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Much of the research on implicit theories has focused on theories of intelligence. The aim of the present study was to examine how implicit theories of emotion were associated with positive and negative indicators of well-being via cognitive reappraisal. College students (n = 355) answered relevant questionnaires. Results indicated that entity theory of emotion (thinking that emotions are uncontrollable) was detrimental to well-being. Entity theory of emotion negatively predicted the use of reappraisal. Entity theory of emotion was positively associated with negative emotions, anxiety, and depression, while at the same time being negatively associated with life satisfaction and positive emotions. The effects of entity theory of emotion were partially mediated by cognitive reappraisal. Theoretical and practical implications are discussed.

The multiple-goals perspective assumes that adopting both mastery and performance goals is better for students. But there has been very little evidence for the multiple-goals perspective in Asian students. A cluster analysis was conducted to identify groups of Filipino students who endorse different goal combinations, revealing four groups comprised of those who adopted (a) predominantly performance goals, (b) predominantly mastery goals, (c) multiple goals or (d) low levels of both goals. Comparisons of cognitive and affective learning variables indicated that reported use of deep learning strategies, enjoyment of learning and less anxiety were associated with the multiple goals group. Although the study did not assess actual learning outcomes, the study shows results consistent with the multiple-goals perspective, as it shows enhanced use of cognitive strategies and more positive affective experiences in the learning processes, adding to the scant evidence on multiple-goals perspective among Asian students.

Objective. To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. Data Sources/Study Setting. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. Study Design. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. Principal Findings. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Conclusions. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform.

Purpose Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. Patients and Methods We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. Results The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P < .001). Mean knowledge scores were higher in the intervention arm than in the control arm (3.3 ± 1.0 v 2.6 ± 1.3, respectively; P < .001), and 65 participants (93%) in the intervention arm were comfortable watching the video. Conclusion Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

In October 2005, the United Network for Organ Sharing (UNOS) implemented a revised allocation policy requiring that renal allografts from young deceased donors (DDs) (35 years old) be offered preferentially to pediatric patients (18 years old). In this study, we compare the pre- and postpolicy quarterly pediatric transplant statistics from 2000 to 2008. The mean number of pediatric renal transplants with young DDs increased after policy implementation from 62.8 to 133 per quarter (p0.001), reflecting a change in the proportion of all transplants from young DDs during the study period from 0.33 to 0.63 (p0.001). The mean number of pediatric renal transplants from old DDs (or =35 years old) decreased from 22.4 to 2.6 per quarter (p0.001). The proportion of all pediatric renal transplants from living donors decreased from 0.55 to 0.35 (p0.001). The proportion from young DDs with five or six mismatched human leukocyte antigen (HLA) loci increased from 0.16 to 0.36 (p0.001) while those with 0 to 4 HLA mismatches increased from 0.18 to 0.27 (p0.001). Revision of UNOS policy has increased the number of pediatric renal transplants with allografts from young DDs, while increasing HLA-mismatched allografts and decreasing the number from living donors.

The rise in hospital-based medicine and the focused-practice area of hospitalists are altering the traditional paradigm of the patient-physician relationship to emphasize efficiency and justice in medical practice. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life.Since the medical information presented to subjects is frequently complex, we hypothesized that apparent differences in end-of-life preferences and decision making may be due to disparities in health literacy. A video of a patient with advanced dementia may overcome communication barriers associated with low health literacy.Before and after oral survey.Subjects presenting to their primary care doctors.Subjects were asked their preferences for end-of-life care after they heard a verbal description of advanced dementia. Subjects then viewed a 2-minute video of a patient with advanced dementia and were asked again about their preferences. For the analysis, preferences were dichotomized into comfort care and aggressive care. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM) and subjects were divided into three literacy categories: low (0-45, sixth grade and below), marginal (46-60, seventh to eighth grade) and adequate (61-66, ninth grade and above). Unadjusted and adjusted logistic regression models were fit using stepwise algorithms to examine factors related to initial preferences before the video.A total of 80 African Americans and 64 whites completed the interview. In unadjusted analyses, African Americans were more likely than whites to have preferences for aggressive care after the verbal description, odds ratio (OR) 4.8 (95% confidence interval [CI] 2.1-10.9). Subjects with low or marginal health literacy were also more likely than subjects with adequate health literacy to have preferences for aggressive care after the verbal description, OR 17.3 (95% CI 6.0-49.9) and OR 11.3 (95% CI 4.2-30.8) respectively. In adjusted analyses, health literacy (low health literacy: OR 7.1, 95% CI 2.1-24.2; marginal health literacy OR 5.1, 95% CI 1.6-16.3) but not race (OR 1.1, 95% CI 0.3-3.2) was an independent predictor of preferences after the verbal description. After watching a video of advanced dementia, there were no significant differences in the distribution of preferences by race or health literacy.Health literacy and not race was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. In addition, after viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to race and health literacy. These findings suggest that clinical practice and research relating to end-of-life preferences may need to focus on a patient education model incorporating the use of decision aids such as video to ensure informed decision-making.

Kenneth Kipnis (2006) presents a normative defense of strict confidentiality, but it follows from an empirical claim that allowing breach would result in all parties being worse off, including, par...

Objectives: To determine whether poor functional status is associated with worse outcomes after attempted cardiopulmonary resuscitation (CPR). Design: Retrospective study of individuals who experienced cardiac arrest stratified according to dependence in activities of daily living (ADLs) and residential status (nursing home (NH) or community dwelling). Setting: Two hundred thirty-five hospitals throughout North America. Participants: Adult inpatients aged 65 and older who had experienced a cardiac arrest as reported to the Get with the Guidelines�Resuscitation registry between 2000 and 2008. Measurements: Primary outcomes were return of spontaneous circulation (ROSC) and survival to discharge. Results: Twenty-six thousand three hundred twenty-nine individuals who experienced cardiac arrest met inclusion criteria. NH residents dependent in ADLs had a lower odds than community-dwelling independent participants of achieving ROSC (odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.63�0.85), whereas participants dependent in ADLs from either residential setting had lower odds of survival (community-dwelling: OR = 0.76, 95% CI = 0.63�0.92; NH: OR = 0.79, 95% CI = 0.64�0.96) after adjusting for participant and arrest characteristics. Duration of resuscitation and doses of epinephrine or vasopressin were similar between groups and had no significant effect on ROSC or survival, although participants dependent in ADLs were more likely to have a do-not-resuscitate (DNR) order placed after ROSC. Overall, median time to signing a DNR order after resuscitation was 10 hours (interquartile range 2�70). Conclusion: Functional and residential status are important predictors of survival after in-hospital cardiac arrest. Contrary to the hypothesis but reassuring from a quality-of-care perspective, less-aggressive attempts at resuscitation do not appear to contribute to poorer outcomes in individuals dependent in ADL, regardless of residential status.

Objective To evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia, and the stability of those preferences after six weeks. Design Randomised controlled trial conducted between 1 September 2007 and 30 May 2008. Setting Four primary care clinics (two geriatric and two adult medicine) affiliated with three academic medical centres in Boston. Participants Convenience sample of 200 older people (≥65 years) living in the community with previously scheduled appointments at one of the clinics. Mean age was 75 and 58% were women. Intervention Verbal narrative alone (n=106) or with a video decision support tool (n=94). Main outcome measures Preferred goal of care: life prolonging care (cardiopulmonary resuscitation, mechanical ventilation), limited care (admission to hospital, antibiotics, but not cardiopulmonary resuscitation), or comfort care (treatment only to relieve symptoms). Preferences after six weeks. The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care. Results Among participants receiving the verbal narrative alone, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain. In the video group, 81 (86%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain (χ2=13.0, df=3, P=0.003). Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher, good or better health status, greater health literacy, white race, and randomisation to the video arm. In multivariable analysis, participants in the video group were more likely to prefer comfort care than those in the verbal group (adjusted odds ratio 3.9, 95% confidence interval 1.8 to 8.6). Participants were re-interviewed after six weeks. Among the 94/106 (89%) participants re-interviewed in the verbal group, 27 (29%) changed their preferences (κ=0.35). Among the 84/94 (89%) participants re-interviewed in the video group, five (6%) changed their preferences (κ=0.79) (P

Primary care physicians report that there is insufficient time to meet patients’ needs during clinical visits, but visit time has increased over the past decade. To determine whether the number of clinical items addressed during the primary care visit has increased, and if so, whether this has been associated with changes in visit length and the pace of clinical work. Analysis of non-hospital-based adult primary care visits from 1997 to 2005, as reported in the National Ambulatory Medical Care Survey. A total of 46,431 adult primary care visits. We assessed changes over time for the total number of clinical items addressed per visit (including diagnoses, medications, tests ordered, and counseling), visit duration, and average available time per clinical item. In adjusted analyses we controlled for patient and physician characteristics. The number of clinical items addressed per visit increased from 5.4 to 7.1 from 1997 to 2005 (p

Instructional advance directives (ADs) are traditionally written to apply in terminal illness. As such, they do not readily capture patient preferences for care in acute and chronic illness.To test whether patients prefer a modified AD that includes preferences to limit life-sustaining therapy (LST) for critical illness and advanced dementia over a traditional AD.A convenience sample of medically stable, hospitalized general medical patients were presented a traditional AD (the recommended Illinois statutory living will that limits LST in terminal illness) and a modified AD. The modified AD presents four conditional options: (1) to limit LST in terminal illness, (2) to limit LST in critical illness to a reasonable trial, (3) to refuse LST in advanced dementia (described in lay language), and (4) to refuse artificial hydration and nutrition (AHN) in advanced dementia. The primary outcome was the preferred AD to present to patients. Secondary outcomes included the AD choice of those who executed an AD and the options chosen by those executing the modified AD.Seventy-two patients completed the survey. Eighty-six percent (95% confidence interval [CI], 76%-93%), preferred that the modified AD be presented to patients over the traditional AD. Twenty-one patients chose to execute an AD. Eighteen (86%; 95% CI, 64%-97%), executed the modified AD. Twelve executed all four options.Traditional instructional ADs fail to capture important patient preferences. Future research should further validate these preferences and explore whether including these specific options in ADs can improve their efficacy.

Advance care planning is a process by which patients plan for future medical care under circumstances of impaired decision-making. Central to this process is the patient's understanding and ability to imagine future health states.A before and after oral survey was used to compare the effect of a video depiction with that of a verbal description of a patient with advanced dementia for individuals selecting level of medical care at 7 primary care clinics at 2 US medical centers. The study enrolled 120 adults, half of whom were nonwhite.A total of 120 subjects completed the interview. Before watching the video, 60 (50.0%) subjects preferred comfort care, 25 (20.8%) desired life-prolonging care, 22 (18.3%) chose limited care, and 13 (10.8%) were unsure of their preferences. Subject preferences changed significantly after the video: 107 (89.2%) of the subjects chose comfort care, none desired life-prolonging care, 10 (8.3%) chose limited care, and 3 (2.5%) were unsure of their preferences (P.001). Unadjusted analysis revealed a statistically significant difference regarding preferences, based on race/ethnicity, before watching the video: 40% of African Americans and 43% of Latinos chose comfort care, compared with 58% of whites (P = .04). Differences were also noted for educational level (P = .03). After the video, differences in preferences based on race/ethnicity and educational level disappeared.Watching the video significantly changed preferences for care, transcending apparent differences in preferences associated with race/ethnicity and educational level. This study suggests that using video in addition to improved verbal communication may lead to more informed advance care planning by enhancing the ability of patients to imagine a hypothetical health state.

The submandibular gland undergoes a complex, androgen-dependent development coincident with sexual maturation in the male mouse. However, in mice with the X-linked syndrome of testicular feminization (Tfm), this sexual dimorphism does not develop, and androgen- mediated production of nerve growth factor is deficient. To determine whether other androgen functions are defective in this mutation, esteroproteolytic activity was assessed in the submandibular glands of normal male and female mice, of Tfm mice, and of heterozygous female carriers for the Tfm mutation before and after the administration of testosterone propionate for 8 days. Both kinetic assays of the total capacity of extracts to catalyze the hydrolysis of tosyl arginine methyl ester (TAME) and immunoelectrophoresis to detect two specific esteroproteases, A and D, were utilized. The Tfm animal exhibited almost no increase in total Tamase activity after treatment with testosterone propionate whereas the heterozygous female carriers developed an i...

Summary1. Large doses of acetylcholine (1.20-2.85 mg) were injected in the yolk sac, air chamber, or directly on the embryo during the 4-12-day incubation period. These doses were well tolerated by the embryo and attended with no gross abnormalities. Atropine similarly administered produced no malformation. 2. The yolk sac of 4-day embryos was injected with weak doses (0.05 mg) of physostigmine salicylate. Shortened beaks, micromelia, and retarded development of eyelids were observed at 8 to 13 days' incubation. Inasmuch as similar anomalies were reported in sulfanilamide and insulin treated animals, these anomalies cannot be considered eserine specific. 3. With larger doses (1-15 mg) of prostigmine bromide or physostigmine salicylate, the above mentioned anomalies were generally associated with severe midline bendings of the vertebral column (Figs. 4,5), and this was interpreted as specific for cholinesterase inhibition.

SummaryA protein obtained from the mouse submaxillary gland, which enhances the growth of sympathetic and spinal ganglia and their processes, is 4-30 times more concentrated in the male than in the female sub-maxillary gland, an organ which shows a sexual dimorphism in histological appearance and in several physiological differences. The masculinization of the gland which occurs during pregnancy and lactation, as a result of increased androgen secretion during that time, has been shown to be correlated to a logarithmic increase in concentration of nerve growth protein, to the point where it may equal that of the male. It is suggested that this increase may serve the function of aiding the development of parts of the nervous system of the suckling mouse.

Se75 was orally administered to 3-week-old chicks fed either selenium deficient or supplemented diets. Distribution of Se75 in serum proteins with time and its effect on serum protein pattern were determined electrophoretically. Selenium in the diet had no effect on the distribution of Se75 in the protein fraction, but markedly decreased its retention. After two hours the major portion of the dose was found in the beta and gamma fraction and the activity in this fraction increased with time. Marked increases in albumin/ globulin (A/G) ratios in depleted chicks were observed within 96 hours after administration of Se75. Albumin was increased and globulin fractions were decreased. Increases in A/G ratios, somewhat smaller in magnitude, were also noted in chicks receiving a diet supplemented with selenium. (auth)

Nerve growth factor has been isolated from submaxillary glands of mnature male mice at specific activities about a million times, and in yields of biological activity ten million times, greater than best previous results. The major improvement in the isolation is related to the separation of a highly active tosylarginine methyl esterase present in cruder preparations. The new nerve growth factor may be an entity different from the older one, although no gross differences in the qualitative aspects of their actions are apparent on superficial examination of chick ganglia influenced by them. The neurites which develop from a ganglion in the presence of nerve growth factor are of nearly equal length. The amount of nerve growth factor determines the number of neurites but not the extent of individual development. The amount of the new nerve growth factor which evokes the appearance of a hundred neurites from a single ganglion appears to be about ten molecules. Since each neurite seems to arise from a different neuron each molecule of nerve growth factor must affect several cells. This result can be rationalized by a catalytic mechanism or by indirect action of nerve growth factor through a hypothetical cell which produces a neurite evocator on contact with the molecule of nerve growth factor.

NERVE-GROWTH factors have been isolated from a variety of substances such as sarcoma, snake venoms and the spinal-axial region of the chick embryo. The best source has been the submandibular saliva...

SummaryThree-week-old chicks fed either a Vit. E deficient or supplemented diet were intraperitoneally injected with Se75, and distribution of the isotope was determined in various tissues at 24, 48, and 168 hours after injection. Similarly, 2-week-old chicks fed a selenium deficient or supplemented diet were given an oral dose of Se75 and the distribution of the isotope in several tissues was determined at 24 and 168 hours after administration. Vitamin E had no effect on distribution of selenium, but selenium itself had a marked effect on the uptake and retention of radioselenium. One-half of the dose was retained by selenium-deficient chicks at 7 days, whereas only 1/5 of the dose was retained by chicks fed 1 ppm selenium from day-of-age. Considerable selenium was deposited and retained in the cerebellum of chicks even though this element cannot prevent encephalomalacia.

SummaryLigation of submandibular salivary ducts causes a loss of production of nerve growth factor. The change is proportional to loss of the polypeptide cofactor “C” rather than to the diminution of the protein “A,” which is continually synthesized. The continued production of “A” in the ligated gland suggests an endocrine function for subman-dibular glands.

History. —Mr. H. C., aged 22, white, American, a coast guard, permit No. 1,574, was admitted to the U. S. Marine Hospital, Port of New York, Nov. 9, 1918, complaining of a dull pain in the right iliac fossa. The complaint had lasted for four days; he was nauseated but he had not vomited. The dull ache, which had no connection with eating, was continuous. The patient complained of diarrhea. There was nothing significant in his past illnesses or family history. He denied venereal disease. His parents and three sisters were living and well. Physical Examination. —The only abnormalities noted were diffuse tenderness in the right hypogastric region and a slight rigidity of the rectus muscle. No signs of tenderness were elicited by pushing gas around in the colon; moderate tenderness was noted in both lumbar regions posteriorly. There was gross abdominal distention; but deep palpation revealed a mobile mass

The unique anatomic relationship of the terminal ileum and the cecum and ascending colon is the reason for reporting this case of fatal intestinal obstruction. The condition present resembled in a general way the condition found in mobile colon, except that the ascending colon had overridden and become secondarily adherent on a coil of the terminal ileum. Still other coils of the ileum lay to the right side of the ascending colon and cecum. Or, conversely, this part of the ileum failed to rotate and descend, whereas the cecum did so to the usual extent. The dominant features of the anomaly were as follows: About 30 inches from the termination of the ileum in the ileocecal valve, the ileum passed under the posterior parietal peritoneum and ran upward and outward to a point 2 inches below the hepatic angle of the colon. There it turned sharply outward under the colon