Convicting with confidence? Why we should not over-rely on eyewitness confidence
MEMORY
Authors: Berkowitz, Shari R.; Garrett, Brandon L.; Fenn, Kimberly M.; Loftus, Elizabeth F.
Abstract
Eyewitness memory researchers have recently devoted considerable attention to eyewitness confidence. While there is strong consensus that courtroom confidence is problematic, we now recognise that an eyewitness's initial confidence in their first identification - in certain contexts - can be of value. A few psychological scientists, however, have confidently, but erroneously claimed that in real-world cases, eyewitness initial confidence is the most important indicator of eyewitness accuracy, trumping all other factors that might exist in a case. This claim accompanies an exaggeration of the role of eyewitnesses' "initial confidence" in the DNA exoneration cases. Still worse, overstated claims about the confidence-accuracy relationship, and eyewitness memory, have reached our top scientific journals, news articles, and criminal cases. To set the record straight, we review what we actually know and do not know about the "initial confidence" of eyewitnesses in the DNA exoneration cases. Further reasons for skepticism about the value of the confidence-accuracy relationship in real-world cases come from new analyses of a separate database, the National Registry of Exonerations. Finally, we review new research that reveals numerous conditions wherein eyewitnesses with high initial confidence end up being wrong.
Nutrition in the critically ill surgical patient
CURRENT OPINION IN CRITICAL CARE
Authors: Puzio, Thaddeus J.; Kozar, Rosemary A.
Abstract
Purpose of review The aim of this study was to discuss recent findings related to providing adequate and well tolerated nutrition to the critically ill surgical patient. Recent findings The majority of nutritional studies in the critically ill have been performed on well nourished patients, but validated scoring systems can now identify high nutrition risk patients. Although it remains well accepted that early enteral nutrition with protein supplementation is key, mechanistic data suggest that hypocaloric feeding in septic patients may be beneficial. For critically ill patients unable to tolerate enteral nutrition, randomized pilot data demonstrate improved functional outcomes with early supplemental parenteral nutrition. Current guidelines also recommend early total parenteral nutrition in high nutrition risk patients with contraindications to enteral nutrition. When critically ill patients require low or moderate-dose vasopressors, enteral feeding appears well tolerated based on a large database study, while randomized prospective data showed worse outcomes in patients receiving high-dose vasopressors. Current evidence suggests early enteral nutrition with protein supplementation in critically ill surgical patients with consideration of early parenteral nutrition in high nutrition risk patients unable to achieve nutrition goals enterally. Despite established guidelines for nutritional therapy, the paucity of data to support these recommendations illustrates the critical need for additional studies.