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.     

Making Sense in and of the Asexual Community: Navigating Relationships and Identities in a Context of Resistance

Despite some increased visibility in recent years, the asexual community and asexuality generally remain largely unknown. Aiming to demystify asexuality, this paper discusses the context of anti‐asexual animosity in which the (largely American) asexual community is situated. Specifically, the asexual community constructed itself in response to hostility, including explicit anti‐asexual discrimination, homophobia against asexual people perceived to be lesbian or gay, and the negative impact of (implicit) pathologising low sexual desire. This theoretical paper outlines some of the unique challenges asexual people face negotiating identities and relationships; the collective sense‐making strategies they use (generating language and discourse) to do so; and why these things are central to understanding asexual people's experiences. This is accomplished through a purposeful review of literature and a case study of the Asexual Visibility and Education Network as an asexual community space. Understanding the challenges asexual people face and the resources they invoke to overcome them helps applied psychologists develop the cultural competence they need to work effectively with the asexual people they will encounter. Copyright © 2014 John Wiley & Sons, Ltd.     

Clamped Corticosterone (B) Reveals the Effect of Endogenous B on Both Facilitated Responsivity to Acute Restraint and Metabolic Responses to Chronic Stress

To determine the effects of both corticosterone (B) and chronic stressors on acute ACTH responses to restraint, young male rats were exposed to streptozotocin-induced diabetes, cold (5-7 degreesC) or intracerebroventricular (icv) neuropeptide Y (NPY) for 5 d and then exposed to restraint within 2 h after lights on. Two groups of rats were studied: intact and adrenalectomized replaced with B pellets that maintained plasma B in the normal mean 24-h range of intact rats. In addition to ACTH and B responses to restraint on d 5, body weight, food intake, fat depots, glucose and other hormones were measured to determine the role of stress-induced elevations in B on energy balance. ACTH responses to restraint were normal in intact rats subjected to diabetes or cold. By contrast, there was no ACTH or B response to restraint in NPY-infused intact rats. All 3 groups of chronically stimulated adrenalectomized rats with clamped B had facilitated ACTH responses to restraint compared to their treatment controls. Overall food intake increased in all groups of stressed rats; however, augmented intake occurred only during the light in intact rats and equally in the light and dark in B-clamped rats. White adipose depot weights were decreased by both diabetes and cold and increased by NPY in intact rats; the decreases with cold and increases with NPY were both blunted and changes in fat stores were not significant in adrenalectomized, B-clamped rats. We conclude that: 1. diabetes- and cold-induced facilitation of restraint-induced afferent input to hypothalamic control of the hypothalamo-pituitary-adrenal (HPA) axis is opposed in intact rats by the elevated feedback signal of B secretion; 2. NPY does not induce facilitation of afferent stress pathways; 3. chronic stimulation of the HPA axis induces acute hyperresponsiveness of hypothalamic neurons to restraint provided that the afferent input of this acute stimulus is not prevented by B feedback; 4. stimulus-induced elevations in B secretion result in day-time feeding; 5. insensitivity of both caloric efficiency and white fat stores to chronic stress in adrenalectomized, B-clamped rats results from loss of normally variable B levels.     

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.