The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.     

An infrared system for the detection of a pigeon''s pecks at alphanumeric characters on a TV screen: the dependency of letter detection on the predictability of one letter by another.

Three pigeons pecked at letters of the alphabet and at the symbol "?" displayed on a computer-driven cathode ray screen. A 4 by 4 matrix of infrared emitting and detecting diodes and associated circuitry identified the location of a pigeon''s responses to the screen. Responses at the target letter T were probabilistically reinforced with food whenever T appeared in a string of three letters in the middle of the screen. Responses at the symbol "?" appearing below this string were probabilistically reinforced whenever T did not appear. The letter F anywhere in the three-character string either strongly predicted the occurrence of the target letter T, in two conditions, or predicted its nonoccurrence, in a third. This manipulation of the frequency with which the familiar letter F predicted T was shown to change the function relating probability of a correct peck at the symbol "?" to the number of Fs in the string. This effect may be interpreted as an instance of the phenomenon where an organism''s acquired knowledge changes what it sees.     

RESCUE AND RECOVERY AS A THEOLOGICAL PRINCIPLE,AND A KEY TO MORALITY IN EXTRATERRESTRIAL SPECIES

New theological understanding can emerge with the advancement of scientific knowledge and the use of new concepts, or older concepts in new ways. Here, the authors present a proposal to extend the concept of “rescue and recovery” found in the United Nations Law of the High Seas, off-world and within a broader purview of other intelligent and self-aware species that humans may someday encounter. The notion of a morality that extends to off-world species is not new, but in this analysis, rescue and recovery become an imperative when any intelligent and self-aware species is in harm's way. Rescue and recovery encompass a necessary action component except perhaps in those cases where rescuers are in danger. The authors explore three biblical examples of rescue and recovery to derive a fundamental meaning of the concept.     

SPIRITUAL INTELLIGENCE: PROCESSING DIFFERENT INFORMATION OR PROCESSING INFORMATION DIFFERENTLY?

This article introduces the concept of spiritual intelligence in terms of a natural human ability to take a different perspective on reality rather than an extraordinary ability to engage with a different/supernatural reality. From a cognitive perspective, spiritual intelligence entails a re-balancing of the two main modes of human cognition, with a prioritization of the holistic-intuitive mind over the conceptual one. From the psychological and phenomenological perspectives, it involves a different kind of engagement with information: slower, more participatory, less objectifying, and not focused entirely on problem solving. The article ends with a reflection on the theological implications of the proposed model and how such an account of spiritual intelligence as knowing differently might relate to theological anthropology and the theology of the spirit and the spiritual.     

An evaluation of the convergent validity of a face-to-face and virtual neuropsychological assessment counter balanced

The COVID-19 pandemic has highlighted the need for further research evaluating the validity of conducting a battery of neuropsychological assessments virtually compared with face-to-face administration. Previous research has suggested that some neuropsychological assessments yield valid results when administered virtually, however, much of the previous research focused on older adults. To determine the validity of virtually administered neuropsychological tests, 28 healthy participants were assessed using a within-subjects, counter-balanced design. Participants completed a neuropsychological assessment battery covering tests of general intellectual functioning, memory and attention, executive functioning, language and information processing speed, as well as effort. There was no significant difference between face-to-face administration of the neuropsychological battery compared with virtual administration for the majority of the tests used. However, there were significant differences in the Colour Naming Task, with participants making fewer errors on the colour naming task and inhibition/switching task when administered virtually compared with face-to-face administration. There was also a significant age cohort effect in the inhibition/switching task. There was also a trending significant difference in mode of administration for the Verbal Fluency Task. Virtually administered neuropsychological assessments largely provide a valid alternative to face-to-face assessments; however, consideration must be given to test selection as well as the population of participants that are being assessed. Other important considerations must focus on preserving the security and integrity of test materials, as well as administration in a medico-legal setting. Future research should focus on validating assessments with specific patient populations and developing a neuropsychological assessment battery using information technology.     

Information processing,neuropsychological function,and the inherited predisposition to alcoholism

Sons of male alcoholics are at particularly heightened risk for the development of alcoholism. This heightened risk frequently appears in association with increased incidence of conduct disorder or hyperactivity, with deficits in abstract thinking and poor school performance, with abnormalities in cued psychophysiological response, and with increased sensitivity to the putatively stress-response-dampening effects of alcohol intoxication. This risk and its associated features are discussed within the context of a neuropsychological theory, predicated on the notions (1) that deficits in cognitive functions theoretically dependent upon the intact functioning of the prefrontal cortex could underlie manifestation of the idiosyncracies commonly attributed to sons of male alcoholics, and (2) that acute alcohol intoxication could relieve the subjective discomfort associated with the consequences of such deficits.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

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.     

Physicians,entrepreneurism and the problem of conflict of interest

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major arguments for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.     

Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.