Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis.

Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.     

Narrative and Metaphysical Ambition: On Being “in Christ”

This article addresses some of the confusion regarding the role of metaphysical claims in narrative theology. Proponents and critics of narrative theology alike wonder at the ambiguous place of metaphysical speech about God as an objective reality. This essay enters the conversation through the side door of soteriology. Rather than focusing on the relationship between narrative and metaphysics or narrative and analogy or narrative and first‐order theological claims, I examine what sort of metaphysical statements are required to make the Christian claim that human beings are “in Christ” intelligible as a soteriological reality. I argue that the Christian grammar itself assumes a Christology with a certain kind of metaphysical ambition without which Christianity lapses into incoherence. To make this case, I show that David Kelsey's “narrative identity” Christology in Eccentric Existence lacks the metaphysical statements necessary to uphold his conviction that human beings are “in Christ.” A comparison with T. F. Torrance and the Book of Hebrews reveals that when narrative circumvents metaphysical statements about the incarnate Son, soteriological claims lack coherence and the biblical narrative itself is distorted by a false metaphysic. Thus, metaphysical claims internal to the narrative of Jesus are necessary to tell the story of God faithfully. In this way, narrative is the expression of a theological metaphysics.     

The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.     

Ambiguity and rationality

Recently, several theories of decision making and probability judgment have been proposed that take into account ambiguity (Einhorn and Hogarth, 1985; Gardenfors and Sahlin, 1982). However, none of these theories explains exactly what the psychological causes of ambiguity are or addresses the issue of whether ambiguity effects are rational. In this paper, we define ambiguity as the subjective experience of missing information relevant to a prediction. We show how this definition can explain why ambiguity affects decisions in the ways it does. We argue that there are a variety of rational reasons ambiguity affects probability judgments and choices in the ways it does. However, we argue that the ambiguity effect does not cast doubt on the claim that utility theory is a standard of rational choice. Rather, we suggest that the effect of ambiguity on decisions highlights the fact that utility theory, like any normative model of decision making only prescribes the optimal decision, given what one knows.     

Declines in Major League Batting Performance as a Function of Game Pressure: A Drive Theory Analysis1

Zajonc's (1965) drive theory explanation argues that greater arousal tends to impair performance on difficult tasks. The hypothesis that arousal generated by “pressure situations” during major league baseball games would hinder batting performance—a difficult task—was tested by examining such performance during the 1989 season. Six “pressure situations” were identified, some occurring during the late innings of close games and others occurring throughout the game when there were two outs. Two measures of batting performance (batting average and slugging average) were employed. Results indicated broad support for the hypothesis. Reasons for this pattern are discussed, as are possible alternative explanations for these findings.     

The Chancellor's memory: Rhetoric and truth in discursive remembering

This paper explores the notion of truthfulness in research on conversational remembering. It argues that people's accounts of past events, before they can be taken as data on the cognitive workings of memory, need to be examined as contextualized and variable productions that perform pragmatic and rhetorical work; no one version can be taken as a person's real memory. The consequences of this discourse-analytical perspective are examined first through a critical discussion of Ulric Neisser's study of John Dean's testimony to the senate ‘Watergate’ committee. The issues are then explored more deeply in an analysis of reportings of a different event, in which similar (Watergate-like) issues of memory, truth and accuracy are also at issue. It is argued that: (a) all of Neisser's three kinds of memory–verbatim, gist and ‘repisodic’–involve problematical assumptions concerning their relation to some true, original event; and (b) that Dean's accounts of his memory and his displays of memory should be approached as occasioned productions oriented pragmatically to the assignment of guilt and avoidance of scapegoating. Through an analysis of newspaper reports (based on memory) of a controversial briefing given by the then British Chancellor of the Exchequer, Nigel Lawson, we then examine: (a) how discourse about what could be used as an arbiter of truth was rhetorically organized; (b) how participants' versions of events were constructed rhetorically, as parts of arguments; (c) that both sides in the dispute maintained the coherence of their positions by a form of error accounting similar to that used by Neisser with respect to Dean. It is suggested that cognitive psychologists, whether working in the laboratory or attempting to do real-world studies of everyday remembering, need to avoid simplistic notions of true original events, and can do so by addressing the rhetorical organization of participants' memory accounts.     

Neighborhood frequency effects and letter visibility in visual word recognition

Two experiments are described that measured lexical decision latencies and errors to five-letter French words with a single higher frequency orthographic neighbor and control words with no higher frequency neighbors. The higher frequency neighbor differed from the stimulus word by either the second letter (e.g.,astre-autre) or the fourth letter (chope-chose). Neighborhood frequency effects were found to interact with this factor, and significant interference was observed only tochope-type words. The effects of neighborhood frequency were also found to interact with the position of initial fixation in the stimulus word (either the second letter or the fourth letter). Interference was greatly reduced when the initial fixation was on the critical disambiguating letter (i.e., the letterp inchope). Moreover, word recognition was improved when subjects initially fixated the second letter relative to when they initially fixated the fourth letter of a five-letter word, but this second-letter advantage practically disappeared when the stimulus differed from a more frequent word by its fourth letter. The results are interpreted in terms of the interaction between visual and lexical factors in visual word recognition.     

Creating new memories that are quickly accessed and confidently held

In two experiments involving a total of 542 subjects, a series of slides depicting a burglary was shown. After the initial event, subjects were exposed to one or more narratives about the event that contained some misinformation or neutral information about four critical details. Finally, subjects were tested on their memories of what they saw, and their reaction times and confidence levels were measured. When subjects took a standard test in which the misinformation item was a possible response option, they responded very quickly and confidently when making this incorrect choice. Misled subjects responded as quickly and confidently to these "unreal" memories as they did to their genuine memories. It does not seem, then, that the misinformation effect arises from a large proportion of subjects who must resolve a conflict between two memories when they are tested, a conflict that would be expected to take time. When subjects took a modified test in which the misinformation item was not a possible response, misled subjects were as accurate as were controls, but they responded more slowly, regardless of whether they ultimately chose the right or wrong option. These findings indicate that misinformation does introduce some form of interference not detected by a simple test of accuracy.     

Motivation and performance: Two consequences of winning and losing in competition

The present study examined the effects of competitive outcome—either a win or a loss—on intrinsic motivation. Winning was hypothesized to facilitate both performance and intrinsic motivation. Fifty-four participants, 29 females and 25 males, competed against a same-gender confederate in a puzzle-solving contest. Following the competition, participants' intrinsic motivation was surreptitiously measured by the amount of time spent playing with the puzzle while alone. Results showed that winning facilitated both actual competitive performance and intrinsic motivation relative to losing. The importance of considering the outcome when predicting intrinsic motivation after competition is discussed.