The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Multidimensional same--different judgments: evidence against independent comparisons of dimensions

Commonly discussed models of performance in the multidimensional same-different task are based on the assumption that independent same-different decisions are reached for each of the stimulus dimensions used in an experiment. In these models, a higher level mechanism examines th outcome of these independent decisions in order to determine whether the stimuli are the same or different overall. Previous evidence indicating that these models are inconsistent with results from same trials is summarized, and a new test of the above assumption using data from different trials is proposed. Detailed analysis of reaction times from different trials is shown, at least for some pairs of dimensions, to be incompatible with the view that separate same-different decisions are reached for each dimension. The major finding is that there are more relatively fast responses in a condition with two dimensions different, compared with the two conditions with only one of the dimensions different, than any processing model treating the dimensions separately could predict. The results suggest that partial information may be combined across dimensions in order to reach a "different" judgment.     

The effect of set size on hemifield asymmetries in letter recognition

Single letters were presented tachistoscopically in the left or right hemifield to right-handed observers. Superior recognition of letters on the right was found for letters chosen from subsets containing four items, but no differences were found when any letter, or any symmetrical letter, could appear. In a second experiment, the right hemifield advantage was found under conditions requiring the subject to determine the subset only when the subset chosen was appropriate. Results were discussed in terms of the adequacy of language-based explanations of hemifield asymmetries in letter recognition.     

Irrelevant differences in the "same"--"different" task

This article examines the effects of irrelevant information on the multidimensional "same"--"different" task. Subjects were instructed to compare two geometric figures with respect to certain attributes but to ignore other attributes in making the "same"--"different" decision. The irrelevant attributes were chosen in such a way that they could not easily be ignored to see how the existence of irrelevant differences would affect the comparison process. As expected, the overall latencies were longer than is usually found in tasks with no irrelevant differences. However, the nature of the comparison process appeared unchanged. The usual finding of a "fast-same" phenomenon persisted even when irrelevant information was present. The similarity of the results in this task to results in the "same"--"different" task with no irrelevant features supports the idea that the same comparison mechanism is used whether or not irrelevant differences are present in the stimulus pairs. The results suggest a more general-purpose comparison mechanism than is usually included in models of this task. Two-process models of visual comparisons are thus ruled out entirely. A modified version of Krueger's noisy-operator theory does appear consistent with the results.     

Contextual potentiation of acquired behavior after devaluing direct context-US associations

In two experiments, water-deprived rats were exposed to tone-footshock pairings in a particular conditioning context. In Experiment 1, the training parameters were selected on the basis of parametric pilot data so as not to produce direct associations between the conditioning context and footshock. Despite independent evidence of no appreciable direct association between the conditioning context and footshock, animals tested in the conditioning context exhibited more lick suppression to the tone than other animals tested with the tone outside of the conditioning context. Thus, the conditioning context potentiated suppression to the tone in the absence of appreciable fear of the conditioning context. In Experiment 2, training parameters were used that permitted the formation of direct associations between the conditioning context and footshock; however, for half the animals, these associations to the context were then extinguished. With the tone absent, a comparison of extinguished animals tested either in the conditioning context or outside the conditioning context detected no differences in suppression, demonstrating the effectiveness of the extinction manipulation. However, other animals also subjected to extinction of direct context-footshock associations displayed greater suppression to the tone within the conditioning context than comparable animals tested outside the context. Collectively the data indicate that the superior retention-test performance seen within the training context can arise both from the commonly assumed direct associations between the training context and the unconditioned stimulus and from the potentiation by the training context of the associations between the nominal conditioned stimulus and unconditioned stimulus.     

Accommodation fatigue and dark focus: The effects of accommodation-free visual work as assessed by two psychophysical methods

Past studies of accommodation fatigue have yielded inconsistent results, partly because they have not used direct measures of accommodation, and partly because they may have been based on a misleading conception of the nature of accommodation. The dual-innervation theory of accommodation suggests that the resting position of accommodation may be neuromuscular rather than just muscular, and that it lies not at optical infinity, as assumed by older conceptions, but at some intermediate position (dark focus). Among the predictions that may be deduced from this theory is that long-term visual work not requiring active accommodation will not induce fatigue. The present study involved continuous measurements of dark focus for 10 young adults over a 3-h period, using the laser optometer with two psychophysical procedures Ibracketing and staircase. Consistent with the prediction, no changes in dark focus were found, in spite of the demanding visual task. Furthermore, it was found that both psychophysical methods yielded essentially identical results. The practical and theoretical implications of these results are discussed, and recommendations are given regarding situations in which each of the psychophysical methods is likely to be most useful.     

Isobias curves in some detection tasks

Signal/noise ratio was varied in three tone-detection tasks while other conditions were held constant, generating 9 8-point and 12 12-point isobias plots. These plots were compared with the theoretical isobias curves associated with seven proposed bias measures. Each of the proposed measures covaried with signal/noise ratio in at least half of the data. For two of the plots, none of the measures was invariant. It is clear that different subjects respond quite differently to change in discriminability, and the implications of this for bias measurement are discussed.