Postmenopausal women undergoing transvaginal ultrasound screening prefer not to have chaperones.

The Royal College of Radiologists has recommended chaperones of the appropriate gender for those undergoing intimate scans. This has significant implications for clinical and research programmes. Two hundred and fifty women undergoing scanning in a screening trial were sent postal questionnaires to determine their views as to the presence of chaperones and the gender of ultrasonographers. Ninety-five percent of 198 women stated that they would not like another person to be present during transvaginal scanning. Of greater consequence to women was the gender of the ultrasonographer, with 83.3% expressing a preference for a female ultrasonographer. This needs to be considered in making decisions about allocation of scarce resources.

Truth may hurt but deceit hurts more: communication in palliative care.

Healthcare professionals often censor their information giving to patients in an attempt to protect them from potentially hurtful, sad or bad news. There is a commonly expressed belief that what people do not know does not harm them. Analysis of doctor and nurse/patient interactions reveals that this well-intentioned but misguided assumption about human behaviour is present at all stages of cancer care. Less than honest disclosure is seen from the moment that a patient reports symptoms, to the confirmation of diagnosis, during discussions about the therapeutic benefits of treatment, at relapse and terminal illness. This desire to shield patients from the reality of their situation usually creates even greater difficulties for patients, their relatives and friends and other members of the healthcare team. Although the motivation behind economy with the truth is often well meant, a conspiracy of silence usually results in a heightened state of fear, anxiety and confusion--not one of calm and equanimity. Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations. In this paper, some examples and consequences of accidental, deliberate, if well-meaning, attempts to disguise the truth from patients, taken verbatim from interviews, are given, together with cases of unintentional deception or misunderstandings created by the use of ambiguous language. We also provide evidence from research studies showing that although truth hurts, deceit may well hurt more. 'I think the best physician is the one who has the providence to tell to the patients according to his knowledge the present situation, what has happened before, and what is going to happen in the future' (Hippocrates).

Two sources of acoustic distortion products from the human cochlea.

The amplitude and phase of both stimulus-frequency and distortion-product emissions have been measured in healthy human ears. In some ears it is possible to model acoustic distortion products (DPs) generated by low-to-moderate stimulus levels as the vector sum of two components originating from distinct regions of the cochlea, one from the f2 place and the other, with a longer delay, from the distortion product place. The phase lag of the more delayed DP component is slightly greater than that of stimulus frequency emissions (SFEs) measured in the same ears.

Effects of aspirin on human psychophysical tuning curves in forward and simultaneous masking.

Psychophysical tuning curves (PTCs) at 4 kHz were measured in forward and simultaneous masking under two experimental conditions: 1 h after listeners had ingested three 320 mg capsules of aspirin every 6 h for 3 days (3.84 g/day), and after an identical schedule of placebo ingestion. Aspirin and placebo allocation was double-blind. In addition to raising thresholds at several audiometric frequencies, aspirin elevated the tips and reduced the slopes of the PTCs, indicating a reduction in frequency selectivity. The aspirin-induced reduction in PTC slopes did not differ significantly between forward and simultaneous masking, nor did the overall reduction differ significantly between the low- and high-frequency side. However, a separate analysis of the data obtained in simultaneous masking indicated that the broadening in tuning caused by aspirin was greatest on the high-frequency side of the PTC.

Effects of forward masking on intensity discrimination, frequency discrimination, and the detection of tones in noise.

A series of experiments investigated the deterioration in intensity discrimination at intermediate levels caused by preceding the brief sinusoidal stimuli by an intense narrow-band noise [Zeng et al., Hear. Res. 55, 223-230 (1991)]. Experiment 1 showed that this deterioration acted in a roughly additive manner with the previously reported midlevel deterioration for the intensity discrimination of brief 6500-Hz tones in quiet. The experiment also showed that a smaller, although still substantial, deterioration occurred for the detection of brief tones in bursts of synchronous noise. In experiment 2, the masker could occur either before the signal (louder tone) or standard (softer tone), the choice being selected at random on a trial-by-trial basis, and with the Weber fraction tracked for each condition separately using two interleaved, adaptive procedures. Weber fractions were lower when the masker preceded the signal than when it preceded the standard, arguing against a major role for adaptation in causing the midlevel deterioration. Instead, it is suggested that the deterioration shared a common mechanism with the phenomenon of "loudness enhancement" [R. J. Irwin and J. J. Zwislocki, Percept. Psychophys. 10, 189-192 (1971); Galambos et al., J. Acoust. Soc. Am. 52, 1127-1130 (1972)]. The third experiment showed that Weber fractions did not depend greatly on whether the forward masker occurred only in interval one or only in interval two of a two-interval trial. A fourth experiment investigated the effect of a forward masker on frequency difference limens (DLs). When the masker was presented in both intervals of each trial, there was only a moderate increase in frequency DLs which, in contrast to the elevation in Weber fractions for intensity discrimination, was independent of signal level. Presenting the masker before only the lower frequency tone of a pair to be discriminated usually yielded lower DLs than presenting it only before the higher frequency tone, but this effect was less consistent than for intensity discrimination. The results of all experiments are discussed with respect to the various ways in which an intense narrow-band masker can affect the perception of subsequent brief sounds.