White coated healer or black coated executioner: health professionals and capital punishment.

In some countries and some jurisdictions health professionals are involved in the process of capital punishment. Their involvement raises difficult ethical issues and the more so with changing attitudes to, and growing support for, assisted suicide, greater respect for autonomy and more universal promotion of human rights, including those of prisoners. These issues are discussed in relation to the various stages of the capital punishment process from the investigation of a potential capital offence to the removal of executed prisoners' tissues and organs for transplantation. It is suggested that some of the ethical difficulties can be resolved, or at least ameliorated, by having regard to the three core concepts of medical ethics: autonomy, best interests and rights. But active involvement of health professionals in capital punishment, however justified ethically, runs the risk that 'reforms' will even more deeply entrench what remains of the death penalty, thus making it more resistant to complete repeal.

Structural relationship between negative thermal expansion and quartic anharmonicity of cubic ScF3.

Cubic scandium trifluoride (ScF3) has a large negative thermal expansion over a wide range of temperatures. Inelastic neutron scattering experiments were performed to study the temperature dependence of the lattice dynamics of ScF3 from 7 to 750 K. The measured phonon densities of states show a large anharmonic contribution with a thermal stiffening of modes around 25 meV. Phonon calculations with first-principles methods identified the individual modes in the densities of states, and frozen phonon calculations showed that some of the modes with motions of F atoms transverse to their bond direction behave as quantum quartic oscillators. The quartic potential originates from harmonic interatomic forces in the DO9 structure of ScF3, and accounts for phonon stiffening with the temperature and a significant part of the negative thermal expansion.

Phonon density of states of LaFeAsO(1-x)Fx.

We have studied the phonon density of states (PDOS) in LaFeAsO(1-x)Fx with inelastic neutron scattering methods. The PDOS of the parent compound (x=0) is very similar to the PDOS of samples optimally doped with fluorine to achieve the maximum Tc (x approximately 0.1). Good agreement is found between the experimental PDOS and first-principles calculations with the exception of a small difference in Fe mode frequencies. The PDOS reported here is not consistent with conventional electron-phonon mediated superconductivity.

Assessing decision-making and capacity in minimally-aware patients.

The assessment of decision-making by minimally-aware patients represents an important challenge for medicine, science and the law. This paper seeks to assist the dialogue between these disciplines by discussing three aspects: the difficulties inherent in establishing a reliable means of communication with the patient; the difficulty of exploring understanding and decision-making once a means of communication has been determined; and the legal implications including problems that may arise with the 'balance of probabilities' legal standard of proof. These aspects are discussed using the example of patients who have very severe acquired brain damage or are in states which verge on the 'persistent vegetative state'. The discussion is informed by existing case law and by reference to clinical method and scientific theory including binomial theory.

Health surveillance using an occupational medical database.

This pilot study sought associations between liver function tests (LFTs) and membership in homogeneous exposure groups (HEGs) at a target plant as pre-clinical indications of possible future occupational health problems. A large company database yielded linear models for each of six LFTs (total bilirubin, alkaline phosphatase, gammaglutamyl transferase, lactate dehydrogenase, aspartate transaminase, and alanine transaminase) in terms of sex, body mass index, age, race (white/non-white), alcohol and cigarette consumption, and production/non-production (P/NP) job, permitting control for these in analyses of LFTs vs HEGs at the plant. These analyses, with HEG substituted for P/NP in the large group model, resulted in loosely "suspect" associations significant at P < 0.10. Collapsed HEG variable (containing "suspects" separately and all other non-significant HEG levels pooled) yielded "confirmed suspects" at P < 0.05 in the analysis of an independent LFT set taken at the plant approximately one year later.

Sexual activity and contraceptive use among low-income urban black adolescent females.

A modified form of Nathanson and Becker's (1983) Health Belief Model Questionnaire and other measures designed to assess cognitive processing were administered to low-income black adolescent female clients of an inner-city comprehensive health care clinic. The purpose of the study was to explore determinants of sexual activity and contraceptive use. Subjects were classified as not sexually active (n = 50), sexually active/noncontracepting (n = 20), or sexually active/contracepting (n = 72). Not sexually active subjects tended to be younger, more career motivated, to have a father at home, to be more influenced by family values, and to have more conservative attitudes regarding adolescent sexuality than did sexually active subjects. Sexually active/noncontracepting subjects tended to report fewer benefits and more barriers to the use of contraception. Level of cognitive processing did not differ among the three groups, but was at a lower-than-expected level for age. Finally, inconsistent contraceptive use was common to both sexually active groups.

PIP: The findings of this longitudinal study of contracepting behavior and attitudes among black and Hispanic females are based on an initial data sample. Study respondents (142 black never-pregnant youths 13-17 years) were recruited from the West Dallas Youth Clinic, a well-established school-based comprehensive health service serving a low income population. Interviews were conducted using the Nathanson and Becker's (1983) HBM questionnaire, Nowicki and Strickland's Locus of Control measure, a Piagetian Logical Reasoning Test, and Stein el al.'s (1968) Future Events Test. 3 groups were differentiated: nonsexually active (NA) (50), sexually active and noncontracepting (A/NC) (20), or sexually active and contracepting (A/C) (72). Initial analyses revealed age differences among the groups (F (2,139) =14.51, p.01). LInear and logistic regression analyses determined in general that group differences could not be attributed to age differences. The mean was 15.1 years for NA, 15.7 years for A/NC, and 16.1 years for A/C. Groups did not differ significantly academically on, e.g., school enrollment, grades, and outside job variables. Maternal characteristics were unrelated to group differences, but having a father living at home was, i.e., 23.8% of A/C had a father living at home vs. 45.8% of N/As and 38.1% of A/NCs. Because motivation scales were unreliable, future research and development are necessary. Nonetheless scale means varied among the groups, i.e., where N/As had higher motivation than A/NCs, and with A/Cs similar to both groups. The Perceived Probability of Pregnancy scale was very heterogenous. A/Cs felt a greater threat of pregnancy and were more likely to practice contraception than A/NCs. In the intercorrelations analysis, positive attitudes were related to a lower probability of sexual activity (r=.36). Those with a more positive attitude toward contraception were more sexually active. A boyfriend as a source of information was positively correlated with reported sexual activity (r=.38). Contraceptive use was associated with the Perceived Probability scale (r=.40), the Attitudes scale (r=.20), the Total Benefits and Barriers scale (r=.35), age (r=.26), and being sexually active (r=.38). Path analysis was deemed inappropriate. Sexual activity was predicted in multiple correlation analyses using separate Benefits and Barriers scales (R=.68, F (12,129) =9.23, p.001). Contraceptive use was also significantly predicted but with significant beta weights only for the General Preference subscale. The General Preference subscale, age, and boyfriend as information source were positively associated with sexual activity, and family influences decisions were inhibitory. The presence of a natural father had nonsignificant beta weight, and is interpreted as the father's role is indirect in inhibiting sexual activity.

Reexamination of Eisen, Zellman, and McAlister's Health Belief Model questionnaire.

Eisen, Zellman, and McAlister proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. We suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Our results increase the likelihood of standardizing HBM measures.

PIP: Eisen, Zellman, and McAlister proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. Bernstein and Keith suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Bernstein and Keith's results increase the likelihood of standardizing HBM measures.