Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age

Objective: To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. Setting: A regional genetics center. Design: A before/after study. Interventions: Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. Subjects: 21 women of advanced maternal age and 17 spouses. Main outcome measures: Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. Results: After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. Conclusions: The decision aid shows promise as a useful aid for preparing couples for counseling.     

TEACHING SEVERELY MULTIHANDICAPPED STUDENTS TO PUT ON THEIR OWN HEARING AIDS

Two experiments were conducted with six severely multihandicapped students with hearing impairments to: (a) train the six students to put on their own hearing aids independently, and (b) provide an empirical evaluation of a comprehensive instructional program for putting on a hearing aid by assessing acquisition, maintenance, and generalization of that skill across environments. All six students acquired the skill rapidly, with two students requiring remedial training on one step of the program. Because for two of the original three students the newly learned skill failed initially to generalize to other environments, a second experiment was initiated to assess generalization across environments as well as to replicate the efficiency of the acquisition program. When a variation of the multiple-probe baseline technique was used, the behavior of three additional students generalized to other settings without direct training in those settings.     

Is World Poverty a Moral Problem for the Wealthy?

This article discusses the question of poverty and wealth in light of several theses put forward by Larry Temkin. The claim that there is a sort of cosmic injustice involved when great disparities of ability or of wealth are found. He is concerned especially about disparities that are undeserved. It is agreed that this is unfortunate, but not agreed that they are unjust in a sense that supports the imposition of rectification on anyone else. Nor is poverty typically undeserved in the only really relevant sense: the poor simply do not produce enough to earn them high incomes, and probably correct incomes they derive are indeed what such efforts are worth in the circumstances. That persons with very low incomes may merit our sympathy is accepted, but sympathy leads to charity, rather than to the involuntary exploitation of the better off. The essay concludes with further observations about the relevance of free markets, and points to the iniquities of the restrictions on commerce that are the most potent source of perpetuated poverty today.     

In Defense of the Responsibility to Protect

This essay responds to Esther Reed's recent critique of the Responsibility to Protect (R2P) principle in this journal. It argues that Reed fundamentally misunderstands and misrepresents R2P. Her critique of R2P would have served well as a critique of the earlier concept of humanitarian intervention had it been penned in the late 1990s. But most of the problems and dangers that Reed identifies are in reality the very problems and dangers that R2P seeks to overcome, and I suggest that it does overcome them quite successfully. R2P does not impose Western ideals on the rest of the world, weaken the legal restrictions on the use of force, or promote abusive interventionism. Rather, it offers a bold but carefully constructed framework that holds the promise of promoting the protection of vulnerable populations from mass atrocities.     

Determining Risk in Pediatric Research with No Prospect of Direct Benefit: Time for a National Consensus on the Interpretation of Federal Regulations

United States federal regulations for pediatric research with no prospect of direct benefit restrict institutional review board (IRB) approval to procedures presenting: 1) no more than “minimal risk” (§ 45CFR46.404); or 2) no more than a “minor increase over minimal risk” if the research is commensurate with the subjects' previous or expected experiences and intended to gain vitally important information about the child's disorder or condition (§ 45CFR46.406) (DHHS 2001). During the 25 years since their adoption, these regulations have helped IRBs balance subject protections with the pursuit of scientific knowledge to advance children's welfare. At the same time, inconsistency in IRB application of these regulations to pediatric protocols has been widespread, in part because of the ambiguity of the regulatory language. During the past decade, three federally-charged committees have addressed these ambiguities: 1) the National Human Research Protections Advisory Committee (NHRPAC) (Washington, DC), 2) the Institute of Medicine (IOM) Committee on the Ethical Conduct of Clinical Research Involving Children (Washington, DC); and 3) the United States Department of Health and Human Services Secretary's Advisory Committee for Human Research Protections (SACHRP) (Washington, DC). The committees have reached similar conclusions on interpretation of language within regulations § § 45CFR46.404 and 406; these conclusions are remarkably consistent with recent international recommendations and those of the original National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1977) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1977. Report and recommendations: Research involving children, Washington, DC: U.S. Government Printing Office.  [Google Scholar] report from which current regulations are based. Drawing on the committees' public reports, this article identifies the ethical issues posed by ambiguities in regulatory language, summarizes the committees' deliberations, and calls for a national consensus on recommended criteria.     

International–local remuneration differences across six countries: Do they undermine poverty reduction work?

Despite the rhetoric of a single global economy, professionals in poorer countries continue to be remunerated differently depending on whether they are compensated at a local vs. international rate. Project ADDUP (Are Development Discrepancies Undermining Performance?) surveyed 1290 expatriate and local professionals (response rate = 47%) from aid, education, government, and business sectors in (1) Island Nations (Papua New Guinea, Solomon Islands), (2) landlocked economies (Mala?i, Uganda), and (3) emerging economies (India, China). Difference in pay was estimated using purchasing power parity, from the World Bank's World Development Indicators 2007. Psychological measures included self‐reported pay and benefits (remuneration), self‐attributed ability, remuneration comparison, sense of justice in remuneration, remuneration‐related motivation, thoughts of turnover and thoughts about international mobility. We included control measures of candour, culture shock, cultural values (horizontal/vertical individualism/collectivism), personality (from the “big five”), job satisfaction and work engagement. Controlling for these and country (small effects) and organization effects (medium), (a) pay ratios between international and local workers exceeded what were perceived to be acceptable pay thresholds among respondents remunerated locally; who also reported a combination of a sense of relative (b) injustice and demotivation; which (c) together with job satisfaction/work engagement predicted turnover and international mobility. These findings question the wisdom of dual salary systems in general, expose and challenge a major contradiction between contemporary development policy and practice, and have a range of practical, organizational, and theoretical implications for poverty reduction work.     

Remuneration discrepancies in the landlocked economies of Malaŵi and Uganda

Although the original study of remuneration differences between local and expatriate development workers took place in the landlocked economy of Mala?i, the study has never been replicated outside of one sector and organization (the National University), and took place prior to the 2000 Millennium Development Goals. Participating in the present studies were 458 aid and development professionals, working across a range of sectors in Mala?i (n = 241, response rate = 50%) and Uganda (n = 217, response rate = 51%). The size of the gap between local and international workers, measured using the World Bank's purchasing power parity, was higher in Mala?i (4.04:1) than in Uganda (1.97:1). The ratio was more clearly within tolerance levels in Uganda than in Mala?i. Consistent with these differences, and controlling for organization, cultural, and demographic factors, locally remunerated workers reported more and expatriate workers less injustice and demotivation in Mala?i than in Uganda. Although sample sizes for the internationally remunerated are small, the findings suggest that wider disparities may (1) hinder perspective‐taking and (2) decrease motivation. In‐country workshops with stakeholders and subject‐matter experts considered the findings, and potential solutions offered through the survey form. They recommended the implementation of performance‐based remuneration, including competency‐based job analysis and evaluation. Competencies in such functions can be provided by humanitarian work psychology.     

Possible Implicit Mechanisms of Minority Representation

Minority representation is an important topic for political science—how do members of a racial majority group identify with the political goals of a minority, even when research documents widespread anti‐Black bias? Does pro‐Black policy support require an individual to be unbiased, or can such support emerge despite internalized anti‐Black bias? This paper draws a distinction between two types of implicit racial attitude measures based on functionalist theories of attitudes ( Katz, 1960 ; Smith, Bruner, & White, 1956 ) and research regarding automatic empathic processes ( Decety & Jackson, 2004 ; Preston & de Waal, 2002 ). According to this distinction, some attitudes evaluate racial groups as attitude objects (evaluative associations), while others involve automatic identification with them as people (relational associations). I use subliminal racial priming for evaluative associations and a measure of implicit closeness to Blacks ( Craemer, 2008 ) for relational associations. The evaluative measure captures association strength between a racial stimulus and race‐unrelated positive or negative target words. The relational measure assesses association strength between the respondent's self‐concept and the mental representation of a racial group based on implicit “self‐other overlap” ( Aron, Aron, Tudor, & Nelson, 1991 ). Implicit measures are obtained in a well powered online reaction time study (n = 1,341). Online results are evaluated against a representative telephone survey (n = 1,200). Consistent with the extant literature, a significant anti‐Black bias emerges in evaluative associations. In contrast, a significant pro‐Black effect emerges in relational associations and the two implicit measures are statistically unrelated. Both measures predict pro‐Black policy support independently of one another and net of other factors. Implicit closeness to Blacks predicts pro‐Black policy support even among White respondents suggesting that minority representation based on relational associations may be possible despite widespread anti‐Black evaluative bias.     

Reference-dependent sympathy

Natural disasters and other traumatic events often draw a greater charitable response than do ongoing misfortunes, even those that may cause even more widespread misery, such as famine or malaria. Why is the response disproportionate to need? The notion of reference dependence critical to Prospect Theory (Kahneman & Tversky, 1979) maintains that self-utility, or benefit to self, is not absolute level of wealth but rather gain or loss relative to a reference point. Four studies show that sympathy (Study 1), dictator offers (Study 2), and judgments of deservingness (Study 3a) are reference-dependent: people respond greater to victims of loss than to victims of chronic conditions. This tendency goes away when people evaluate victims in comparison (Study 3b) and when evaluating affect-poor “statistical victims”, as compared to affect-rich “identifiable victims” (Study 4). Together, these results shed light on seemingly irrational patterns of humanitarian aid.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.