A study of the foundations of ethical decision making of clinical medical ethicists

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.     

THE “WHERE IS IT?” REFLEX: AUTOSHAPING THE ORIENTING RESPONSE

The goal of this review is to compare two divergent lines of research on signal-centered behavior: the orienting reflex (OR) and autoshaping. A review of conditioning experiments in animals and humans suggests that the novelty hypothesis of the OR is no longer tenable. Only stimuli that represent biological “relevance” elicit ORs. A stimulus may be relevant a priori (i.e., unconditioned) or as a result of conditioning. Exposure to a conditioned stimulus (CS) that predicts a positive reinforcer causes the animal to orient to it throughout conditioning. Within the CS-US interval, the initial CS-directed orienting response is followed by US-directed tendencies. Experimental evidence is shown that the development and maintenance of the conditioned OR occur in a similar fashion both in response-independent (classical) and response-dependent (instrumental) paradigms. It is proposed that the conditioned OR and the signal-directed autoshaped response are identical. Signals predicting aversive events repel the subject from the source of the CS. It is suggested that the function of the CS is not only to signal the probability of US occurrence, but also to serve as a spatial cue to guide the animal in the environment.     

The second offspring of General Process Learning Theory: Overt behavior as the ambassador of the mind

Wasserman suggested in a recent book review that the study of intervening cognitive processes represents a current focus of interest in animal learning and that this has led to a revitalization of comparative psychology. An examination of the volume reviewed suggests that he may have overstated the case. Most of the authors to whom he refers expressed dissatisfaction with traditional stimulus-response associationism but few argued for the extreme (information processing) sort of cognitive approach described by Wasserman.     

Stimulus discriminability in free-operant and discrete-trial detection procedures.

Six pigeons were trained to discriminate different light intensities in four experimental procedures. Experiment 1 compared stimulus discriminability in a yes-no signal-detection task with discriminability measures obtained from two free-operant procedures. Discriminability estimates were significantly lower in the detection procedure. Experiment 2 showed this lowered discriminability to be a function of the delay between stimulus presentation and the availability of the choice-response keys in the standard detection task. In addition, reinforcement sensitivity was lowest when correct choice responses were intermittently, rather than continuously, reinforced.     

ANALYSIS OF THE CONSISTENCY OF OBJECTIVE MEASURES OF SEXUAL AROUSAL IN WOMEN

Eight adult women volunteers viewed the same erotic film in two different sessions. Their resulting genital responses were recorded simultaneously by three different measures: vaginal pressure pulse, vaginal blood volume, and labial temperature change. During the erotic stimulation, the vaginal pressure pulse and labial responses always increased, and the vaginal blood volume response increased on all but two occasions. Although there was considerable intersubject variability in each genital measure, all three measures were found to have some intrasubject consistency over sessions with respect to either their response amplitudes or patterns, with labial temperature being the most consistent on both parameters. The relationship between the response patterns of the three measures during the film was also relatively consistent across sessions, as was the correspondence between subjective ratings of arousal and both vaginal pressure pulse and labial responses but not vaginal blood volume response. To overcome the problem of considerable intrasubject variability of response amplitudes, it was suggested that the inclusion in the data analysis of several parameters of response patterns, which were relatively stable over sessions, might facilitate the evaluation of a treatment.     

Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.     

Considerations in the choice of interobserver reliability estimates

Two types of interobserver reliability values may be needed in treatment studies in which observers constitute the primary data-acquisition system: trial reliability and the reliability of the composite unit or score which is subsequently analyzed, e.g., daily or weekly session totals. Two approaches to determining interobserver reliability are described: percentage agreement and "correlational" measures of reliability. The interpretation of these estimates, factors affecting their magnitude, and the advantages and limitations of each approach are presented.     

Two simple classes of mastery scores based on the beta-binomial model

Two simple classes of mastery scores which are suitable for hand calculations are presented for beta-binomial test score distributions combined with linear and cubic referral success. The models provide a simple way to explore the consequences of selecting an arbitrary mastery score. Such assessment would be useful whenever the test user is not willing to posta priori a loss ratio, but wishes to look at the various consequences before aiming at a particular score.     

Fitting and testing carroll's weighted unfolding model for preferences

A quadratic programming algorithm is presented for fitting Carroll's weighted unfolding model for preferences to known multidimensional scale values. The algorithm can be applied directly to pairwise preferences; it permits nonnegativity constraints on subject weights; and it provides a means of testing various preference model hypotheses. While basically metric, it can be combined with Kruskal's monotone regression to fit ordinal data. Monte Carlo results show that (a) adequacy of true preference recovery depends on the number of data points and the amount of error, and (b) the proportion of data variance accounted for by the model sometimes only approximately reflects true recovery.This study is based on a doctoral dissertation submitted to the University of Illinois at Urbana-Champaign. The author wishes to thank the members of his dissertation committee—Lawrence E. Jones, Chairman, Charles Lewis, Stephen Golding, Ledyard Tucker, and Nancy Wiggins—for their helpful comments.     

A note on computing Louis’ observed information matrix identity for IRT and cognitive diagnostic models

Using Louis’ formula, it is possible to obtain the observed information matrix and the corresponding large-sample standard error estimates after the expectation–maximization (EM) algorithm has converged. However, Louis’ formula is commonly de-emphasized due to its relatively complex integration representation, particularly when studying latent variable models. This paper provides a holistic overview that demonstrates how Louis’ formula can be applied efficiently to item response theory (IRT) models and other popular latent variable models, such as cognitive diagnostic models (CDMs). After presenting the algebraic components required for Louis’ formula, two real data analyses, with accompanying numerical illustrations, are presented. Next, a Monte Carlo simulation is presented to compare the computational efficiency of Louis’ formula with previously existing methods. Results from these presentations suggest that Louis’ formula should be adopted as a standard method when computing the observed information matrix for IRT models and CDMs fitted with the EM algorithm due to its computational efficiency and flexibility.