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This paper offers a summary of the general findings from a study on unilateral sensorineural hearing loss as well as some comments with regard to possible reasons for outcome. Additional comments are provided on the management of unilaterally hearing-impaired children, future directions for research, and an emphasis on the limitations and interpretations of this investigation.
The aim of this study was to describe and understand patients' positive and negative experiences of General Practitioners (GPs). Forty-six consultations were videotaped in four primary health care centres in Sweden. Afterwards the patients commented on the recorded consultations. The comments were categorized and analyzed using an exploratory qualitative approach. An image of the "good" GP emerged that had two major characteristics: that of being a caring human; an individual who listens, understands, and is concerned. At the same time, the good GP acts like an ordinary person and treats the patient as an equal. The personal relationship with the GP also influenced the choice and course of medical interventions. For the patient, the manner in which an intervention is seen is linked to whether the GPs treats the patient with respect or not. A typical experience of a "bad" GP was that the GP appeared unreachable as a person. An example is when the patient feels that the GP was not taking his or her symptoms seriously. Another characteristic of the bad GP is failure to communicate to the patient his or her standpoint on issues raised during consultations.
In this paper we made two brief commentaries on Harver's (1987) experiment. The first comment is an observation on the growing area of respiratory psychophysics for which we prefer the name Behavioral Physiology. In the second comment it is suggested that the stable individual differences in the exponent of the psychophysical power law reported by Harver may be an artifact of the psychophysical method employed: category production.
To compare patient and doctor views of the consultation process, 46 consultations were videotaped in four primary health care centres. Twelve general practitioners and 46 patients participated. Later, the patients and the doctors (on different occasions) spontaneously commented on the recorded consultations. Qualitative methods were used for the analysis. The patients seemed to have a perspective oriented towards relationships, while the doctors were more oriented towards medical tasks. There was an association of power between the parties that implies a relationship of mutual dependency. The doctors depended on the patients to obtain the information they needed about the symptoms to be able to fulfil their professional task. The patients depended on the doctor to get their important needs satisfied; everything from a particular medicine to being treated as a human being. The major differences in the comments by the patients and the doctors reflected their different roles and the asymmetry in the relationship.
The increasing use of human tissues in medical research has spawned a host of ethical and legal debates. Legal analysis in this area has almost exclusively focused on the question of property rights in both the tissues used in research and in the resulting products. One illustrative case is Moore v. Regents of the University of California, in which a patient sued his doctor for conversion of his spleen which had been removed for therapeutic purposes. The doctor later used the spleen to develop a patented and profitable cell-line. This Comment examines and rejects the property law approach to this issue. Instead, this Comment proposes two legislative changes which would 1) eliminate any trade in human tissues and 2) require doctors to inform their patients of any research interest in proposed medical procedures. These proposals resolve the problem presented in Moore, and avoid the misleading, and inevitably unanswerable, question of property rights.
In Kartell v. Blue Shield of Massachusetts, Inc., the First Circuit held that Blue Shield's reimbursement practice known as the "ban on balance billing" did not constitute an unlawful restraint of trade in violation of the antitrust laws. Underlying the First Circuit's decision was deference to what it viewed as efforts by Blue Shield and by the Commonwealth to promote cost containment. This Comment argues that, to the contrary, under an appropriate analysis of antitrust law, the practices employed by Blue Shield did constitute unreasonable restraints of trade on the physicians' service industry in Massachusetts, given Blue Shield's market dominance in the Commonwealth. The Comment also argues that such inhibition of the competitive functioning of this industry is unwise, and that costs should instead be contained by effectuating the antitrust laws and encouraging the development of competitive forces within this industry.
Comments received in response to a questionnaire seeking opinion about hair examination have been considered. The questionnaire was in two parts: the first was concerned with the description of microscopic features and the second with the use of numerical features and data sheets in hair examinations. The same format is used to present a synopsis of the many individual comments and suggestions contained in questionnaire returns. It is argued that a hair examination form can contribute to more effective hair examinations although not replacing direct side-by-side comparisons. A hair examination form is presented with recommendations for its use.
These comments were prepared by the PDA ad hoc Task Force on USP <1116>. The members of the Task Force are listed at the end of the comments.
This comment is in response to a paper previously published in the Journal entitled "Let there be life", by A. C. Elitzur. Elitzur ascribes to Eigen the proposal that life began with the appearance of an autocatalytic (self-replicating) molecule. This was discussed by biologists and philosophers in the nineteenth century. Eigen's proposal is moot: there never was a primeval soup. The absence of evidence is evidence of absence. Elitzur also confuses thermodynamics with statistical mechanics. The statistical equation of Boltzmann and Planck for entropy appears in discussions of statistical mechanics, not in discussions of classical thermodynamics. Elitzur calls the Second Law of Thermodynamics an explanation of evolution. On the contrary, his mentor Eigen wrote: "In physics we know of principles which cannot be reduced to any more fundamental laws. As axioms, they are abstracted from experience, their predictions being consistent with the consequences that can be subjected to experimental test. "Typical examples are the first and second law of thermodynamics. Darwin's principle of natural selection does not fall into the category of first principles." The reader is invited to compare the material in Elitzur's paper with the discussion in Yockey's (1992) book, Information Theory and Molecular Biology, Cambridge, Cambridge University Press.
We would like to comment on the investigations of Vaara, M., Plachy, W.Z. and Nikaido, H. (Vaara, M. et al. (1990) Biochim. Biophys. Acta 1024, 152-158) on the partitioning of hydrophobic probes in lipopolysaccharide bilayers. These authors reported that they did not succeed in preparing closed vesicles (liposomes) from rough mutant lipopolysaccharide. We describe the conditions under which lipopolysaccharide liposomes are formed most readily. We, furthermore, summarize data which strongly support the existence of thermotropic phase transitions of lipopolysaccharides (with transition temperatures lying in the range of 30-36 degrees C) contradictory to Vaara et al. who argue that such transitions are artefacts. Exemplary measurements of the beta in equilibrium alpha acyl chain melting for lipopolysaccharide from Escherichia coli deep rough mutant (strain F515) as compared to synthetic and natural phospholipids are presented using fluorescence spectroscopy, Fourier-transform infrared spectroscopy and differential scanning calorimetry. These results unequivocally prove the necessity to perform experiments at 37 degrees C for a determination of the outer membrane permeability under physiological conditions.
During the 1980s the behavior therapy movement was infiltrated by cognitivists, people who believe that all maladaptive fears are based on wrong beliefs and all can be overcome by cognitive correction. This article asserts and defends the following propositions: (1) There are numerous maladaptive fears demonstrably immune to cognitive correction but removable by deconditioning. (2) These conditioning based fears constitute the majority, but there are also some based on mistaken beliefs. (3) Proponents of the cognitivist viewpoint have overrated the outcomes of cognitive therapy, because they have not realized the fact that conditioned anxiety is often inadvertently weakened by simultaneous competing emotions (nonspecific therapeutic effects). (4) This overrating led to the fiction that cognitive-behavior therapy is behavior therapy's best resource to overcome non-psychotic depression, a fiction that was exposed by cognitive-behavior therapy's inferior performance in the National Institute of Mental Health's Collaborative Research Project. (5) There is data to suggest that use of the full resources of behavior therapy would have produced notably superior results. The commentary concludes with comments on the other contributions to the symposium, From Behavior Theory to Behavior Therapy.
Epelboim, Booth, and Steinman [1994 Vision Research, 34, 1735-1766] recently published an article in this journal in which they argued that "unspaced text is relatively easy to read" (p. 1760). From this they concluded that the spaces between words "are relatively unimportant for guiding reading eye movements" (p. 1760). We have serious reservations concerning these conclusions. In this letter we argue that (1) reading unspaced text is not easy for most readers and (2) there are more diagnostic ways to examine the role of spacing. We also comment on the implications for models of eye movements in reading.
Some critical comments are offered with regard to the use of the designation psychotherapy dropout in the article by Weisz, Weiss, and Langmeyer (1987). It is proposed that individuals who do not begin a course of psychotherapy should not be viewed as dropouts. Reference is also made to problems of generalization.
The purpose of this comment is to point out some potential pitfalls in the study of similarity judgments, particularly with regard to comparison of similarity judgments between modalities. These are discussed in the context of the article by Ritov, Gati, and Tversky (1990).
A recent paper in this journal has examined the ventilatory compensation for metabolic acidosis with increasing oxygen uptake, making extensive use of mathematical and statistical techniques. The authors conclude that '...respiratory compensation for metabolic acidosis during incremental exercise is a continuous process...'. While this may indeed be so, the following major aspects of the paper render the evidence at best dubious, surely inconclusive and perhaps even worthless: (1) The mathematical and statistical methodology is sloppy, incomplete and, at times, flawed. (2) No discontinuous model is presented for comparative purposes, only three continuous ones. (3) The authors ignore the fact that some threshold models produce smooth continuous data, and as a consequence, a good fit of a smooth continuous model cannot exclude the presence of a threshold. (4) The data in Table 5 show the amplitude parameter A of the preferred model to be not significantly different from zero. This paper draws these matters to the attention of readers of this journal, reviewers of manuscripts and other researchers, with comment and suggestion. This is done in the hope that all those concerned with mathematical and statistical methodologies will become more aware of their proper use.
The author comments on articles that discuss the roles of demographic variables, qualitative variables, and the interview in making sound selection for medical school admission; analyze the effectiveness of traditional predictors in selecting successful students; and examine the predictors that best identify minority students likely to succeed in medical training. Together, the articles review the literature, analyze the findings, and recommend sound practices and areas of future research germane to selecting students. The discussions highlight the predictor role, initial importance, and relatively short half-life of academic criteria in physicians' total careers, and emphasize that academic predictors must be complemented by other factors in the applicant's background. Because selection for medical school leads in almost all cases to eventual practice as a physician, the admission decision has far-reaching impact. Those concerned with the admission process should use the distilled information in these articles to improve the assessment of applicants and the selection process.
There are several important issues raised in the paper by Cattell and in the comments upon it: the empirical status of the Cattell factors; the experimental verification of factors; difficulties with confirmatory analysis and the value of P-analysis. The relevance of these points is explicated in this paper.
The Zwislocki et al. ["Earphones in Audiometry," J. Acoust. Soc. Am. 83, 1688-1689 (1988)] Letter to the Editor states that insert earphones have some unresolved technical problems, such as limited frequency response, limited dynamic range and power handling capability, intersubject variability, and hygiene safety. In evaluating circumaural earphones, Zwislocki et al. say that the lack of a standard coupler disqualifies them for audiometry. Since this letter carries the weight of a CHABA committee recommendation, these issues are commented on herein. Section I was written primarily by Mead Killion and Sec. II primarily by Edgar Villchur. For brevity throughout, the authors of the Zwislocki et al. letter will be referred to as "the authors."