Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

单眼视剥夺2小时对雏鸡记忆保持的影响

以2日龄雏鸡为研究对象,采用一次性被动回避学习模型,以不透明胶纸封贴一侧眼的方法,研究2日龄雏鸡单侧眼视剥夺2小时后对视觉学习记忆的影响,并与双眼学习条件下的记忆情况进行比较;试图探讨雏鸡在视觉信息加工过程中左、右半球的作用。实验结果表明：剥夺一侧眼（无论左或右）2小时后对雏鸡的短时记忆无影响,明显干扰雏鸡的中期和长时记忆,特别是剥夺左眼干扰更明显。     

EFFECTS OF REINFORCEMENT HISTORY AND INSTRUCTIONS ON THE PERSISTENCE OF STUDENT ENGAGEMENT

We examined the effects of three reinforcement histories on the persistence of task engagement by 2 fourth-grade students using a partially counterbalanced ABCDBCD design. In each condition, an experimenter made four student contacts during the first 2 min of each session (reinforcement baseline), followed by an 8-min extinction period. The reinforcement history that contained an instructional control component produced the greatest persistence in student engagement. The applied relevance of instructional control is discussed.     

汉字内隐记忆的实验研究（Ⅱ）：任务分离和反应倾向

在实验Ｉ的基础上,操纵学习时的呈现时间（２５０ｍｓ,５００ｍｓ,７５０ｍｓ）和注意变量（目标和非目标字）,运用任务分离方法及间接证明逻辑,比较了再认测验和整字偏好测验在不同条件下的辨别力（Ａ′）和反应倾向（Ｂ″）。结果：（１）双向功能分离的出现表明再认测验和偏好测验存在本质差异。根据“过程纯净”假设,可以推证内隐记忆存在于偏好测验中。此时,匹配比较法的标准未满足。（２）偏好测验中,５００ｍｓ呈现目标字时,有显著正向启动效应：７５０ｍｓ呈现非目标字时,有显著负向启动效应。（３）内隐记忆和外显记忆发生时,都具有稳定的心理状态。但是前者的报告标准较松宽,而后者的较严格。     

REDUCING ESCAPE BEHAVIOR AND INCREASING TASK COMPLETION WITH FUNCTIONAL COMMUNICATION TRAINING,EXTINCTION AND RESPONSE CHAINING

The effects of functional communication training, extinction, and response chaining on 3 subjects' escape-maintained aberrant behavior were evaluated using a multielement design. Functional communication training consisted of teaching subjects a verbal response that was functionally equivalent to their aberrant behavior. Subjects initially were allowed to escape from a task contingent on the trained verbal response. In subsequent treatment phases, escape was contingent on the trained verbal response plus the completion of the specified number of steps in the task (response chaining). The number of steps was increased until a subject completed the task to obtain a break. Results showed that the treatment reduced rates of aberrant behavior and that the chaining procedure was effective in decreasing the availability of escape.     

Reflections on segregating and assessing areas of competence

Various complexities that arise in the application of legal and/or clinical criteria to the actual assessment of competence/capacity are discussed, and a particular way of understanding the nature of such criteria is recommended.     

TEACHING THE HANDICAPPED TO EAT IN PUBLIC PLACES: ACQUISITION,GENERALIZATION AND MAINTENANCE OF RESTAURANT SKILLS

This study examined classroom-based instruction in restauranting skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.     

Decomposing the encoding of action events: A dual conception

Two experiments are reported in which we tested the hypothesis that encoding of verbal features of subject-performed tasks or SPTs (e.g., bounce the ball, lift the spoon) is attention-demanding and effortful, whereas physical features of this memory task (e.g., color, weight) are acquired with little effort, and without deliberate encoding strategies. In Experiment 1, subjects were asked to perform a series of SPTs and were examined on recall of verbal instructions and colors of objects involved under conditions of focused or divided attention. In Experiment 2, performance of a series of SPTs was followed by recall of verbal instructions and recall of weights of objects involved. Results of both experiments indicated that recall of the verbal task component was negatively affected by requirements of dual-task performance, whereas recall of both physical task features was equally good in both encoding conditions. The obtained pattern of outcome is interpreted as supportive of the dual conception hypothesis of the nature of the encoding of action events.     

Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.