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PubMed1998

Cortical map reorganization enabled by nucleus basalis activity.

Little is known about the mechanisms that allow the cortex to selectively improve the neural representations of behaviorally important stimuli while ignoring irrelevant stimuli. Diffuse neuromodulatory systems may facilitate cortical plasticity by acting as teachers to mark important stimuli. This study demonstrates that episodic electrical stimulation of the nucleus basalis, paired with an auditory stimulus, results in a massive progressive reorganization of the primary auditory cortex in the adult rat. Receptive field sizes can be narrowed, broadened, or left unaltered depending on specific parameters of the acoustic stimulus paired with nucleus basalis activation. This differential plasticity parallels the receptive field remodeling that results from different types of behavioral training. This result suggests that input characteristics may be able to drive appropriate alterations of receptive fields independently of explicit knowledge of the task. These findings also suggest that the basal forebrain plays an active instructional role in representational plasticity.

Acetylcholine↗
PubMed1993

Comparing two modes of teaching a question-answering strategy for enhancing reading comprehension: didactic and self-instructional training.

This study investigated the comparative efficacy of two instructional approaches--didactic teaching and self-instructional training--in teaching average and poor readers a comprehension question-answering strategy. Forty-five average students and 45 poor readers from Grades 5 and 6 participated. These 38 girls and 52 boys were equally and randomly assigned to one of three treatment conditions: didactic teaching of the strategy, self-instruction, or control (no training). Students in the first two treatment conditions learned a mnemonic strategy ("Here," "Hidden," and "in my Head") to indicate question-answer relationships that are text explicit, text implicit, or script implicit, respectively. Essentially, the 3H mnemonic cued students to use appropriate text and/or knowledge-base information in answering comprehension test questions. In addition, students in the self-instruction group learned three self-questions to guide their use of the 3H strategy. Specifically, the self-questions focused students' attention on the task, provided a basis for decision making concerning the categorization of comprehension test questions, and reminded students to check their answers. The results indicated that both didactic teaching and self-instructional training of the strategy effected significant improvements in students' reading comprehension performance. However, self-instructional training was more effective in enhancing and maintaining students' reading comprehension performance than didactic teaching. Moreover, results from the oral questionnaire indicated that the 3H strategy training increased students' general meta-cognitive knowledge. Lastly, of the 60 trained students, 52 wrote that they would encourage other children to learn the 3H strategy. Thus, the response to strategy learning was clearly positive.

Attention↗
PubMed2001

Rational use of computerized protocols in the intensive care unit.

Excess information in complex ICU environments exceeds human decision making limits, increasing the likelihood of clinical errors. Explicit decision-support tools have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice that persists even when guidelines based on reputable evidence are available. Computerized protocols used for complex clinical problems generate, at the point-of-care, patient-specific evidence-based therapy instructions that can be carried out by different clinicians with almost no inter-clinician variability. Individualization of patient therapy is preserved by these explicit protocols since they are driven by patient data. Computerized protocols that aid ICU decision-makers should be more widely distributed.

Clinical Protocols↗
PubMed2004

How dependent are grip force and arm actions during holding an object?

In everyday life, when manipulating objects, arm actions and precision grip force are tightly coupled by the central nervous system. To investigate the extent of this neural coupling, 11 subjects were asked to perform tasks that encourage either the coupling (Task 1) or the dissociation (Task 2 and 3) of grip force and arm actions. During Task 1, subjects held a grasping device, with an extra load suspended underneath by a string. Then, using the other hand, subjects were asked to lift or release the suspended load, while maintaining unaffected the posture of the grasping arm. During Task 2, while holding the device, subjects received similar instructions, but this time the extra load was suspended underneath the forearm. During Task 3, subjects were explicitly asked to modulate their grip force without moving the arm. In Task 1, grip force changed in parallel with, or slightly ahead of, changes in load, which is consistent with the view of a feedforward mechanism making grip force largely subordinate to ongoing arm actions. In Task 2, even though subjects had no obvious reasons to modulate their force (i.e. the load of the device was constant) they did so, with a number of features that resemble performance in Task 1. In Task 3, as expected, voluntary modulations in grip force had no effect on arm actions. It is concluded that the neural coupling between arm actions and grip force (1) can possibly lead to clumsy reactions, (2) depends on the focal action, and (3) is only unidirectional.

Adult↗
PubMed1998

Icons improve older and younger adults' comprehension of medication information.

We examined whether timeline icons improved older and younger adults' comprehension of medication information. In Experiment 1, comprehension of instructions with the icon (icon/text format) and without the icon (text-only format) was assessed by questions about information that was (a) implicit in the text but depicted explicitly by the icon (total dose in a 24 hour period), (b) stated and depicted in the icon/text condition (medication dose and times), and (c) stated but not depicted by the icon (e.g., side effects). In a separate task, participants also recalled medication instructions (with or without the icon) after a study period. We found that questions about dose and time information were answered more quickly and accurately when the icon was present in the instructions. Notably, icon benefits were greater for information that was implicit rather than stated in the text. This finding suggests that icons can improve older and younger adults' comprehension by reducing the need to draw some inferences. The icon also reduced effective study time (study time per item recalled). In Experiment 2, icon benefits did not occur for a less integrated version of the timeline icon that, like the text, required participants to integrate dose and time information in order to identify the total daily dose. The integrated version of the icon again improved comprehension, as in Experiment 1, as well as drawing inferences from memory. These findings show that integrated timeline icons improved comprehension primarily by aiding the integration of dose and time information. These findings are discussed in terms of a situation model approach to comprehension.

Adult↗
PubMed2003

Source versus content memory in patients with a unilateral frontal cortex or a temporal lobe excision.

It has been suggested previously that patients with a frontal lobe lesion might have a specific impairment in the retrieval of the source of information despite adequate memory for facts. Patients with an anterior temporal excision are known to have impairments in memory for facts and the question arises as to whether they are also impaired in source memory. The present study compared memory for facts and their source in patients with a unilateral frontal cortical or an anterior temporal excision in a situation in which both types of information were encoded explicitly. Patients with a unilateral frontal cortex or a temporal lobe excision watched videos of a game show and were instructed to attend to both the trivia facts and their source (the identity of the speaker or the relative time of presentation). Patients with a frontal cortex excision were not impaired on either fact or source memory. This was true even when a subgroup of patients with an excision involving the dorsolateral frontal cortex was examined. In contrast, patients with a left temporal lobe excision were impaired in both fact and identity source memory and right temporal lobe patients were impaired in identity source memory. All patients performed similarly to normal controls in temporal source memory. The present results are consistent with the view that source information is part of an associative network of information about an episode and that the medial temporal region is critical for both source and content memory. Furthermore, if source information is encoded explicitly, the frontal cortex does not appear to be necessary for its retrieval. Instead, it is proposed that the frontal cortex plays a metacognitive role in memory retrieval.

Adolescent↗
PubMed1999

Training phonological awareness with and without explicit attention to articulation.

One hundred twenty-two second- to fifth-grade (7- to 11-year-old) children with reading difficulties studied phonological awareness with or without explicit attention to articulation and with or without manipulation of sounds. They all studied identical phonics and read stories on the computer with speech and decoding support for difficult words. Regular-instruction controls received regularly scheduled language-arts or reading activities. After 40 h of training, children in all three trained conditions outperformed controls on all tests except math. Conditions that manipulated sounds showed advantages over the condition without explicit practice manipulating sounds, but only on the two measures of phonological awareness. Articulatory awareness training yielded no unique benefits during this training period. Individual differences in response to treatment related to initial levels of phonological awareness, naming speed, IQ, and grade. The similar outcomes of the three conditions suggest that specific variations in good phonological training may be less important than once thought for most children with reading difficulties.

Attention↗
PubMed1993

Evoking the permission schema: the impact of explicit negation and a violation-checking context.

Cheng and Holyoak (1985) proposed that realistic reasoning in deontic contexts is based on pragmatic schemas such as those for assessing compliance with or violation of permission and obligation rules, and that the evocation of these schemas can facilitate performance in Wason's (1966) selection task. The inferential rules in such schemas are intermediate in generality between the content-independent rules proposed by logicians and specific cases stored in memory. In one test of their theory, Cheng and Holyoak demonstrated that facilitation could be obtained even for an abstract permission rule that is devoid of concrete thematic content. Jackson and Griggs (1990) argued on the basis of several experiments that such facilitation is not due to evocation of a permission schema, but, rather, results from a combination of presentation factors: the presence of explicit negatives in the statement of cases and the presence of a violation-checking context. Their conclusion calls into question both the generality of content effects in reasoning and the explanation of these effects. We note that Jackson and Griggs did not test whether the same combination of presentation factors would produce facilitation for an arbitrary rule that does not involve deontic concepts, as their proposal would predict. The present study tested this prediction. Moreover, we extended Jackson and Griggs' comparisons between performance with an abstract permission rule versus an arbitrary rule, introducing clarifications in the statement of each. No facilitation was observed for an arbitrary rule even when explicit negatives and a violation-checking context were used, whereas strong facilitation was found for the abstract permission rule under the same conditions. Performance on the arbitrary rule was not improved even when the instructions indicated that the rule was conditional rather than biconditional. In contrast, a small but reliable degree of facilitation was obtained for the abstract permission rule, with violation-checking content even in the absence of explicit negatives. The theory of pragmatic reasoning schemas can account for both the present findings and those reported by Jackson and Griggs.

Adolescent↗
PubMed1991

Does organization improve priming?

In five experiments, the effects of organization on implicit memory or priming tests were compared with its effects on the explicit memory tests of free and cued recall. Organization was manipulated by varying list structure (blocked vs. random presentation of categorized items) and by instructions. The results showed that organization had parallel effects on the category-production priming test and free- and cued-recall tests; performance was enhanced by organization on both types of tests. It was also demonstrated that the effect of organization on priming was limited to the category-production test and was not obtained with the word-identification priming test. These results suggest that performance on implicit and explicit memory tests is similarly affected by experimental manipulations when both types of tests rely on conceptually driven processing. In addition, performance on two implicit tests is dissociated when one test relies on conceptually driven processing and the other on data-driven processing.

Adult↗
PubMed1977

A model for macromolecular selection in complementary instructing systems.

In this paper we consider a model for the selection and evolution of biological macromolecules when their reproduction is based on complementary instruction. The model is an extension of one of Eigen's models for selection and takes in account explicitly the formation of both single stranded and double stranded molecular complexes. We construct exact solutions to the rate equations for the case of constant rate parameters and error distributions. Criteria for selection are discussed.

Biological Evolution↗
PubMed1987

Use of manipulative therapy for mechanical pain of spinal origin.

Manipulation of the spinal joints for the relief of pain is an ancient remedy that is in widespread use today. Clinical trials investigating the effectiveness of manipulative therapy are briefly reviewed, and some experimental evidence suggesting possible causes of spine pain is presented. The rationale for the use of spinal manipulative therapy within the context of R. A. McKenzie's diagnostic and therapeutic system is detailed and explicitly stated. Spinal mobilization and manipulation are presented as a logical treatment progression from the use of postural instruction and exercise therapy. Extensive description of technique is not given, but the clinical signs that indicate the need to use or avoid mobilization and manipulation in a particular direction are detailed.

Back Pain↗
PubMed1979

Teaching toothbrushing behavior in severely retarded adults: systematic reduction of feedback and duration training.

Eight severely retarded adults were trained to brush their teeth. Component behaviours were trained in a predetermined sequence of 15 steps. Training included scheduled opportunities for independence performance, instruction, modelling and partial and total physical guidance. Four types of feedback were used, i.e., verbal praise plus explicit head nodding, explicit nodding, inconspicous nodding and no feedback. Stepwise reduction of feedback was made contingent on a subject's repeated performance of each individual step. Five of the eight subjects learned to perform all 15 steps for three consecutive sessions. A different procedure for fading out feedback was used for the other three subjects, two of which learned to perform 14 steps reliably. Acquisition training was followed by procedures to establish persistance of criterion performances for an interval of eight days. Training procedures were based on interval shaping. All seven subjects learned to demonstrate the 14 or 15 component behaviours after an interval of eight to 17 days in which no systematic training occured.

Adult↗
PubMed1995

Effect of implicit and explicit "rule" presentation on bound-morpheme generalization in specific language impairment.

This study addressed whether generalization of a trained bound morpheme to untrained vocabulary stems differs between children with specific language impairment (SLI) and children with normal language (NL) under two controlled instructional conditions. Twenty-five children with NL and 25 children with SLI matched for age served as subjects. Contrasts between affixed and unaffixed words highlighted the affixation "rule" in the "implicit-rule" condition. The "rule" was verbalized by the trainer in the "explicit-rule" condition. Bimodal generalization results occurred in both subject groups, indicating that generalization was not incremental. Chi-square analyses suggested that the SLI group generalized the bound morpheme less often than the NL group under the explicit-rule training condition. The findings add to those that indicate children with SLI have a unique language-learning style, and suggest that the explicit presentation of metalinguistic information during training may be detrimental to bound-morpheme generalization by preschool-age children with SLI.

Child↗
PubMed2003

Task instructions modulate neural responses to fearful facial expressions.

BACKGROUND: The amygdala, hippocampus, ventral, and dorsal prefrontal cortices have been demonstrated to be involved in the response to fearful facial expressions. Little is known, however, about the effect of task instructions upon the intensity of responses within these regions to fear-inducing stimuli. METHODS: Using functional magnetic resonance imaging, we examined neural responses to alternating, 30-sec blocks of fearful and neutral expressions in nine right-handed male volunteers during three different 5-min conditions: 1) passive viewing; 2) performance of a gender-decision task, with no explicit judgment of facial emotion; 3) performance of an emotionality judgment task - an explicitly emotional task. RESULTS: There was a significant effect of task upon activation within the left hippocampus and the left inferior occipital gyrus, and upon the magnitude of response within the left hippocampus, with maximal activation in these regions occurring during passive viewing, and minimal during performance of the explicit task. Performance of the gender-decision and explicit tasks, but not passive viewing, was also associated with activation within ventral frontal cortex. CONCLUSIONS: Neural responses to fearful facial expressions are modulated by task instructions.

Amygdala↗
PubMed1985

Improving the efficiency of patients' comprehension monitoring: a way of increasing patients' participation in general practice consultations.

The aim of the investigations reported was to examine the effects of helping patients to check their understanding of instructions and advice given during their consultations with general practitioners. Three groups of patients were both tape recorded during their consultation and interviewed immediately afterwards. The groups differed in the written information they were given prior to their consultations. The 'Normal' group were informed only that the researcher was interested in how well doctors and patients understand each other. The 'Permission' group was explicitly invited to raise queries with the doctor during their consultation. The 'Guidance' group was asked to use two specified strategies to check their understanding of instructions and advice given by the doctor. We coded the frequency of questions and comments about treatment which patients produced during their consultations, and the accuracy and completeness of their subsequent accounts of the recommended treatment. The Normal and Permission groups did not differ in either respect. The Guidance group produced significantly more questions and comments than the Normal group and gave more complete and accurate accounts of the recommended treatment. A partial replication in a different practice produced consistent results.

Family Practice↗
PubMed2004

A dissociation between implicit and explicit verbal memory in left temporal lobe epilepsy.

PURPOSE: Temporal lobe epilepsy patients are well known to present deficits on explicit verbal memory procedures (e.g., recall, recognition). The integrity of implicit memory procedures in these patients is not established. Previous studies in this area used implicit memory measures contaminated by the effects of explicit memory. METHODS: We examined the integrity of verbal implicit and explicit memory in left temporal lobe epilepsy (LTLE) patients and hypothesized that a clear dissociation in performance would be found with a relative preservation of implicit memory. TLE patients (n = 15) and age- and education-matched healthy normal patients (n = 15) were shown a 40-word study list, followed by a test phase requiring completion of word stems based on the study words or new/unseen words. Experimental conditions involved instructions to provide either the old (study) words or novel/nonlist words when completing the stem. Measures of automaticity and recollection provided uncontaminated indices of implicit and explicit memory, respectively. RESULTS: The data showed a significant difference (p < 0.001) between the patients (Recollection, 0.12; SD, 0.18) and controls (0.50, SD, 0.15) on the measure of explicit memory. In contrast, the patients (Automaticity, 0.51; SD, 0.11) and controls (0.45, SD, 0.18) performed similarly on the implicit memory measure, with patient scores clearly at normative levels based on other Process Dissociation Procedure data. CONCLUSIONS: The data demonstrate the integrity of implicit memory in LTLE patients. Finding a dissociation between the two forms of verbal memory in LTLE patients provides evidence that they rely on different neuroanatomic systems.

Adolescent↗
PubMed2002

The parental daily diary. A sensitive measure of the process of change in a child maltreatment prevention program.

There is a substantial deficit of sensitive measures of parental discipline in the area of prevention, generally, and in child maltreatment prevention specifically, despite reports that over a million children experience maltreatment in the United States every year. Part of the challenge in locating such measures is the impossibility of obtaining accurate observational measures of the degree of harsh discipline, unless extremely large populations are used. The majority of studies on harsh discipline have dealt with this problem by using self-report instruments or proxy observation tasks (such as observing mother-child interactions in a compliance framework). The most well-known self-report instruments, such as the Child Abuse Potential Inventory (Milner, 1986), are constructed to measure parental pathology in maltreating parents rather than to identify parents who might benefit from preventive endeavors. In contrast, there are no well standardized measures of mother-child interaction that document a sensitivity to the presence of harsh discipline, possibly due to the clear pressure of social desirability problems. This paper outlines a daily self-observation measure of parental disciplinary behavior in the form of a diary. This self-monitoring instrument offered data on the overall feelings and disciplinary behaviors used daily following each session on parenting group interventions. The study showed a gradual decrease in physical punishment and a gradual increase in planned ignoring across treatment, as these were introduced as part of an ongoing curriculum. The use of an explicit technique, such as time-out, increased abruptly rather than gradually and effects were seen only after specific instruction. Advantages and future applications of this kind of ongoing self-observation measure of treatment progress are described.

Anger↗
PubMed2006

[Critical appraisal of stroke guidelines].

BACKGROUND: Despite the increasing burden of disease and known deficiencies of actual stroke care there is a lack of evidence-based stroke guidelines in Germany. For future guideline development and implementation in Germany, critically appraising internationally available guidelines might be useful. OBJECTIVES: To identify and evaluate published evidence-based German and English language stroke/cerebrovascular disorder guidelines using the established "German Guideline Appraisal Instrument". METHODS: Systematic literature search (published in 1992-2002) using Medline and English-/German language guideline databases. A total of 626 hits resulted in 54 guideline articles. 13 articles (from Australia, Germany, the United Kingdom, Singapore and the USA) fulfilled specific inclusion criteria (recommended for countrywide implementation, complete guidelines for prevention and/or diagnostic/treatment and/or rehabilitation). The systematic guideline appraisal consisted of a) the assessment of the methodological quality using the established "German Guideline Appraisal Instrument" attributing scores and ranking the guidelines according to their overall quality; b) the systematic documentation of appraisal using structured abstracts. RESULTS: The methodological quality of "content and form" (10-17 of a total of 17 points) of the 13 guidelines was comparable. Regarding the domains of the "quality of the development process" (the guidelines achieved 4-15 of 17 points) and "guideline applicability" (0-3 of 6 points), though, the appraised guidelines varied impressively. The 6 best guidelines (> or = 25 of a total of 40 points) were characterized by explicitly linking recommendations and supporting evidence, by expert reviews of the guidelines prior to publication, and the provision of instructions for guideline implementation. CONCLUSION: None of the 13 appraised guidelines covered all key methodological quality criteria. The analysis shows, however, that it should be possible to compile a methodologically sound stroke guideline by using those parts of the different appraised guidelines that fitted the quality criteria best.

Evidence-Based Medicine↗