre change (e.g., ascending interval involving a shift from a dull to a bright timbre), an incongruent timbre change (e.g., ascending interval involving a shift from a bright to a dull timbre), or no timbre change. Ratings of interval size were strongly influenced by timbre. The six-semitone interval with a congruent timbre change was perceived to be larger than the seven-semitone interval with an incongruent timbre change (interval illusion). Experiment 2 revealed similar effects for musically trained participants. In Experiment 3, participants compared the size of two intervals presented one after the other. Effects of timbre were again observed, including evidence of an interval illusion. Experiment 4 confirmed that timbre manipulations did not distort the perceived pitch of tones. Changes in timbre can expand or contract the perceived size of intervals without distorting individual pitches. We discuss processes underlying interval size perception and their relation to pitch perception mechanisms.     

Perception of visual speed while moving

During self-motion, the world normally appears stationary. In part, this may be due to reductions in visual motion signals during self-motion. In 8 experiments, the authors used magnitude estimation to characterize changes in visual speed perception as a result of biomechanical self-motion alone (treadmill walking), physical translation alone (passive transport), and both biomechanical self-motion and physical translation together (walking). Their results show that each factor alone produces subtractive reductions in visual speed but that subtraction is greatest with both factors together, approximating the sum of the 2 separately. The similarity of results for biomechanical and passive self-motion support H. B. Barlow's (1990) inhibition theory of sensory correlation as a mechanism for implementing H. Wallach's (1987) compensation for self-motion.     

The training and transfer of real-world perceptual expertise

A hallmark of perceptual expertise is that experts classify objects at a more specific, subordinate level of abstraction than novices. To what extent does subordinate-level learning contribute to the transfer of perceptual expertise to novel exemplars and novel categories? In this study, participants learned to classify 10 varieties of wading birds and 10 varieties of owls at either the subordinate, species (e.g., "great blue crown heron,"eastern screech owl") or the family ("wading bird,"owl") level of abstraction. During training, the amount of visual exposure was equated such that participants received an equal number of learning trials for wading birds and owls. Pre- and posttraining performance was measured in a same/different discrimination task in which participants judged whether pairs of bird stimuli belonged to the same or different species. Participants trained in species-level discrimination demonstrated greater transfer to novel exemplars and novel species categories than participants trained in family-level discrimination. These findings suggest that perceptual categorization, not perceptual exposure per se, is important for the development and generalization of visual expertise.