The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process.     

Visual perspective in remembering and episodic future thought

According to the constructive episodic simulation hypothesis, remembering and episodic future thinking are supported by a common set of constructive processes. In the present study, we directly addressed this assertion in the context of third-person perspectives that arise during remembering and episodic future thought. Specifically, we examined the frequency with which participants remembered past events or imagined future events from third-person perspectives. We also examined the different viewpoints from which third-person perspective events were remembered or imagined. Although future events were somewhat more likely to be imagined from a third-person perspective, the spatial viewpoint distributions of third-person perspectives characterizing remembered and imagined events were highly similar. These results suggest that a similar constructive mechanism may be at work when people remember events from a perspective that could not have been experienced in the past and when they imagine events from a perspective that could not be experienced in the future. The findings are discussed in terms of their consistency with—and as extensions of—the constructive episodic simulation hypothesis.     

Reevaluating the link between dispositional optimism and positive functioning using a temporally expanded perspective

Dispositional optimism is typically defined in terms of generalized positive expectancies for personal future life outcomes. Yet, multiple lines of inquiry have demonstrated fundamental interconnections among all three temporal perspectives (past, present, and future). Hence, in the present work, we examine the commonality underlying dispositional optimism and individuals’ evaluations of their past, present, and anticipated future lives. Results (n = 459; 80% female; M age = 19.68) suggest that dispositional optimism loads strongly on an underlying (latent) tendency to evaluate one’s life positively across temporal perspectives. This latent tendency was significantly associated with each Big Five personality dimension; independent of this latent tendency dispositional optimism was associated only with neuroticism. Controlling for personality dimensions, the latent tendency was predictive of positive functioning (mental health, coping, physical health, and social resources); in contrast, independent of this latent tendency dispositional optimism had no significant residual associations with any of the various functioning indicators.     

The New Learning Environment and Adult Developmental Needs

The link between an adult's learning capabilities and an organization's learning and adaptation is highlighted in this study of workers in a new training program. Studies have found that worker productivity differences are rooted in psychological factors. The most successful firms have supportive workplace psychologies that foster perspective transformation, yield high productivity, high involvement, high job satisfaction, low cost, and high profits. This study suggests the importance of workers having a whole-organization perspective. The findings of this study are generalizable to other organizations making the transition from training to learning in which individuals learn to continuously grow, develop, and problem solve to the benefit of all.     

用户换位型思维的形成及对机会信念绩效的影响

用户换位型思维是创业者进行机会识别并应对市场竞争的重要因素,但已有研究忽视了其模式、形成机理及对机会信念绩效的影响。针对此问题,基于结构映射理论与注意力参与模型解构用户换位型思维模式,包括吸收式、归纳式、启发式和分析式;然后,从“个体-用户”双元视角探讨与用户有关的先验知识、灵活的角色导向、认知复杂性以及用户需求不确定性和碎片化等因素对用户换位型思维形成的正向影响;最后,以机会信念形成速度和创新性为绩效指标,阐释用户换位型思维模式对机会信念形成绩效的影响,并考察适应新的信息环境和调用自身知识结构的认知管理策略对用户换位型思维模式与机会信念形成绩效的调节作用。研究结论将丰富用户换位型思维的内涵,拓展结构映射理论与注意力参与模型的解释范围,也为指导创业者运用用户换位型思维去识别机会提供参考,对创业者思考与理解用户有重要意义。     

Client perspectives on counselling: Before,during and after

This four‐year study investigated the under‐researched area of first‐time users’ perceptions of counselling and how these evolved over time. Research participants were drawn from six settings within university counselling services, the voluntary sector and primary care. Using an interpretive hermeneutic framework based on thematic analysis, 30 interviews were carried out. Results revealed that before counselling, participants were uncertain about the nature of counselling and what to expect, described stigma associated with peer influence and varying levels of confusion about specialist language. During counselling, participants experienced some level of positive change. At the same time, divergences of counsellor and client perception highlighted theoretical issues concerning counsellor approach and the exploration of emotions. Post‐counselling interviews revealed further positive change, and practical issues with implications for counsellor training and practice in terms of client assessment, preparation for counselling and the influence of cultural assumptions on theory and practice.     

中国古代医德教育对现代医学生医德教育的启示

医德医风已成为全社会普遍关注的焦点,特殊职业要求医务工作者应具有高尚的医德,而高尚医德的培养应从医学生教育阶段开始,努力提高医学生的医德素养。我国传统的医德教育方法,如医学生人品的选拔,老师言传身教,徒弟满师传统等等对于培养现代医学生关爱病人、救死扶伤的医德风范仍具有积极的借鉴意义。     

Evolutionary perspective on indirect victimization in adolescence: the role of attractiveness, dating and sexual behavior

We studied indirect victimization from an evolutionary perspective by examining links between this type of victimization and several indicators of attractiveness (past sexual behavior, dating frequency and physical appearance). Two thousand three hundred and nineteen (56% female) students (ages 13-18) from a region of southern Ontario, Canada, completed self-report measures of indirect victimization, physical appearance, dating frequency, recent sexual behavior (number of partners in previous month) and past sexual behavior (number of lifetime partners minus number of partners in previous month) as well as indexes of depression, aggression and attachment security, which were used to control for psychosocial maladjustment. Consistent with an evolutionary framework, physical appearance interacted significantly with gender, wherein attractive females were at greater risk for indirect victimization, whereas for males physical attractiveness was a protective factor, reducing risk of victimization. Physical appearance also interacted with grade, being inversely related to indirect victimization for younger adolescents and having a nonsignificant association with victimization for older youth. Finally, recent sexual behavior was associated with increased risk of indirect victimization for older adolescents only, which we discussed with regard to peer perceptions of promiscuity and short-term mating strategies. These findings have important implications for the development of interventions designed to reduce peer victimization, in that victims of indirect aggression may represent a rather broad, heterogeneous group, including attractive individuals with no obvious signs of maladjustment.