When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution.     

Muscimol,AP5, or scopolamine infused into perirhinal cortex impairs two-choice visual discrimination learning in rats

The perirhinal cortex (PRh) has been strongly implicated in object recognition memory and visual stimulus representation. Studies of object recognition have revealed evidence for the involvement of several neurotransmitter subsystems, including those involving NMDA (N-methyl-d-aspartic acid) and muscarinic cholinergic receptors. In the present study, we assessed the possible involvement of PRh and related receptor subsystems in two-choice visual discrimination learning by Lister Hooded rats tested in touchscreen-equipped operant boxes. In Experiment 1, daily pre-training inactivation of PRh with the GABA_A receptor agonist muscimol (0.5 μg/hemisphere) significantly impaired acquisition of the two-choice visual discrimination. In Experiment 2, daily pre-training blockade of either NMDA or muscarinic receptors in PRh with AP5 (5.9 μg/hemisphere) or scopolamine (10 μg/hemisphere), respectively, impaired task acquisition. These results parallel the findings from object recognition studies and suggest a generality of neurotransmitter receptor involvement underlying the role of PRh in both object recognition memory and visual discrimination learning. The involvement of PRh in both types of tasks may be related to its role in complex visual stimulus representation.     

Meaning-Centered Couples Therapy: Logotherapy and Intimate Relationships

Viktor Frankl’s logotherapy posits that human life has purpose and that human beings are motivated to discover meaning in their lives. This paper’s objective is to present a case for incorporating meaning into couples therapy as a way of enhancing a clinician’s existing approach. Logotherapy is a potentially useful modality, regardless of the clinician’s theoretical orientation, given its collaborative nature and focus on the significance of meaning and values to the human condition. A logotherapeutic approach to couples therapy (i.e., meaning-centered couples therapy) would involve values clarification (individually and collectively) and emphasis on a love that is based on acceptance and self-transcendent growth. Logotherapy techniques are discussed, a composite illustration is presented, and recommendations for research are offered.     

Tic-Tac-Toe performance as a function of maturational level of retarded adolescents and nonretarded children

Two groups of retarded adolescents, differing from each other primarily in IQ (and mental age), were compared with two groups of nonretarded children, differing from each other in chronological age (and mental age), on a modified tic-tac-toe game. The mental ages of the retarded and nonretarded groups were approximately the same. It was found that the slope of performance improvement with increasing maturational level was the same for both subject groups, but the performance of the retarded adolescents was approximately 1.5 years behind mental age expectations, as derived from the performance levels of the normal children. These findings support previous suggestions of a major retardate deficit in tasks requiring logical foresight.     

Lateral preference for identical geometric forms: II. Retardates

Adolescent educable retardates made size discriminations between pairs of equal-sized geometric forms presented tachistoscopically (Experiment I) or manually with unlimited exposure (Experiment II). There was no side preference under tachistoscopic presentation. Under unlimited exposure Ss showed a strong preference to choose the right-side stimulus as the larger (59.1%). Normals, from previous studies, had a preference to perceive the right-hand stimulus as larger under both conditions.     

Scopolamine infused into perirhinal cortex improves object recognition memory by blocking the acquisition of interfering object information

In a previous study, we reported apparently paradoxical facilitation of object recognition memory following infusions of the cholinergic muscarinic receptor antagonist scopolamine into the perirhinal cortex (PRh) of rats. We attributed these effects to the blockade by scopolamine of the acquisition of interfering information. The present study tested this possibility directly by modifying the spontaneous object recognition memory task to allow the presentation of a potentially interfering object either before the sample phase or in the retention delay between the sample and choice phases. Presentation of an object between the sample and choice phases disrupted subsequent recognition of the sample object (retroactive interference), and intra-PRh infusions of scopolamine prior to the presentation of the irrelevant object prevented this retroactive interference effect. Moreover, presentation of an irrelevant object prior to the sample phase interfered proactively with sample object recognition, and intra-PRh infusions of scopolamine prior to the presentation of the pre-sample object prevented this proactive interference effect. These results suggest that blocking muscarinic cholinergic receptors in PRh can disrupt the acquisition of potentially interfering object information, thereby facilitating object recognition memory. This finding provides further, strong evidence that acetylcholine is important for the acquisition of object information in PRh.     

Effect of shared information and owner behavior on showing in dogs (Canis familiaris)

Animal Cognition - Dogs’ production of referential communicative signals, i.e., showing, has gained increasing scientific interest over the last years. In this paper, we investigate whether...     

Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure

Disclosure rates of child sexual abuse (CSA) to both social supports and law enforcement are concerningly low, although more research is needed to understand factors that impact disclosure. Thus, the present study examined rates of informal (i.e., to a social support) and formal (i.e., to law enforcement) disclosure of CSA, as well as victims' self-reported experiences with telling others about their own abuse and their perceptions of the overall advantages and disadvantages of disclosure. In all, 76 undergraduate women (who collectively experienced 105 instances of abuse) participated in a semi-structured interview regarding their history of CSA. Results revealed that approximately 50% of cases involved the victim informally disclosing, and only 10% of cases being formally disclosed to authorities. The quantitative and qualitative data shed light on a number of factors that lead victims to not disclose, as well as the identification of factors that may promote a victim to share their abuse with others. The implications for improved prevention and responses to CSA disclosure are discussed.