Breach of Medical Confidence in Ohio

Fortunately, the patchwork of state and federal statutory, administrative, and case law has greatly limited unrestricted disclosure of medical secrets through the threat of civil and criminal liability. While the law governing the disclosure of medical information sorely lacks a comprehensive approach, one overriding principle emerges from this patchwork: the concern for confidentiality represented in the Hippocratic Oath is alive in Ohio and should guide the release of any medical secrets in the state. There are several statutes that regulate the release of certain types of medical information. For example, information concerning patients suffering from alcohol or drug abuse is covered by Sections 5234 and 5275 of the Public Health Services Act, and the comprehensive regulatory scheme thereunder,6 and information concerning mental illness may be subject to the restrictions of Section 5122.31 of the Ohio Revised Code. The burden of regulating the disclosure of most types of medical information, however, has fallen upon the common law. The common law also acts to close the gaps in statutory schemes seeking to limit the disclosure of a particular type of medical information. This article deals with the development of the common law in this area and the emergence of breach of confidence as a recognized tort in Ohio

The distribution of pre-Norman sculpture in South-West Scotland : provenance, ornament and regional groups.

In 4 volsSIGLEAvailable from British Library Document Supply Centre- DSC:D175400 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The other side of the bridge: A study of social capital in further education provision for young disabled people

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis is a detailed account and analysis of young disabled people‟s inclusions within one Further Education College. These inclusions were tied to a number of complex interactions between the people who exist there and key reforms to Further Education systems which aim to support an individual‟s capacity to offer entrepreneurial performances. Central to these reforms is alternative provision, which offer places in college to school aged students who risk failing to invest in the work-related skills and knowledge that apparently has measurable consequences for future earnings and social justice. This thesis shows how the inclusion of young disabled people in a contemporary college community has some unintended effects and consequences, and how their lives were differentially affected by social capital arising from social networks based on trust. An emancipatory, qualitative methodology was used to gather data. The findings provide important insights into how young disabled people possess, produce and utilise social capital, to build new relationships, to develop identity, to resist or manipulate pre-assigned social roles, networks and resources and to make the transition from school to college. In their own words, young disabled people question the sense of optimism often attributed to alternative provision and the extent to which their existence in college has overcome the social barriers and closed networks that can be associated with disabled people as a marginalised group. To harness such existences and to further develop social capital theory, my conclusions set out a young disabled person‟s negotiation of college as an ethical project in which everyone - college students, teaching staff and researchers - have work to do on themselves. This makes alternative provision not something that is just done to many young disabled people but a project for which everyone is responsible. This thesis, therefore, re-reads the story of alternative provision with a wary eye, using a critical approach to social capital theory. In doing so, the research not only confirms the significance of social capital as a crucial analytical tool for young disabled people, but also confronts the overly positive underpinnings of the social capital debate in education

The measurement of meaning in personality research

The first study reported in this dissertation represented an attempt to test the validity of an assumed isomorphism between meaning as a representational mediating process and meaning as defined by co-ordinate points derived from Semantic Differential ratings and plotted in the Semantic Space- It was hypothesized that if this isomorphism were valid, Semantic Differential ratings of concepts would be subject to the influence of mediated generalization. The results of this study were positive and are interpreted as constituting partial support for the isomorphism. It is important to note that the observed mediated generalization does not constitute proof that meaning is in fact a representational mediating process. In this respect, the safest conclusion that can be drawn is that differences and similarities in meaning as defined by Semantic Differential performance appear to be valid indices of certain internal determinants of behaviour. Furthermore, the inter-relationships of meanings revealed in the Semantic Space appear to reflect the organization of these determinants within the individual.The second and third studies revealed that the factors of neurosis (or neuroticism) and introversion are associated with fairly distinctive patterns of meaning as measured by the Semantic Differential scales. Borrowing from the findings of the first study it was hypothesized that ambivalent reactions to positively-valued concepts would produce shorter concept-origin distances in the Semantic Differential protocols of neuotics than in those of normals. This hypothesis was supported in both the second and third studies. The third study also suggested that introverts tend to produce shorter concept-origin distances than do normals.From all of the studies reported, it is possible to draw a number of general conclusions concerning the use of the Semantic Differential in personality research: 1. The Semantic Differential appears to be a valid index of connotative meaning. 2. The Semantic Differential scales appear to have fairly stable dimensional characteristics over time and subjects. Since there is some possibility that these characteristics are partly a function of the particular concepts rated, it would be necessary to factorize scales where the degree of concept-scale interaction is unknown. 3. The Semantic Differential appears to have considerable promise as a research tool in comparative studies of different clinical groups.In each of the studies reported, there arose problems that have implications for both the theoretical and research aspects of Osgood's approach to meaning. In this, the concluding section of the dissertation, it is possible to review these problems in the light of the findings taken as a whole, and to suggest solutions that might be tested in subsequent investigations.The major and recurring difficulty concerns the social desirability factor in Semantic Differential performance. In the first study, although it was argued that the findings could not be satisfactorily explained in terms of social desirability, the discussion centred on the post-treatment analysis. No reference was made to the possibility that the pre-treatment performance of both the control and experimental groups could have been influenced by a desire to reflect the socially accepted meanings of the concepts that formed the subject of the investigation. From the subsequent studies, however, it became evident that in simple comparative investigations in which no experimental treatment was introduced, social desirability constituted a possible source of variance. It will be recalled that an examination of the cluster characteristics and the concept-origin distances of the various groups indicated that if in fact the factor of social desirability did influence scale ratings, then its influence was largely restricted to the performance of extraverts. This suggests that research should be carried out to test this hypothesis. If the hypothesis is supported, it might be of value to repeat the first investigation but restricting the sample to introverts. Alternatively, both extraverts and introverts could be employed if a suitable design were developed (for example, analysis of covariance).These suggestions ignore, of course, the challenge posed by the hypothesized existence of the social desirability factor for Osgood's approach to meaning. Before passing to a discussion of the second problem arising from these investigations, therefore, some consideration should be given to this issue.Perhaps the simplest way of handling socially desirable responses within the framework of Osgood's theory of learning is to treat them as attempts to reduce anxiety produced by ambivalence of connotative meaning. Let us assume that the individual is asked to say what a concept means to him. If this concept has been previously associated with significates that gave rise to responses of both approach and avoidance, ambivalence of meaning will be present. The co-existence of reciprocally antagonistic meanings would normally mediate, as was suggested in Studies II and III, a response that constituted a compromise between the responses that might be mediated by the respective meanings considered singly. However, if we assume that the individual has either been punished, or has not been reinforced for producing compromises in the past, we would predict that this kind of response would be suppressed, and one of the two responses forming the initial basis of the conflict would be elicited. Reinforcement of the response would strengthen the probability of its occurrence. Now since the constitution of reinforcing agencies (in the shape of people) is subject to variation it would be expected that the major determinant of any of the alternative responses (extreme or compromise) would be the social context in which the concept is presented. This leads to the prediction that the detection of a socially desirable response to a concept would be facilitated by manipulating the situational variables.There is nothing in this analysis to suggest that a socially desirable response is a response that does not reflect a "true" meaning of a concept for the individual. The analysis implies rather that a socially desirable response is one of a number of alternative responses elecited by a concept, and what is involved here is not a sin of commission but one of omission.The second problem arising from the investigation concerns the use of personality tests for the purpose of obtaining clinically differentiated groups. A review of the findings of Studies II and III reveals that comparisons of Semantic Differential performance across groups are of limited value when differentiating criteria (in this case, the Rorschach and the Maudsley Personality Inventory) do not correlate highly. This problem is, of course, as old as the history of personality test development, and there is still no evidence of an imminent solution. Related to this issue is that posed by the Foulds and Caine studies cited earlier, namely, the behavioural variability of individuals assigned to a given personality type on the basis of test performance. It is obvious that if test-designated dysthymics behave either like dysthyraics or hysterics, there is something wrong either with the test or with the behavioural analysis.In the light of this problem, it is suggested that in comparative investigations of Semantic Differential performance, both test and symptom-clusters should be employed as the bases for group differentiation. In this respect, there need not necessarily be any close degree of agreement between behavioural analysis and clinical designation by personality test. Furthermore it is not outwith the bounds of possibility that the development of a suitable form of the Semantic Differential may serve not merely as a dependent variable, but also as an important independent variable in establishing distinctive clinical groups. It may very well be that this technique may serve to discriminate between individuals whose sympton-clusters correspond to their personality types and those in whom such correspondence is absent.If further research continues to support the validity of the Semantic Differential as a quantitative measure of connotative meaning, this instrument should prove to have considerable value in clinical work. The principal advantage lies in the fact that the psychologist may explore the meaning of any area in the life of the patient or client without relying exclusively on his own subjective impressions. It is obvious, of course, that through the operation of a reaction formation or some other defence-mechanism, the patient may give mis¬ leading responses. This suggests that precautions should be taken to include scales whose meanings are not obvious but which correlate highly with those scales that might cue defensive reactions