Using a new analysis of the best interests standard to address cultural disputes: Whose data,which values?

Clinicians sometimes disagree about how much to honor surrogates’ deeply held cultural values or traditions when they differ from those of the host country. Such a controversy arose when parents requested a cultural accommodation to let their infant die by withdrawing life saving care. While both the parents and clinicians claimed to be using the Best Interests Standard to decide what to do, they were at an impasse. This standard is analyzed into three necessary and jointly sufficient conditions and used to resolve the question of how much to accommodate cultural preferences and how to treat this infant. The extreme versions of absolutism and relativism are rejected. Properly understood, the Best Interests Standard can serve as a powerful tool in settling disputes about how to make good decisions for those who cannot decide for themselves.     

ICU患者外出检查风险分析与对策

为了探讨ICU危重患者外出检查风险的原因,从而降低ICU危重患者外出检查风险,本文通过对312例ICU患者外出检查风险因素进行讨论分析,研究降低风险的对策,即在规范ICU患者外出检查流程、做好检查前准备和注意途中安全及返回后的护理,结果提示285例患者无意外发生,安全返回病房,其余27例患者存在一定风险,但在相应处理措施下均安全返回病房。     

汉语口语词汇产生的音韵编码单元：内隐启动范式的ERP研究

本研究中选择英语水平低的汉语母语者, 排除作为二语的英语音韵编码单元(音素)可能对汉语口语词汇产生过程的影响后, 运用事件相关电位技术, 考察了汉语口语产生过程中音节和音素效应的时间进程。实验采用内隐启动范式, 要求被试看到提示词之后说出对应的目标词。事件相关电位分析结果发现, 音节效应出现在线索词呈现后的100~400 ms之间, 音素效应出现在500~600 ms之间, 波形表现为相关条件比无关条件的波形更正。这表明在词汇选择之后的音韵编码阶段讲话者首先提取的单元是音节, 而音素效应出现的时间窗口可能是音韵编码阶段后期或者是语音编码阶段, 结果验证了合适编码单元假说的观点。     

Hemispheric laterality measured in Rembrandt's portraits using pupil diameter and aesthetic verbal judgements

Eckhard Hess claimed that pupils dilate to pleasant images and constrict to unpleasant images. However, his work was confounded since his image's luminances and contrasts across conditions were inconsistent. We overcome this limitation and suggest a new, promising methodology for research in this area. We presented rightward or leftward facing male and female portraits by Rembrandt to observers in either their original or mirror-reversed position. Since emotional content may be expressed differently on each side of the face, we used Rembrandt's portraits since most of his males had their right-cheek exposed and females had their left-cheek exposed. This raises questions regarding the emotional and cognitive significance of such biased positioning. Simultaneously, we measured observers pupil size while asking observers to report how (dis)pleasing they found each image. We found that in viewing male portraits pupil diameter was a function of arousal. That is, larger pupil diameter occurred for images rated both low and high in pleasantness. We discuss these findings in regard to the perceived dominance of males and how emotional expressions may be driven by hemispheric laterality.     

Time and again: Intermittent Brief Dynamic Therapy

Abstract

The author notes that in many of the settings in which Brief Therapy takes place that a client may return after the ending for a further series of sessions. Time-limited therapy has placed an emphasis upon the termination phase of the therapy and linked this to the process of individuation and separation. Such an approach, as articulated by Mann (1973 Mann, J. 1973. Time-limited psychotherapy, Cambridge, MA: Harvard University Press.  [Google Scholar]), which draws conceptually from the work of Winnicott (1965 Winnicott, D. W. 1965. The maturational processes and the facilitating environment, London: Hogarth Press.  [Google Scholar]) and the notion that the infant achieves unit status from the original undifferentiated merger with the mother, is not easily compatible with Intermittent Brief Dynamic Therapy. The work of attachment theorists and Stern (1985 Stern, D. N. 1985. The interpersonal world of the infant, New York: Basic Books.  [Google Scholar]) provide an alternative basis upon which to conceive of the development of the infant. While emphasizing the importance of attending to affects at points of separation and ending, as is evidenced in the work of Della Selva (2004 Della, Selva P. C. 2004. Intensive short-term dynamic psychotherapy, London: Karnac.  [Google Scholar]), such a framework is more readily compatible with the development of Intermittent Therapy, and with the realities of the settings in which much brief work takes place. The author also comments upon the flexibility inherent in Winnicott's own practice of brief consultations, and the implications of this for the development of Intermittent Brief Dynamic Therapy. The paper includes a case study that illustrates this debate and which provides evidence for the therapeutic potency of a form of Brief Dynamic Intermittent Therapy where a dynamic focus maintains a structuring pattern to the narrative over a sequence of several periods of Brief Therapy, spread over a number of years.     

Cognitive-behavioural Anger Management Training for Adults with Mild Intellectual Disability

Although people with intellectual disabilities often display anger control problems, little research has been conducted on the development and evaluation of cost-effective anger management training programs for this special population. This study evaluated the efficacy of cognitive-behavioural anger management for 11 adults with mild intellectual disabilities in a group therapy format. Improvements were evident on self-report measures of anger and self-esteem. Additionally, caregiver reports indicated general improvements in emotional and behavioural adjustment. Limitations of the study are acknowledged, including the absence of a control condition.     

Adolescent mental health: the role of youth and college pastors

The present study investigates the gatekeeping role of youth and college pastors, specifically exploring their psychological training, perceptions, attitudes, and interactions concerning adolescent congregants' mental illness. Texas youth and college pastors were anonymously surveyed regarding referral patterns, mental health interventions and contact, adolescent mental health perceptions, and means of collaboration. While the sample reported actively working with numerous adolescent mental health issues, the majority did not feel qualified to work with significant psychopathology. Despite this, they reported using various intervention methods, with the most common being initial counselling followed by a referral. Although the sample frequently referred to other professionals, they described many perceived barriers in collaborating with others in the mental health field. Overall, a positive role exists for youth and college pastors in adolescent mental health; however, tensions and conflicts between pastors and mental health professionals hinder the usefulness of these unique gatekeepers. Implications and recommendations for mental health professionals are highlighted.     

The segment as the minimal planning unit in speech production: Evidence based on absolute response latencies

A minimal amount of information about a word must be phonologically and phonetically encoded before a person can begin to utter that word. Most researchers assume that the minimum is the complete word or possibly the initial syllable. However, there is some evidence that the initial segment is sufficient based on longer durations when the initial segment is primed. In two experiments in which the initial segment of a monosyllabic word is primed or not primed, we present additional evidence based on very short absolute response times determined on the basis of acoustic and articulatory onset relative to presentation of the complete target. We argue that the previous failures to find very short absolute response times when the initial segment is primed are due in part to the exclusive use of acoustic onset as a measure of response latency, the exclusion of responses with very short acoustic latencies, the manner of articulation of the initial segment (i.e., plosive vs. nonplosive), and individual differences. Theoretical implications of the segment as the minimal planning unit are considered.     

Refusing to be excluded: finding ways of integrating psychotherapeutic modalities to the emerging needs of a Pupil Referral Unit

This paper describes the application of child psychotherapy, its theory and practice, in a Pupil Referral Unit (PRU). It examines the importance of a flexible approach to outreach work and the implementation of interventions that take into consideration both the internal and the external world of the adolescent. Furthermore, the process of development of a psychodynamic group with PRU students is described and illustrated. Additionally, it explores the importance of developing psychodynamic models of working with allied professionals in supervision and collaborative efforts in general. The paper explores the usefulness of the concept of mentalisation when working in the context of schools as well as the need to develop an accessible psychodynamic language that enables multidisciplinary collaboration. Overall, this paper reflects on the importance of holding in mind the challenge of balancing the needs of the external and the internal world, which becomes very evident in the process of outreach work.