Development of differences in response latencies to right and left visual fields

Robust lateralization developed in right-handed adults who were asked to judge letter pairs as "same" or "different" during 4608 trials. By the end of the first two blocks (768 trials) "same" responses were favored when presented in the RVF (transmitted directly to the left hemisphere) and "different" responses were favored when presented in the LVF (transmitted direction to the right hemisphere). This gradually reversed over sessions with "same" responses becoming faster for letters presented in the LVF, and "different" responses becoming faster for stimuli presented in the RVF. The laterality acquired under these conditions was cumulative and reproducible, appeared in all 16 subjects, and was preserved between sessions a week apart. The data suggest that laterality is a flexible and reversible characteristic of the human brain even when stimulus and task remain constant.     

Unaltered ethical standards for individual physicians in the face of drastically reduced resources resulting from an improvised nuclear device event

When disaster disrupts healthcare and other systems, the ethical allocation of resources should follow principles of justice, defined as fairness, established for normal clinical practice. Standards of clinical practice may be altered during disaster, but ethical standards must remain centered on prioritizing the treatment of patients according to need and the effectiveness of treatment. Should resources become extremely limited, it is fair to restrict their use to patients who have the highest needs, provided that the intervention is effective. When resources become more available, patients with lower priority can be increasingly accommodated.     

Training in clinical ethics: launching the clinical ethics immersion course at the Center for Ethics at the Washington Hospital Center

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.     

Building esprit de corps: learning to better navigate between "my" patient and "our" patient

Excellence in the care of hospital patients, particularly those in an intensive care unit, reflects esprit de corps among the care team. Esprit de corps depends on a delicate balance; each clinician must preserve a sense of personal responsibility for "my" patient and yet participate in the collaborative work essential to the care of "our" patient. A harmful imbalance occurs when a physician demands total control of the decision-making process, especially concerning end-of-life treatment options. Although emotional factors may push a physician to claim decision-making exclusivity, compounded by a legal framework that overemphasizes individual responsibility, esprit de corps can be preserved through timely communication among clinicians and a recognition that optimal care for "my" patient requires effective team practice.