Efficacy of behavioral management and patient education on vascular access cleansing compliance in hemodialysis patients

Compared four treatment conditions to test their ability to enhance compliance with vascular access cleansing (VAC) procedures in a group of 56 hemodialysis patients. The conditions were patient education, behavioral management with monetary incentive, patient education/behavioral management, and attention control. Behavioral observers rated VAC behavior at pretreatment, posttreatment 1-month follow-up, and 1-year follow-up. Knowledge of VAC procedures was also assessed via a questionnaire at pretreatment and posttreatment. Data were analyzed using repeated-measures multivariate analyses of variance. Results indicated that the patients in the education/behavioral, behavioral, and education groups gave significantly more correct answers on our VAC knowledge questionnaires at posttreatment than did patients in the attention control group. Further, patients in the education/behavioral and behavioral groups completed significantly more VAC steps at posttreatment and 1-month follow-up than did patients in the education group and in the attention control group. Differences were not maintained at 1-year follow-up, although more than 50% of the patients were lost to follow-up. Implications of the present findings for behavioral and educational interventions are discussed.     

RELIGION AND FRANCIS BACON'S SCIENTIFIC UTOPIANISM

Francis Bacon often is depicted as a patriarch of modernity who promotes human rational action over faith in divine Providence and as a secular humanitarian who realized that improvement of the human condition depended on human action and not on God's saving acts in history. Bacon's New Atlantis is usually described as a “scientific utopia” because its ideal order, harmony, and prosperity are the result of the investigations of nature conducted by the members of Solomon's House. I challenge these characterizations by showing that Bacon's so‐called scientific utopianism is grounded in his religious convictions that his age was one of Providential intervention and that he was God's agent for an apocalyptic transformation of the human condition. I examine the centrality of these religious themes in two of his philosophical works, The Advancement of Learning and The Great Instauration, which are well known for setting out Bacon's critique of the state of learning and for presenting the principles of his epistemology. Analysis of The Advancement of Learning demonstrates Bacon's conviction that his reform of natural philosophy was part of a Providentially guided, twofold restoration of the knowledge of nature and the knowledge of God. Examination of The Great Instauration reveals that Bacon sees his age as one of apocalyptic transformation of the human condition that restores humanity to a prelapsarian state. Analysis of the New Atlantis shows that utopian perfection can be achieved only through a combination of right religion and the proper study of nature. Moreover, when the “scientific” work of Solomon's House is recontextualized within the religious themes of salvation and deliverance that permeate the New Atlantis, the full scope of Bacon's “scientific utopianism” can be seen, and this project is not the one usually portrayed in scholarly treatments. Bacon's program for rehabilitating humanity and its relation to nature is not a secular, scientific advance through which humanity gains dominion over nature and mastery of its own destiny but rather one guided by divine Providence and achieved through pious human effort.     

A double bootstrap method to analyze linear models with autoregressive error terms

A new method for the analysis of linear models that have autoregressive errors is proposed. The approach is not only relevant in the behavioral sciences for analyzing small-sample time-series intervention models, but it is also appropriate for a wide class of small-sample linear model problems in which there is interest in inferential statements regarding all regression parameters and autoregressive parameters in the model. The methodology includes a double application of bootstrap procedures. The 1st application is used to obtain bias-adjusted estimates of the autoregressive parameters. The 2nd application is used to estimate the standard errors of the parameter estimates. Theoretical and Monte Carlo results are presented to demonstrate asymptotic and small-sample properties of the method; examples that illustrate advantages of the new approach over established time-series methods are described.     

Scientific societies and whistleblowers: the relationship between the community and the individual

Formalizing shared ethical standards is an activity of scientific societies designed to achieve a collective goal of promoting ethical conduct. A scientist who is faced with the choice of becoming a “whistleblower” by exposing misconduct does so in the context of these ethical standards. Examination of ethics policies of scientific societies which are members of the Council of Scientific Society Presidents (CSSP) shows a breadth of purpose and scope in these policies. Among the CSSP member societies, some ethics policies chiefly present the ethical culture of the community in an educational context and do not have enforcement procedures. Other policies are more comprehensive and include standards for certification, procedures for addressing ethical issues, and established sanctions. Of the 36 member societies of CSSP that have developed a code or adopted a code of another professional society, 18 specifically identified a responsibility to expose ethical misconduct, demonstrating an acknowledgment of the possible critical role of the whistleblower in addressing ethical issues. Scientific societies may revise their ethics codes based upon experience gained in addressing cases of ethical misconduct. In most cases, the action of a whistleblower is the initial step in addressing an ethics violation; the whistleblower may either be in the position of an observer or a victim, such as in the case of someone who discovers that his or her own work has been plagiarized. The ethics committee of a scientific society is one of several possible outlets through which the whistleblower can voice a complaint or concern. Ethical violations can include falsification, fabrication, plagiarism and other authorship disputes, conflict of interest and other serious violations. Commonly, some of these violations may involve publication in the scientific literature. Thus addressing ethical issues may be intertwined with a scientific society’s role in the dissemination of new scientific results. For a journal published by a scientific society, the editor can refer at some point to the ethics committee of the society. Whereas, in the case of a journal published by a commercial publisher, the editor may be without direct support of the associated scientific community in handling the case. The association of a journal with a scientific society may thus direct a whistleblower towards addressing the issue within the scientific community rather than involving the press or talking to colleagues who may gossip. A formal procedure for handling ethics cases may also discourage false accusers. Another advantage of handling complaints through ethics committees is that decisions to contact home institutions or funding agencies can be made by the ethics committee and are not the responsibility of the whistleblower or the editor of the journal. The general assessment is that the establishment of ethics policies, especially policies covering publication in society journals, will promote a culture supportive of whistleblowers and discouraging to false accusers. An earlier version of this paper was presented at the symposium entitled “Damned If You Do, Damned If You Don’t: What the Scientific Community Can Do About Whistleblowing” held during the Annual Meeting of the American Association for the Advancement of Science, Seattle, Washington, 15 February, 1997.     

Subjective Well-Being in Pediatric Oncology Patients

Using negative and positive measures of subjective well-being (SWB), we compared reports of 29 youth with cancer to a matched control sample of 29 youth. Youth with cancer did not differ from healthy controls on self-report measures of life satisfaction, hope, positive affect, or negative affect. Scores on measures of hope were positively correlated with time since diagnosis; none of the other SWB variables was significantly related to time since diagnosis. Except for negative affect, moderate correlations were found between parents’ reports of their own SWB and their youths’ self-reported SWB. Parents’ estimates of their youths’ SWB were also moderately associated with youth self-reports, except for negative affect. Parents of youth with cancer and their youth may use different criteria for reporting the nature and frequency of negative affect, but use similar criteria for reporting positive affect and other positive measures (hope, life satisfaction). Implications for more comprehensive assessments of the well-being of pediatric oncology patients are discussed.