Learning from the law to address uncertainty in the precautionary principle

Environmentalists have advocated the Precautionary Principle (PP) to help guide public and private decisions about the environment. By contrast, industry and its spokesmen have opposed this. There is not one principle, but many that have been recommended for this purpose. Despite the attractiveness of a core idea in all versions of the principle—that decision-makers should take some precautionary steps to ensure that threats of serious and irreversible damage to the environment and public health do not materialize into harm—even one of the most widely endorsed principles needs considerable specification and refinement before it can be used. Moreover, the PP is an approach or guide to utilizing scientific evidence in social or legal decision-making contexts. In this it does not differ in kind from other approaches to using factual information such as in the law. The law provides some models for different strategies to guide decision-making under uncertainty when factual issues cannot be resolved with certainty. These in turn can help guide the formulation of different versions of PP and help clarify some presuppositions of the principle. Once some plausible versions of PP are articulated, I suggest some applications to existing environmental problems.     

Beyond the Obvious: Chronic Vividness of Imagery and the Use of Information in Decision Making

The authors investigate two competing hypotheses about how chronic vividness of imagery interacts with the vividness and salience of information in decision making. Results from four studies, covering a variety of decision domains, indicate that chronic imagery vividness rarely amplifies the effects of vivid and salient information. Imagery vividness may, in fact, attenuate the effects of vivid and salient information. This is because, relative to nonvivid imagers, vivid imagers rely less on information that appears obvious and rely more on information that seems less obvious. This tendency is so robust that vividness of imagery may amplify the effects of vivid information only when this information is the only information available in the decision field. The findings seem to reflect vivid imagers' tendency to totally immerse themselves in a decision problem and scrutinize the available information creatively.     

Behavioral and pharmacological variables affecting risky choice in rats.

The effects of manipulations of response requirement, intertrial interval (ITI), and psychoactive drugs (ethanol, phencyclidine, and d-amphetamine) on lever choice under concurrent fixed-ratio schedules were investigated in rats. Responding on the "certain' lever produced three 45-mg pellets, whereas responding on the "risky" lever produced either 15 pellets (p = .33) or no pellets (p .67). Rats earned all food during the session, which ended after 12 forced trials and 93 choice trials or 90 min, whichever occurred first. When the response requirement was increased from 1 to 16 and the ITI was 20 s, percentage of risky choice was inversely related to fixed-ratio value. When only a single response was required but the ITI was manipulated between 20 and 120 s (with maximum session duration held constant), percentage of risky choice was directly related to length of the ITI. The effects of the drugs were investigated first at an ITI of 20 s, when risky choice was low for most rats, and then at an ITI of 80 s, when risky choice was higher for most rats. Ethanol usually decreased risky choice. Phencyclidine did not usually affect risky choice when the ITI was 20 s but decreased it in half the rats when the ITI was 80 s. For d-amphetamine, the effects appeared to he related to baseline probability of risky choice; that is, low probabilities were increased and high probabilities were decreased. Although increase in risky choice as a function of the ITI is at variance with previous ITI data, it is consistent with foraging data showing that risk aversion decreases as food availability decreases. The pharmacological manipulations showed that drug effects on risky choice may be influenced by the baseline probability of risky choice, just as drug effects can be a function of baseline response rate.     

Pathways to Risk Among Inner-City African-American Adolescent Females: The Influence of Gang Membership

Differential rates of participation in three categories of risk behaviors (i.e., sexual activity, substance use, violence) were explored, comparing gang members to nonmembers, within a sample of 1,143 inner-city African American adolescent females. The relationship between gang membership and risk behavior also was examined, by exploring the association between a variety of microsystemic influences (e.g., gang, family, school) and participation in risk behaviors. MANOVA analyses indicated that gang members, relative to nonmembers, reported higher rates of participation in each of the three categories of risk behaviors. Stepwise linear regression analyses indicated that gang membership was the variable with the most consistent predictive ability, across all categories of risk, as it entered early in all equations and remained in all three final models after controlling for other statistically significant contextual variables. Findings suggest that intervention efforts aimed at reducing adolescent females' participation in sexual activity, substance use, and violence should consider the influence of gang membership on the participation in these behaviors.     

循证医学的辩证思维

随着临床医学的发展,临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据,如随机对照研究的结果,特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题,同时强调不断进行知识更新,掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗,因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据,为了提高服务质量并且充分把握特殊专业领域的现状,临床工作者也需要不断了解新的依据信息。在众多的研究信息中,我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析,确定该结论是否真实并适合我们的实际,从而制定有据可查的诊疗方案。     

Embodied Knowledge and Making Sense of Prenatal Diagnosis

Open-ended, qualitative interviews with women to whom amniocentesis was offered were analyzed to understand how women made sense of these tests. We found that women, whether tested or not, negotiated with biomedical information. They transformed it through identifiable processes, then wove it with their own instincts and beliefs and with their personal experiences, thereby creating embodied knowledge on which their decisions were based. Women who were and were not tested may have differed from each other when categorized on the basis of a final, binary choice, but they were more alike than unalike in reaching this point. The apparent importance of embodied knowledge suggests the critical role of the listening activities of the genetic counselor and of awareness of the validity and importance of women's complementary ways of knowing and doing in understanding the uses and meanings of prenatal genetic testing.     

Conduct Disorder in Girls: A Review of the Literature

The study of Conduct Disorder (CD) has primarily been limited to boys. The lack of research resulted from a premise that CD in girls was rare. However, CD in girls is a relatively common psychiatric diagnosis, and appears to be associated with several serious outcomes, such as Antisocial Personality Disorder and early pregnancy. Understanding gender differences in the course and severity of CD may lead to important information about etiology. Empirical studies on precursors, developmental course, risk factors and treatment for CD in girls are reviewed, while highlighting similarities and differences between girls and boys. Generally, CD symptoms in girls are stable. Precursors to CD in girls probably include Oppositional Defiant Disorder and temperamental factors, but also may include certain negative cognitions. What distinguishes CD in girls is the high risk they have to develop comorbid conditions, especially internalizing disorders. Risk factors for CD in girls partly overlap with those known for boys, but some factors appear to be highly salient for girls. Finally, there may be some significant effects of gender on treatment efficacy. Implications of these findings for future etiologic research are discussed.     

The Burden of Dementia: A Medical and Research Perspective

Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase the likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Two Envelopes and Binding

This paper describes a way of defending a modification of Eckhardt's [2013] solution to the Two Envelopes Paradox. The defence is based on ideas from Arntzenius, Elga, and Hawthorne [2004].