Reinforcement schedule thinning following treatment with functional communication training

We evaluated four methods for increasing the practicality of functional communication training (FCT) by decreasing the frequency of reinforcement for alternative behavior. Three participants whose problem behaviors were maintained by positive reinforcement were treated successfully with FCT in which reinforcement for alternative behavior was initially delivered on fixed-ratio (FR) 1 schedules. One participant was then exposed to increasing delays to reinforcement under FR 1, a graduated fixed-interval (FI) schedule, and a graduated multiple-schedule arrangement in which signaled periods of reinforcement and extinction were alternated. Results showed that (a) increasing delays resulted in extinction of the alternative behavior, (b) the FI schedule produced undesirably high rates of the alternative behavior, and (c) the multiple schedule resulted in moderate and stable levels of the alternative behavior as the duration of the extinction component was increased. The other 2 participants were exposed to graduated mixed-schedule (unsignaled alternation between reinforcement and extinction components) and multiple-schedule (signaled alternation between reinforcement and extinction components) arrangements in which the durations of the reinforcement and extinction components were modified. Results obtained for these 2 participants indicated that the use of discriminative stimuli in the multiple schedule facilitated reinforcement schedule thinning. Upon completion of treatment, problem behavior remained low (or at zero), whereas alternative behavior was maintained as well as differentiated during a multiple-schedule arrangement consisting of a 4-min extinction period followed by a 1-min reinforcement period.     

Desires in Palliative Medicine. Five Models of the Physician‐Patient Interaction on Palliative Treatment Related to Hellenistic Therapies of Desire

In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has.     

Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians

There has been growing concern about the effects on the patient–physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called double agency. Various authors have proposed ways to restore patient centeredness to the patient–physician interaction. We have previously discussed the need to establish a patient–physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug doctor; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient–physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.     

Communication and Strong Compositionality

Ordinary semantic compositionality (meaning of whole determined from meanings of parts plus composition) can serve to explain how a hearer manages to assign an appropriate meaning to a new sentence. But it does not serve to explain how the speaker manages to find an appropriate sentence for expressing a new thought. For this we would need a principle of inverse compositionality, by which the expression of a complex content is determined by the expressions of it parts and the mode of composition. But this presupposes that contents have constituent structure, and this cannot be taken for granted. However, it can be proved that if a certain principle of substitutivity is valid for a particular language, then the meanings expressed by its sentences can justifiably be treated as structured. In its simplest form, this principle says that if in a complex expression a constituent is replaced by another constituent with a different meaning, the new complexhas a meaning different from the original. This principle is again inversely related to the normal compositional principle of substitutivity. The combination of ordinary and inverse compositionality is here called strong compositionality. The proof is carried out in the algebraic framework developed by Wilfrid Hodges and Dag Westerståhl.     

Body-part metaphors: a cross-cultural survey of the perception of translatability among Americans and Japanese

What kinds of linguistic resources do people utilize when they try to translate metaphors into a foreign language? This investigation of the perception of translatability of body-part metaphors examined the effects of the following factors: the similarity between the human body part and the metaphorical expression (e.g., "eye" in "electric eye") in appearance and function; the frequency of the use of the metaphor in the native language; and the perceived distance between the first language and the target language. The results of a survey of American (n = 151) and Japanese (n = 116) university students showed that both Similarity in Appearance and Similarity in Function correlated positively with Translatability, while the effect of the former was stronger than the latter. Frequency correlated positively with Translatability for the Americans, although the correlation was weaker when the target language is "distant" (Japanese or Chinese) than when the target language is "close" (Spanish). Among the Japanese, Frequency did not correlate with translatability regardless of the target language.     

Assessment and treatment of elopement: a replication and extension

The current investigation replicated and extended the assessment and treatment methodology of elopement. The environmental variables that maintained elopement were identified in each case, and successful treatments were implemented for the 3 participants in settings that were similar to those in which elopement occurred.     

对SARS病人及相关人员实施隔离等强制措施的思考

对SARS病人及相关人员采取隔离等强制措施是有效控制疫情扩展的重要和主要手段,但同时也是剥夺公民人身自由的一种行为。SARS防治的要求与现行法律存在着一定的冲突;紧急特殊情况下的行政应急措施应属必要。对相关法律进行完善,严格依照法定的条件符合法定程序实施强制措施,才能既有利于控制疫情又充分保障被隔离者的合法权益。     

Re-Evaluating Professional Autonomy in Health Care

Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will take responsibility forpatient care.