Personal Assistants and Collaborative Decision Making: Promoting a Better Balance of Autonomy and Well-Being for Adults with Moderate, Mild, and Borderline Mental Retardation

Autonomy is a core value of American tradition and is promoted in health care through the doctrine of informed consent. The notion underlying informed consent is that patients should have the right to decide, and are often in the best position to know, what will enhance their own well-being. Although this ethic has been extended to incompetent patients, by employing surrogate decision making, providing surrogate decision makers for adults with moderate, mild, and borderline mental retardation ("M-BMR"), who could potentially make their own decisions if adequate supports were offered, unreasonably restricts the autonomy of such individuals and often results in disregard for the patients' human dignity.This thesis recommends that health care institutions provide a personal assistant for all health care visits involving adults with M-BMR. In her role as an advocate for the patient, the personal assistant would offer a less restrictive means of promoting the patient's autonomy in medical decision making than has limited guardianship, thus furthering the goals of guardianship reform that limited guardianship has been unable to do. Serving as an educator and translator, the personal assistant would provide a means to equalize the patient's opportunity to understand the diagnosis, treatment options, and risks and benefits of those treatments. Alternatively, in cases where a surrogate decision maker is required, the personal assistant would aid in equalizing the patient's opportunity to understand what is happening during medical procedures by ensuring continued communication with the patient with M-BMR. Finally, having training in ethics, the personal assistant would foster a collaborative approach to medical decision making that recognizes the importance of incorporating both the physician's experience and knowledge and the family member or caregiver's unique understanding of the patient in the medical decision. Together, the personal assistant and the collaborative decision making approach will enhance discussion between the physician, patient, and family member or caregiver, thereby helping balance the autonomy and the well-being of the patient with M-BMR, while also ensuring that the patient's dignity is respected

The Effect of Fasting on Toxicity Profiles of Patients Undergoing Chemotherapy

Cancer is the second leading cause of death overall in the United States yet accounts for most cases of pre-mature mortality in those younger than 85 years of age. Chemotherapy acts as one of the major treatment options. Unfortunately, the toxic properties of chemotherapy are not limited solely to neoplastic tissue and the quest for cancer reduction or elimination often leads to serious side effects. However, preliminary research has demonstrated that cycles of short-term fasting (STF) promote selective toxicity of cancer cells while protecting normal, healthy cells from chemotoxic damage, suggesting the practice may be a promising adjunct to human chemotherapy. Yet, is fasting safe, efficacious and tolerable? In order to explore the potential of fasting as an adjunct to cancer treatment, we must first ask: can periodic fasting alter toxicity profiles in cancer patients undergoing chemotherapy

Differences in Cognitive Flexibility Within the Primate Lineage and Across Human Cultures: When Learned Strategies Block Better Alternatives

By applying learned rules, humans are able to accurately solve many problems with minimal cognitive effort; yet, this sort of habit-based problem solving may readily foster a type of cognitive inflexibility termed ‘cognitive set’. Cognitive set occurs when an alternative – even more efficient – strategy is masked by a known, familiar solution. In this research, I explored how cognitive set differs between primate species and across human cultures, using a nonverbal computerized ‘LS-DS’ task, which measures subjects’ ability to depart from a three-step, learned strategy (LS) in order to adopt a more efficient, one-step, direct strategy (DS or ‘the shortcut’). First, I compared baboons’, chimpanzees’, and humans’ abilities to break cognitive set and found that all baboon and chimpanzee subjects used the DS shortcut when it became available; yet, humans exhibited a remarkable preference for the LS. Next, in an effort to elucidate how cognitive set occludes alternative strategies, I tracked human participants’ eye movements to identify whether better solutions are a) visually overlooked or b) seen but disregarded. Although human subjects saw the shortcut, they did not use it until their conceptualization of the problem constraints were altered. Lastly, to further distinguish between perceptual and conceptual influences on cognitive set, I compared shortcut-use between Westerners and the semi-nomadic Himba of northern Namibia. This study found that susceptibility to cognitive set varied across human cultures and presented further evidence that problem conceptualization, and not perceptual processing, influences individuals’ ability to break set and use the alternative. Overall, this research provides a novel comparison of cognitive flexibility within the primate lineage and across human cultures. The implications for set-promoting influences, including the potentially mechanizing problem-solving methods typical of Western education, are discussed

Dominant Cognitive Strategy in Aphantasia

The purpose of this research was to explore the impact on thinking when an individual is not able to see with a mind\u27s eye. This is known as aphantasia and is the reduction or absence of visual imagery, which can have large impacts on problem solving and remembering one\u27s own past. The current study examines these impacts by exploring the different ways in which thinking may occur, verbal-analytical, visual imagery, spatial imagery, and how a one\u27s dominant thinking strategy affects performance on a paired work task, a mental rotation task, and an object memory task. Comparing those with typical imagery abilities and those with aphantasia revealed large differences in visual and verbal thinking between those with and without typical imagery abilities, but no differences within the spatial imagery thinking strategy appeared between the two groups. In order to determine if thinking strategy predicts performance on an associated task (verbal-analytical and the paired work task, object imagery and the object memory task, and spatial imagery and the mental rotation task) regression models were used. The analyses revealed only a marginal predicting value for the spatial imagery subscale and the mental rotation task, and no predicting value for the object imagery and verbal-analytical subscales. Results corroborate past research indicating that spatial imagery skills remain intact for those with aphantasia and add to the current literature that aphantasiacs prefer to use verbal thinking strategies over visual ones. However, ceiling effects on the object memory task limited interpretation of the statistical results. Furthermore, the questionnaire used to assess types of thinking has questionable validity. Future research will focus clarifying the different types of thinking and exploring the developmental trajectory of those with aphantasia and the impact on education

A New Palaeolithic Giant Handaxe from Britain: Initial Results from Excavations at Maritime Academy, Medway, Kent

This paper will present initial results from excavations at Maritime Academy, Frindsbury which produced several handaxes, two of which can be classed as ‘giant handaxes’. Artefacts were recovered from fluvial deposits in the Medway Valley and are thought to date from the Marine Isotope Stage 9 interglacial. This paper will focus on the largest of these handaxes and will present metrical data for the artefact and initial comparison with similar artefacts from the British Palaeolithic

Microbiota as a mediator of cancer progression and therapy

Complex and intricate circuitries regulate cellular proliferation, survival, and growth, and alterations of this network through genetic and epigenetic events result in aberrant cellular behaviors, often leading to carcinogenesis. Although specific germline mutations have been recognized as cancer inducers, the vast majority of neoplastic changes in humans occur through environmental exposure, lifestyle, and diet. An emerging concept in cancer biology implicates the microbiota as a powerful environmental factor modulating the carcinogenic process. For example, the intestinal microbiota influences cancer development or therapeutic responses through specific activities (immune responses, metabolites, microbial structures, and toxins). The numerous effects of microbiota on carcinogenesis, ranging from promoting, preventing, or even influencing therapeutic outcomes, highlight the complex relationship between the biota and the host. In this review, we discuss the latest findings on this complex microbial interaction with the host and highlight potential mechanisms by which the microbiota mediates such a wide impact on carcinogenesis