Forum Reports Research Articles

When Should Judges Admit or Compel Genetic Tests?

During the past two decades, the use of DNA tests has revolutionized court proceedings in criminal and paternity cases. On the horizon is a new challenge for judges--whether to admit or compel genetic tests to confirm or predict genetic diseases and conditions in many more judicial contexts, e.g., decisions regarding culpability, sentencing, liability, causation, and damages. This Policy Forum reports on an empirical study of how judges would analyze these issues. The authors discuss the challenges these types of cases will bring to the court-room and suggest a series of questions that judges should consider in evaluating the need for genetic information in legal cases.

Development, Environmental Health, and English Cooking

Development, Environmental Health, and English Cooking

Treating adolescent conversion disorders: Are hypnotic techniques reusable?

When treating disabling conversion disorders in hospitalized adolescents, clinicians must act to restore function as rapidly as possible. After attempting to rule out physical causes for the symptoms and trying to find persuasive psychological reasons that the patient will accept and use to resolve the condition, the inpatient staff of a multidisciplinary therapeutic milieu must seek additional approaches to the care of these seriously ill individuals. This clinical forum reports the author's experience treating 2 young patients, a 12-year-old girl and a 15-year-old boy, with hypnosis. Therapists of every experience level find hypnotic techniques that work for them in a variety of patients, but are hypnotic techniques really reusable? The author reports what he learned once again.

Stakeholders, Social Responsibility, and Performance: Empirical Evidence and Theoretical Perspectives

The management of competing stakeholder interests has emerged as a significant topic in the management literature. Related issues are the relationship between stakeholder management and the perception that a firm is socially responsible, and the performance implications of both stakeholder management and social responsibility. Theory and models surrounding these issues are abundant, but empirical research is in an early stage. This research forum reports six excellent efforts to tackle fundamental ideas about stakeholders, social responsibility, and performance.

STAKEHOLDERS, SOCIAL RESPONSIBILITY, AND PERFORMANCE: EMPIRICAL EVIDENCE AND THEORETICAL PERSPECTIVES.

The management of competing stakeholder interests has emerged as a significant topic in the management literature. Related issues are the relationship between stakeholder management and the perception that a firm is socially responsible, and the performance implications of both stakeholder management and social responsibility. Theory and models surrounding these issues are abundant, but empirical research is in an early stage. This research forum reports six excellent efforts to tackle fundamental ideas about stakeholders, social responsibility, and performance.

Sepsis/septic shock: participation of the microcirculation: an abbreviated review.

An overview of the importance of understanding mechanisms occurring in the microcirculation during septic and endotoxic shock. The thesis of the paper is to place emphasis on this important vascular network to ultimately benefit the patient. Early descriptions of vascular reactions to endotoxin which suggest that the microcirculation is a major site of attack during shock. More recent studies were sought out and examined as to their possible impacts on the microcirculation. Early comprehensive studies concerning vascular reactions in the microcirculation during shock were selected. Subsequent studies identified from the mainstream scientific medical literature describe the actions of blood, cells, and the emerging significant role of the vascular endothelium among other factors. A consensus view is identified, pointing to the causes of a malfunctioning microcirculation during shock. Data gathered from reports in the mainstream, well-established basic and clinical literature, from reviews and forum reports, from studies by well-established investigators, and from more recent reports of excellent quality. The microcirculation undergoes massive alterations during sepsis/septic shock. There are numerous changes, including slowing of capillary blood flow due to depressed perfusion pressure as a result of systemic pressure reduction and local arteriolar constriction. Observations suggest that the microcirculation is shut off early in severe sepsis, allowing the effects of hypoperfusion and attacks by microorganisms to prevail in their destructive capabilities. Widespread capillary dilation may ultimately occur. However, with blood flow diverted through some arteriovenous channels, important areas of capillary exchange are bypassed. Decreased capillary blood flow during shock results from failure to allow normal passage of cellular elements, including erythrocytes and neutrophils. This defect occurs, in part, because of decreased perfusion pressure, decreased deformability of red and white cells, constricted arterioles, circulating obstructive fragments (including hemoglobin), and plugging of microvessels with "sludge." Other factors are adherence of cells to capillary and venular epithelial membranes creating increased resistance to flow, loss of fluid through abnormal transcapillary exchange, differential vascular resistance changes between various beds (e.g., intestinal vs. muscle), and the relative absence of regulatory neurohumoral control of small vessel segments of the circulation. During sepsis/septic shock, endothelial cells are reported to modulate vascular tone, control local blood flow, influence the rate of leakage of fluids and plasma proteins into tissues, modulate the accumulation and extravasation of white cells into tissues, and influence white cell activation. As a result of the predominance of many destructive factors, a subsequent round of tissue damage may occur. Because of prolonged capillary vascular stasis, deficient flow, and factors released from injured cells, the microcirculation becomes a trap for uncontrolled bacterial growth enhanced by sustained hypoxemia, acidosis and toxemia. These events may combine to contribute to the loss of normal cell integrity and death of the host. The purpose of this review is to draw the readers' attention to the growing list of adverse factors occurring in the microcirculation during sepsis/septic shock. A further aim is to point to the realization of the complexity of factors which may contribute to the importance of a well-functioning microcirculation.

Do Investors Price Social Responsibility?

In the past few decades society has placed increasing demands on managers of firms to change corporate policy and to make decisions in ways that are deemed socially responsible by society. The scope of activities under the corporate social responsibility umbrella has in cluded environmental issues, the involvement of women and minorities in management, investing in South Africa, pollution control, ethical treatment of animals, nuclear testing and other related issues. Society's demands in these areas have inspired (and in some cases even coerced) both managers of corporations and portfolio managers of investment funds to respond. Many of the leading mutual fund investment companies now offer funds that are ethically screened. The Society Investment Forum reports that the value of socially responsible investment funds exceeded $600 billion by the end of 1991. A new stock index, the Domini 400 Social Index, has been constructed to measure the performance of the stocks of 400 corporations that have passed multiple social screens. Coupled with the demand for increasing corporate social re sponsibility, there has been a move away from the traditional view that managers make decisions that are in their common shareholders' best interests to a stakeholder concept where managers make decisions for and serve a much broader group of claim-holders than just share holders. Joichi Aoi, Chairman of the Board at Toshiba Corporation, has argued that today's managers need to broaden their perspective beyond the traditional shareholder thinking:

The Consulting Teacher in the Context of Educational Reform

Consulting Teacher in the Context of Educational Reform In her article The Consulting Teacher Model: Risks and Opportunities, (February, 1988), Dixie Snow Huefner makes some important and timely distinctions between the roles of resource teachers and consulting teachers and identifies critical issues related to teacher preparation and program evaluation this model. However, with respect to the literature of general reform and that of reform in teacher in particular, I believe her anlysis is flawed and is illustrative of misinterpretation within the special community regarding the meaning of reform and the potential role of special consultation. My purpose in writing this commentary is to examine (a) contradictions between the concept of the consulting teacher as master teacher presented by Huefner and the concept of master teacher as represented in the reform literature, and (b) contradictions regarding the role of the consulting teacher itself. two points are necessarily related. Proposals career ladders are a hallmark of both the Holmes Group (1986) and the Carnegie Forum (1986) reports on the teaching profession. According to these reports, career ladders, through advancement within the school, encourage capable teachers to remain in classrooms and discourage them from moving out to administration. Holmes Group (1986) described career professionals as teachers who combine outstanding teaching of children with outstanding work with adults in education (p. 96). Career professionals be capable of assuming responsibility not only within the classroom but also at the school level (p. 65). Using the term lead teachers, the Carnegie Forum (1986) stated that those who are most experienced and highly skilled play the lead role in guiding the activity of others (p. 58). Lead teachers also take collective responsibility helping colleagues who were not performing up to par by arranging coaching, technical assistance, course-work, and other remediation that might be called for (p. 59). Clearly, the experiential basis these master teachers is successful teaching in the general environment, combined with additional, specialized, graduate-level training. Although the concept of the consulting teacher appears to be consistent with the general idea of differentiated staffing, the preparation and certification structure proposed by Huefner represents a departure from the assumption in these reports that master teachers would come from the ranks of experienced classroom teachers. Dual certification is correctly proposed as the basis the consulting teacher, but 2 to 3 years of experience in a general or special classroom is suggested. assumption here is that, should a consulting teacher choose (or a state mandate) special experience, preservice preparation alone in general is sufficient as a basis consideration as a master teacher--one who be expected to improve the educational effectiveness of their colleagues as well as their students (Huefner, 1988, p. 413). Further, such master teachers would be asked to perform both regular and special functions (p. 413). With their emphasis on the professionalization of the classroom teacher, it is difficult to imagine that the architects of reform had in mind a narrow band of special experience as the foundation the highest rung on proposed career ladders. Yet Huefner's interpretation, I believe, is not atypical of special education's stance relative to reform in general and is based on teh acceptance of traditional special techniques as the primary source of appropriate remediation the majority of classroom and classroom teacher problems that consulting teachers would face. She enumerates the following techniques: task analysis, behavioral management, diagnostic assessment, curriculum adaptation, and continuous measurement of progress. …