Case vignette: premature surrender

Three commentaries are offered on the following case: George, age 57, is a previously healthy man who recently underwent surgery for removal of a low-grade malignant thymoma. At the time of admission to the hospital, George stressed to the staff that he had long ago signed a "living will," which he renewed immediately after he learned of his cancer diagnosis. At the time of surgery, the tumor was found to extend into his mediastinum; although it was removable, this required revision of part of the sternum and grafting of the vessels feeding the heart chambers. Because of the resultant tissue damage and neuronal hyperactivity, George experienced postoperative episodes of cardiac arrhythmia and bronchospasm. Unanimous medical opinion was that this situation was a temporary problem that would resolve itself as the tissues healed. Until that time, however, it will be difficult to wean him from ventilatory support. When his stay in the intensive care unit became prolonged, George and his family began to insist that his status be changed to "do not resuscitate" and reminded the staff about his longstanding living will. All of this is happening despite the fact that the patient and family seemingly comprehend that although the short-term interventions are invasive, there is a high probability of a successful outcome. George's cancer prognosis is excellent, and, although he may well have an episode of life-threatening arrhythmia, he is likely to respond to resuscitation interventions. Once the immediate postoperative period is over, his potential for a long and productive life with full capacities is excellent. Consider the following questions: (a) Should George's expressed wishes be respected, or should the staff take additional steps to help him survive the postoperative period, even if that means violating his stated wishes? and (b) What steps might the staff follow in sorting through this problem?     

Longitudinal Modeling of Adolescents' Activity Involvement, Problem Peer Associations, and Youth Smoking

Longitudinal associations among different types of organized activity involvement, problem peer associations, and cigarette smoking were examined in a sample of 1040 adolescents (mean age = 15.62 at baseline, 16.89 at 15-month assessment, 17.59 at 24 months) enriched for smoking experimentation (83% had tried smoking). A structural equation model tested longitudinal paths between three categories of involvement (team sports, school clubs and activities, and religious activities, measured at baseline and 15 months), problem peer associations (baseline and 15 months), and cigarette smoking behavior (baseline and 24 months). Multi-group analyses indicated pathways differed by type of activity and adolescent gender. Boys' baseline team sports and religious involvement predicted lower levels of smoking at 24 months via continued activity involvement at 15 months. Girls' involvement in school clubs and activities and religious activities indirectly predicted lower levels of smoking at 24 months via reduced exposure to problem peers at 15 months.     

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

We examined knowledge, attitudes, and behaviors related to skin cancer, sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about skin cancer was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to skin cancer, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The one-session, school-based intervention significantly increased knowledge and perceived susceptibility to skin cancer but not behavioral intentions.     

Human participants challenges in youth tobacco cessation research: researchers' perspectives

Recruiting adolescents into smoking cessation studies is challenging, particularly given institutional review board (IRB) requirements for research conducted with adolescents. This article provides a brief review of the federal regulations that apply to research conducted with adolescents, and describes researchers' experiences of seeking IRB approval for youth cessation research. Twenty-one researchers provided information. The most frequently reported difficulty involved obtaining parental consent. Solutions to commonly reported problems with obtaining IRB approval are also identified. Waivers of parental consent can facilitate recruitment of youths into studies; however, researchers must ensure that their protocols comply with federal regulations when requesting a waiver.     

On the relationship between vowel and consonant identification when cued by the same acoustic information

When listening to speech, do we recognize syllables or phonemes? Information concerning the organization of the decisions involved in identifying a syllable may be elicited by allowing separate phonetic decisions regarding the vowel and consonant constituents to be controlled by the same acoustic information and by looking for evidence of interaction between these decisions. The duration and first formant frequency of the steady-state vocalic segment in synthesized consonant-vowel-consonant syllables were varied to result in responses of /bεd/, /bæd/, /bεt/, and /bæt/. The fact that the duration of the steady-state segment controls both decisions implies that that segment must be included in its entirety in the signal intervals on which the two decisions are based. For most subjects, no further significant interaction between the vocalic and consonantal decision is found beyond the fact that they are both affected by changes in the duration parameter. A model of two separate and independent phonetic decisions based on overlapping ranges of the signal adequately accounts for these data, and no explicit syllable level recognition needs to be introduced.     

Discriminations among perceptual and symbolic stimuli

This research compares the time required for perceptual discriminations among pairs of physically present objects (circles) with the time required to discriminate pairs of symbols Inonsense syllables) that subjects learned to associate uniquely with each of the circles. Four experiments show very large differences between symbolic and perceptual discriminations. Discrimination times for the perceptual stimuli declined systematically as their size ratio increased, but discriminations among the associated nonsense syllables showed only a strictly ordinal effect of position in the series. Discriminations among the symbolic stimuli showed a large semantic congruity effect, but the perceptual stimuli showed none. The research does not replicate previous results showing similarities between perceptual and symbolic processing suggestive of image processing. We conclude that in the symbolic task subjects use only ordinal information rather than images or analog representations of the associated circles. We propose that perceptual discriminations show a semantic congruity effect only when they are processed as if the perceptual stimuli were symbolic.     

Figural goodness effects in perception and memory

There is an apparent contradiction concerning configurational effects in visual information processing. Some studies have shown that when an array is organized into a “good” or unitary Gestalt, analysis of a single part of it is facilitated, while others have shown “good” arrays to impede search for a part. The three experiments reported here support the proposition that goodness of form can facilitate performance when memory is used, but that goodness impairs strictly perceptual search for a part of an array. These experiments compare detection of a single feature in faces (unitary figures) and nonfaces. They show that when the face or nonface is presented before the target feature (and must be held in memory), performance is better for faces than for nonfaces. When the target is presented before the face or nonface and perceptual search is required, faces give worse performance than nonfaces. Implications for perceptual phenomena, including the object-superiority and word-superiority effects, are discussed.     

Position effects in comparative judgments of serial order: List structure vs. differential strength

Two experiments are reported that test the hypothesis that the serial position effect in comparative judgment of ordinal position in arbitrary serial lists results from differential memory or associative strength among list items. The serial position effect in comparative judgment is typically a pattern in which pairs that contain a term from one of the two extremes of the list are processed faster and more accurately than pairs that contain no end terms. The experiments show that a new term added to either the end or the middle of a well-practiced fourterm series behaves almost immediately like the end or central term, respectively, of a well-practiced five-term series. Furthermore, when the added term is removed, the list reverts immediately to the position effect obtained in a four-term series. Theories that explain the position effect by differential build-up of item strength or of interitem associative strength over practice cannot explain these effects. We propose instead that learning of a serial list is accomplished by assigning list members to positions in a general-purpose linear order schema and that subjects can make these assignments rapidly and flexibly.     

A National Evaluation of Community-Based Youth Cessation Programs: End of Program and Twelve-Month Outcomes

Most youth cessation treatment research consists of efficacy studies in which treatments are evaluated under optimal conditions of delivery. Less is known about the effectiveness of youth cessation treatments delivered in real-world, community based settings. A national sample of 41 community-based youth cessation programs participated in a longitudinal evaluation to identify site, program, and participant characteristics associated with successful cessation. Validated quit rates were comparable to those in randomized controlled trials; 7-day abstinence at the end of program averaged 14% and 30-day abstinence at 12 months averaged 12%. Multivariate GEE models explored predictors of smoking cessation at the end of the programs and at 12 months. Results showed correlates of both short- and long-term cessation. Findings point to the importance of both individual and community-level variables, including motivation, opportunities for and encouragement to engage in activities outside of academics, having youth participate in treatment before they become highly dependent smokers, and community norms and ordinances that discourage youth purchase, use and possession of tobacco. Providing evidence-based treatment to youth in community-based settings results in successful cessation.     

The Embodied God: Core Intuitions About Person Physicality Coexist and Interfere With Acquired Christian Beliefs About God,the Holy Spirit,and Jesus

Why are disembodied extraordinary beings like gods and spirits prevalent in past and present theologies? Under the intuitive Cartesian dualism hypothesis, this is because it is natural to conceptualize of minds as separate from bodies; under the counterintuitiveness hypothesis, this is because beliefs in minds without bodies are unnatural—such beliefs violate core knowledge intuitions about person physicality and consequently have a social transmission advantage. We report on a critical test of these contrasting hypotheses. Prior research found that among adult Christian religious adherents, intuitions about person psychology coexist and interfere with theological conceptualizations of God (e.g., infallibility). Here, we use a sentence verification paradigm where participants are asked to evaluate as true or false statements on which core knowledge intuitions about person physicality and psychology and Christian theology about God are inconsistent (true on one and false on the other) versus consistent (both true or both false). We find, as predicted by the counterintuitiveness hypothesis but not the Cartesian dualism hypothesis, that Christian religious adherents show worse performance (lower accuracy and slower response time) on statements where Christian theological doctrines about God's physicality (e.g., incorporeality, omnipresence) conflict with intuitions about person physicality. We find these effects for other extraordinary beings in Christianity—the Holy Spirit and Jesus—but not for an ordinary being (priest). We conclude that it is unintuitive to conceptualize extraordinary beings as disembodied, and that this, rather than inherent Cartesian dualism, may explain the prevalence of beliefs in such beings.