Reducing aversion to side effects in preventive medical treatment decisions

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit.     

Addressing Consent Issues in Donation After Circulatory Determination of Death

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria (i.e., brain death), there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients.     

A Public Culture For Guinea Pigs: US Human Research Subjects after the Tuskegee Study

Abstract

Tissue engineering is one potential arm of the much-heralded regenerative medicine. We use the concepts of technological zone, risk framing and regulatory jurisdiction to analyse what risks are formulated in the zone of tissue engineering and whether those risks are reflected in emerging regulatory policy in Europe. In the regulatory jurisdictions of the European Union, public health risks have become increasingly important. Tissue engineering challenges pre-existing regulatory frameworks. Scientific–industrial actors formulate the risks of tissue engineering in three primary frames: technological safety risk; therapeutic efficacy risk; and economic risk. Study of the prevailing configuration of European Commission institutions and the EU process of regulatory regime-building for tissue engineering shows that risk frames are mobilized selectively. Whilst the technological safety frame and the economic frame are strongly mobilized, therapeutic efficacy—especially comparative efficacy—is not. Additionally the regime avoids any Europe-level position on the so-called ethics of sourcing and engineering tissues and cells. Efficacy and ethics are defined as the jurisdiction of national authorities, underpinned by the subsidiarity principle. Outcomes include the likely banning of certain therapeutic technologies by European countries that have objections to products deriving from controversial materials and processes, and the prevention of adoption of products due to efficacy concerns, so creating new imbalances in the European therapeutic marketplace. Consequently, the tissue-engineered medical products that European societies consume, at least in the near term, will reflect the medically defined needs of the European population to a limited and patchy extent.     

Motivational determinants of integrating positive and negative past identities

Five studies examined whether quality of motivation (as individual differences and primed) facilitates or thwarts integration of positive and negative past identities. Specifically, more autonomously motivated participants felt closer to, and were more accepting of, both negative and positive past characteristics and central life events, whereas more control-motivated participants were closer to and more accepting of positive, but not negative, past characteristics and events. Notably, controlled motivation hindered participants' acceptance of their own negative identities but not of others' negative identities, suggesting that control-motivated individuals' rejection of negative past identities was an attempt to distance from undesirable parts of themselves. Defensive processes, reflected in nonpersonal pronouns and escape motives, mediated interaction effects, indicating that lower defense allowed fuller integration. Integration of both positive and negative past identities predicted indicators of well-being, namely, vitality, meaning, and relatedness satisfaction.     

Autonomy and control in dyads: effects on interaction quality and joint creative performance

Two studies examined interaction quality and joint performance on two creative tasks in unacquainted dyads primed for autonomy or control orientations. It was hypothesized that autonomy-primed dyads would interact more constructively, experience more positive mood, and engage the task more readily, and as a result these dyads would perform better. To test this, Study 1 primed orientation and explored verbal creative performance on the Remote Associates Task (RAT). In Study 2, dyads were primed with autonomy and control orientation and videotaped during two joint creative tasks, one verbal (RAT) and one nonverbal (charades). Videotapes were coded for behavioral indicators of closeness and task engagement. Results showed that autonomy-primed dyads felt closer, were more emotionally and cognitively attuned, provided empathy and encouragement to partners, and performed more effectively. The effects of primed autonomy on creative performance were mediated by interpersonal quality, mood, and joint engagement.     

Attributing autonomous versus introjected motivation to helpers and the recipient experience: Effects on gratitude,attitudes, and well-being

Three studies examined the effects of motivation attributed to helpers on recipient reactions. Participants read and responded to scenarios depicting various helping events, in which indicators of helpers having autonomous or controlled (introjected) motivations were embedded. Results showed that recipients experienced more gratitude toward autonomous helpers than those helping for controlled motivations. Helping interactions involving more autonomous attributions were also predictive of positive attitudes toward helpers, positive affect, and felt closeness. Gratitude mediated the effects of autonomous versus controlled helping on recipient positive attitude, well-being, and closeness to helpers. Study 3 confirmed that helper autonomous motivation independently predicted gratitude and other positive reactions to receiving help even when controlling for other important attributions, namely, perceived helper empathy, cost to helper, valuing of help, and perceived similarity.     

An investigation into assessment centre validity,fairness, and selection drivers

This study examined the construct‐related validity of an assessment centre (AC) developed by a national distribution company for the selection and development of lower‐grade managers. In five locations throughout Britain, 487 individuals were observed on nine dimensions, each of which was measured through six distinct exercises. Multitrait‐multimethod analyses conducted to investigate the convergent and discriminant validity of the AC revealed strong exercise (“method”) effects. This finding was corroborated by an exploratory factor analysis showing that AC ratings clustered into factors according to exercises, rather than according to performance dimensions. A series of MANOVAs and chi‐squared tests demonstrated that neither the exercise ratings nor the selection decision were biased by sex, ethnicity, or training location, and a logistic regression determined which exercises had most impact on the final decision.     

Superluminal Signaling and Relativity

Special relativity is said to prohibit faster-than-light (superluminal) signaling, yet controversy regularly arises as to whether this or that physical phenomenon violates the prohibition. I argue that the controversy is a result of a lack of clarity as to what it means to ‘signal’, and I propose a criterion. I show that according to this criterion, superluminal signaling is not prohibited by special relativity.     

Fluent Reading as the Improvement of Stimulus Control: Additive Effects of Performance-Based Interventions to Repeated Reading on Students' Reading and Error Rates

The impact of adding performance-based interventions to a skill-based intervention on oral reading fluency was examined with 3 elementary students identified as having difficulty with reading. Two performance-based interventions were combined with the skill-based intervention Repeated Reading (RR) to create the three instructional packages investigated. The packages included Repeated Readings (RR), Repeated Readings with Performance Feedback (RR/FB), and Repeated Readings with Performance Feedback and Contingent Reward (RR/FB/REW). Results suggested that Repeated Reading (RR) alone led to the greatest increase in reading fluency for participants with the highest reading rates and lowest error rates at baseline. In contrast, the participant who exhibited the lowest reading rate and highest error rate benefited the most when Repeated Readings was offered in conjunction with Performance Feedback (RR/FB) or Performance Feedback plus Contingent Reward (RR/FB/RW). Implications for blending skill- and performance-based interventions to develop stimulus control over fluent reading and future research directions are discussed.