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 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.     

USE OF A SELF-RECORDING AND SUPERVISION PROGRAM TO CHANGE INSTITUTIONAL STAFF BEHAVIOR

The use of a self-recording and supervision program to increase interactions between direct care staff and profoundly retarded persons in a state residential facility was investigated. Following baseline, staff were provided with instructions regarding what to self-record, criteria for how many interactions to record, and a prepared card on which to make the recordings. Throughout the study, the staff supervisor monitored intermittently staff-client interactions. Observations indicated that when the staff recorded their interactions with clients in a loosely structured dayroom setting, the rate of interactions increased noticeably for each staff person. Behavioral ecology measures indicated that other staff responsibilities, such as maintaining the cleanliness of residents and the physical area, were not affected detrimentally when social interactions increased and actually showed small improvements. Additionally, small decreases in resident self-stimulatory and disruptive/aggressive behaviors occurred when the rate of social interactions from staff persons increased. Follow-up measures indicated that the rate of staff self-recording was variable, but when staff did self-record, the increased rate of staff-client interactions maintained.     

Standardized classroom management program: Social validation and replication studies in Utah and Oregon

A comprehensive validation study was conducted of the Program for Academic Survival Skills (PASS), a consultant-based, teacher-mediated program for student classroom behavior. The study addressed questions related to: (a) brief consultant training, (b) subsequent teacher training by consultants using PASS manuals, (c) contrasts between PASS experimental teachers and students and equivalent controls on measures of teacher management skills, student classroom behavior, teacher ratings of student problem behaviors, and academic achievement, (d) reported satisfaction of participants, and (e) replication of effects across two separate school sites. Results indicated that in both sites significant effects were noted in favor of the PASS experimental group for (a) teacher approval, (b) student appropriate classroom behavior, and (c) four categories of student inappropriate behavior. Program satisfaction ratings of students, teachers, and consultants were uniformly positive, and continued use of the program was reported a year later. Discussion focused upon issues of cost-effectiveness, differential site effects, and the relationship between appropriate classroom behavior and academic achievement.     

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.     

SHORT- AND LONG-TERM EFFECTS OF CONTINGENCY MANAGED INSTRUCTION ON LOW,MEDIUM, AND HIGH GPA STUDENTS1

Undergraduate students had been assigned to a contingency managed course or a conventional lecture course (Du Nann and Fernald, Journal of Applied Behavior Analysis, 1976, 9 , 373–374). Two years later, some 35% (N = 86) of the original classes responded to a letter offering them $2.00 to participate in a study of their educational experiences. These students completed a multiple-choice test on material from the course, and answered questions about activities and attitudes that might have been affected by the experience in Introductory Psychology. In the contingency management course 2 yr past, students were tested each week on a chapter of textbook material with 10-item multiple-choice quizzes. The course employed a modified “Doomsday Contingency”, requiring each student to achieve 80% mastery on one of the four weekly quizzes or drop the course. Quizzes were given in small groups and scored individually, while the student stood near, by an undergraduate proctor assigned to that group. The proctor was asked to show interest in the students' quiz performances, help clear up difficult areas, and develop a friendly working relationship with each student. While many students passed the quiz on the first attempt, others were given individual tutoring, so that no one was in fact forced to drop the course. In addition to the weekly quiz assignment, students in the contingency managed group were asked to attend one lecture each week. While the contingency management course procedures had much in common with PSI (Keller, Journal of Applied Behavior Analysis, 1968, 1 , 79–89), several departures made them unique. First, self-pacing was curtailed because students were required to master one unit per week or drop the course. Second, proctors met with students in small groups, usually giving individual tutoring only to those students who did not pass the quiz on the first attempt. Finally, students were asked to attend one lecture per week. Students in the conventional lecture group were not asked to pass weekly quizzes, but instead attended three 50-min lectures each week. Two of these lectures followed the textbook material closely, while the third, which was also attended by students from the contingency management course, covered material only indirectly related to the text. This partition of lecture content allowed material to be similar across the two instructional groups. Although students in the lecture condition were told they could obtain copies of the quizzes, few of them did so. Course grades were determined by scores on two 45-item multiple-choice hourly exams, each covering half the semester material (each worth 25%), and by a 90-item final exam, which served as a measure of short-term retention. Before analyzing the follow-up data, several characteristics of the returning students were compared to determine the comparability of the sample from the two original classes. Most important, both attrition and the current mean GPAs of students from the two classes were very similar. These considerations, and others, suggested there was no systematic sampling bias to confound comparisons of student performance. A 2 (contingency management versus traditional lecture) by 3 (high, medium, and low GPA) analysis of variance was computed on the course final-exam scores and the follow-up measures. Instructional procedure and GPA interacted on the final exam such that low and medium GPA students performed significantly better under contingency management, but there was no significant effect of instructional procedure with high GPA students. On the 2-yr retention measures, students from the contingency management course performed significantly (p < 0.01) better on items drawn from quizzes used in their original course, and marginally better (p < 0.10) on items drawn from the final exams, but no interactions with GPA appeared. Furthermore, instructional method produced no significant main effects or interaction with how many students became majors or minors in psychology, how many psychology courses were later taken, how many books in psychology were reported to have been read, or on students' evaluation of the interest and importance of psychology.     

MODIFICATION OF THE EXCESSIVE INAPPROPRIATE CLASSROOM BEHAVIOR OF TWO ELEMENTARY SCHOOL STUDENTS USING HOME-BASED CONSEQUENCES AND DAILY REPORT-CARD PROCEDURES1

Two experiments investigated home-based reinforcement contingencies to control excessive behavior in normal classrooms. Subjects were, respectively, a 12-yr-old fifth-grade boy and a 9-yr-old fourth-grade boy, each in a separate classroom and with a different teacher. Following baseline observations in which observers recorded several categories of student behavior and teacher-student interaction, separate conferences were held including parents of the two children, the principal, teachers, and experimenters. A daily report-card procedure was agreed on, stipulating a one-day suspension from school following three successive “undesirable” daily report cards as well as the supervision of home-based privileges and other reinforcers usually contingent on satisfactory daily reports. Measurements of daily rates of teacher attention indicated no important change in this variable throughout the various experimental conditions. The daily report procedure significantly reduced disruptive classroom behavior. In a second experiment, a teacher-operated timer cued her own time-sample observations. Reliability measures revealed that the teacher could accurately measure the child's behavior while she was teaching the class. The procedure was ultimately successfully expanded to the teacher's total contact hours each day.