Cognitive guidelines for simplifying medical information: Data framing and perception

In this paper, 1 describe psychological guidelines for simplifying medical information — methods to aid the perception and recognition of abnormalities in medical test reports. These techniques resemble natural human editing strategies outlined in prospect theory. The methods pre-edit data as humans do but to reduce human effort. I review empirical studies assessing these techniques and discuss needs for further research.     

Drug-behavior interaction history: modification of the effects of morphine on punished behavior.

Squirrel monkeys were trained to respond under a multiple fixed-interval, fixed-interval schedule in which the first response after 5 min terminated a visual stimulus in the presence of which electric shocks could occur. During one component of the schedule, correlated with one color of stimulus lights, every 30th response also produced electric shock; responding was suppressed during this component to approximately 10 to 12% of that occurring in the alternate component in which responding was not punished. In contrast to previous research, morphine (0.03 to 1.0 mg/kg) increased punished responding. Unpunished responding, however, was either not affected or decreased at doses of morphine that increased punished responding. Increases in rate of punished responding also occurred when the single-schedule punishment condition was studied alone in these animals. Subsequent experimentation, which systematically analyzed the development of the rate-enhancing effects of morphine on punished responding, involved the study of drug effects in additional monkeys trained initially under a single-schedule punishment condition. The effects of morphine on punished responding were studied before, after, and then during exposure to the multiple schedule that included a component in which responding was not punished. Increases in response rate with morphine did not occur until it was administered during exposure to the multiple schedule that included a component in which responding was not punished. As with the other monkeys, once the rate increases in punished responding occurred under the multiple schedule, these effects of morphine persisted, even when the multiple schedule was removed.(ABSTRACT TRUNCATED AT 250 WORDS)     

RESCUE AND RECOVERY AS A THEOLOGICAL PRINCIPLE,AND A KEY TO MORALITY IN EXTRATERRESTRIAL SPECIES

New theological understanding can emerge with the advancement of scientific knowledge and the use of new concepts, or older concepts in new ways. Here, the authors present a proposal to extend the concept of “rescue and recovery” found in the United Nations Law of the High Seas, off-world and within a broader purview of other intelligent and self-aware species that humans may someday encounter. The notion of a morality that extends to off-world species is not new, but in this analysis, rescue and recovery become an imperative when any intelligent and self-aware species is in harm's way. Rescue and recovery encompass a necessary action component except perhaps in those cases where rescuers are in danger. The authors explore three biblical examples of rescue and recovery to derive a fundamental meaning of the concept.     

Cultural psychological processes underlying workplace remuneration in Japanese and European American contexts

Japan's remuneration systems are moving away from seniority-based pay towards individual performance-based pay. We tested how the latter system works within the Japanese cultural context and whether the operation and functioning of the system reflects general psychological tendencies found in Japan. Japanese (Study 1 n = 197; Study 2 n = 235) and European American (Study 1 n = 201; Study 2 n = 186) participants read vignettes that described workplace success centred on a focal employee and including a team. Participants attributed contribution and rewards (financial and status) to a range of agents and factors with graded levels of focus, from the focal employee having the greatest and luck having the least. In general, we found that Japanese participants attributed greater contribution and reward to less focal agents and factors while European American participants attributed greater contribution and reward to more focal agents, in addition to some specific differences between the tasks and reward types. We discuss implications for more nuanced theorizing of the interaction between institutional systems and psychological processes.     

All's well that ends well? Outcome bias in pilots during instrument flight rules

The objective of the present study was to examine if the Outcome Bias also occurs in pilots flying under instrument flight rules (IFR). In a scenario-based survey, 60 pilots evaluated weather-related decisions made by hypothetical pilots. Participants rated the decisions as better, less risky, and regarded the probability that they would have made the same decision as higher when they were followed by a positive outcome, than when they were followed by a negative outcome. This effect showed likewise for novice pilots and for experienced pilots. These findings could be relevant for the flight-related decision-making of pilots, which sometimes is affected by the decisions made by third-party pilots. In particular, decisions made by other pilots that have led to positive outcomes might be hastily followed, whereas those that have led to negative outcomes might be hastily rejected.     

Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

STIMULUS (INSTRUCTIONAL) FADING DURING EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

BEHAVIORAL PERSISTENCE AND VARIABILITY DURING EXTINCTION OF SELF-INJURY MAINTAINED BY ESCAPE

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.