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PubMed2004

Item- and task-level processes in the left inferior prefrontal cortex: positive and negative correlates of encoding.

Activity in the left inferior prefrontal cortex (LIPC) is often thought to reflect processes that support episodic encoding. Functional magnetic resonance imaging (fMRI) was used to test whether processes subserved by LIPC could be negatively related to subsequent memory performance. Specifically, the current experiment explicitly tested the hypothesis that LIPC processing would positively impact encoding when primarily focused towards specific target items (item-level processing), whereas it would negatively impact encoding when primarily focused on the retrieval and instantiation of current task instructions (task-level processing). Two methods were used to identify regions that were sensitive to the two types of processes: a block-level manipulation of encoding task that influenced subsequent memory, and a back-sort procedure. LIPC was sensitive to item- and task-level processing, but not in a way that always facilitates encoding. LIPC was more active for subsequently remembered words than subsequently forgotten words, but it was also more active in a task that emphasized task-level processing relative to a task that emphasized item-level processing, although this former condition led to poorer subsequent memory performance. This pattern indicates that processes subserved by LIPC are not always positively correlated with episodic encoding. Rather, LIPC processes can support both the controlled semantic processing of items and the controlled retrieval of relevant semantic task context. When devoted to the latter, the diversion of LIPC processes to the task level can have a negative consequence for item-level analysis and encoding.

Adult↗
PubMed2005

Advance directives and cancer decision making near the end of life.

Seriously ill individuals, including those seriously ill with cancer, are frequently encouraged to complete instructional advance directives (i.e., living wills) to ensure that their wishes about the use of life-sustaining treatment are honored if they should lose the ability to make decisions for themselves. The authors present a social psychological analysis making explicit a series of steps that must necessarily take place if living wills are to honor the wishes of incapacitated patients. They then focus on 3 key steps in the analysis and review relevant research from the medical and psychological literatures. In each case, this research raises serious questions about the psychological assumptions underlying the effective use of living wills in end-of-life decision making. Discussion focuses on the need for policy and law guiding the use of advance directives to be informed by both basic and applied research on judgment and decision making.

Advance Directives↗
PubMed1996

Exact and conceptual repetition dissociate conceptual memory tests: problems for transfer appropriate processing theory.

Three experiments examined whether a conceptual implicit memory test (specifically, category instance generation) would exhibit repetition effects similar to those found in free recall. The transfer appropriate processing account of dissociations among memory tests led us to predict that the tests would show parallel effects; this prediction was based upon the theory's assumption that conceptual tests will behave similarly as a function of various independent variables. In Experiment 1, conceptual repetition (i.e., following a target word [e.g., puzzles] with an associate [e.g., jigsaw]) did not enhance priming on the instance generation test relative to the condition of simply presenting the target word once, although this manipulation did affect free recall. In Experiment 2, conceptual repetition was achieved by following a picture with its corresponding word (or vice versa). In this case, there was an effect of conceptual repetition on free recall but no reliable effect on category instance generation or category cued recall. In addition, we obtained a picture superiority effect in free recall but not in category instance generation. In the third experiment, when the same study sequence was used as in Experiment 1, but with instructions that encouraged relational processing, priming on the category instance generation task was enhanced by conceptual repetition. Results demonstrate that conceptual memory tests can be dissociated and present problems for Roediger's (1990) transfer appropriate processing account of dissociations between explicit and implicit tests.

Adult↗
PubMed2004

Three-word recall in normal aging.

Three-word recall tasks are widely used as brief measures of verbal memory function, although interpretation of performance is complicated by variations in test instructions and procedures. The purpose of this study was to examine 3-word recall performance in samples of healthy subjects aged 5275 (M age = 70) and age 7692 (M age = 82) compared to patients with Alzheimer's Disease (AD) when explicit prompts to remember the words were given. Those in the younger aging group remembered significantly more words than those in the older sample after a brief delay (M= 2.8 and 2.3, respectively). However, the majority of control subjects recalled 2 or 3 words after the delay, with only 3% of the 5075 year old group and 17% of the 76+ year old group recalling 0 or 1 word on delayed recall. This is in stark contrast to the 87% of individuals with AD who recalled 0 or 1 word. Even though 3-word recall performance decreases with age, good recall (2 or 3 words) can be expected in most cases of normal aging.

Aged↗
PubMed1993

Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.

OBJECTIVE: In the United States, 20% or more of nursing home residents receive antipsychotic drugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychotic use through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychotic withdrawal. DESIGN: In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychotic use; two other comparable homes were selected as concurrent controls. PATIENTS: Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychotic use per 100 days of nursing home residence. MAIN OUTCOME MEASURES: The primary end points were postintervention changes in administration of antipsychotics and other psychotropic drugs, use of physical restraints, and frequency of behavior problems. RESULTS: Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P < .001). No significant changes were noted in the use of other psychotropic drugs in either group. Days of physical restraint use decreased 36% in the education homes vs 5% in the control homes (P < .001). Behavior problem frequency did not increase in either group, even among the 48% of baseline antipsychotic users in the education homes who had antipsychotic drug regimens discontinued for 3 or more months. CONCLUSIONS: The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems. This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.

Aged↗
PubMed2007

Increasing print awareness in preschoolers with language impairment using non-evocative print referencing.

PURPOSE: This study examined the extent to which using non-evocative, explicit referencing of print concepts during shared storybook reading in the context of language therapy facilitated print concept knowledge in children with language impairment. METHOD: Five children, ages 4 to 5 years, were provided scripted input on 20 print concepts during shared storybook reading that was incorporated into individualized 30-min language intervention sessions that were conducted in the children's classroom twice weekly. The children were not required to make any response to the input on print concepts, and the input was secondary to instruction in the language targets during the 10-min shared storybook reading activity. RESULTS: Using a single-subject, multiple probe design across subjects, results indicated that children's knowledge of print concepts improved markedly when the procedure was incorporated into shared storybook reading and that they continued to learn and maintain knowledge of print concepts with repeated input. CLINICAL IMPLICATIONS: These findings suggest that children with language impairment may benefit from simple non-evocative, explicit referencing strategies that can be easily incorporated into the context of storybook reading during language therapy, thus providing speech-language pathologists with an additional tool for facilitating children's literacy skills.

Awareness↗
PubMed1997

Dramatic play: a format for 'literate' language?

BACKGROUND: Research literature discussing the possibility of a relationship between dramatic play and literacy development in school beginners has evoked interest in the context of the formalisation of early years curriculum, particularly relationships between oral syntactic competence in preschool children and later reading ability. AIMS: The aim of the present study was to investigate possible differences in syntax between sociodramatic play and other play activities in small play groups. It was predicted that the language in sociodramatic play would be more 'literate', i.e., more decontextualised, explicit and linguistically elaborated. The hypothesis tested was that sociodramatic play elicits more advanced syntactic language in children. SAMPLES: Six children (six-year-olds) in groups of three girls and three boys were observed in 11 free play episodes (five sociodramatic play episodes and six other group play episodes). Approximately 100 utterances from each child in each play category were analysed. The children had normal intelligence and language ability, and had a middle class background. METHODS: The play groups were observed during indoor free play in a playroom equipped for family play and with different toys. No instructions were given. The observations were video- and audiotaped and the children's utterances transcribed and analysed syntactically, i.e., utterance types (complexity and completeness), sentence adverbials and expansions. Chi-square was used to test for statistically significant differences in children's use of syntax. RESULTS: The children's language turned out to be significantly more advanced and 'literate' with more syntactically complete and complicated utterances, use of explicit references and elaborated nominal groups in sociodramatic play than in any other play activity. CONCLUSIONS: The demands of conveying meaning to peers in dramatic play contexts seem to provide children with opportunities to practise 'literate' language, language that is similar to what is demanded when writing for an absent audience.

Chi-Square Distribution↗
PubMedDate not supplied

Integrating values education into an allied health curriculum; Part II.

Values education involves the explicit attempt to teach individuals about values and the process of valuing. An overview of popular approaches to values education includes inculcation, value clarification, moral development, and value analysis. Each approach is presented by detailing the purpose, teaching methods, and an instructional model. Methods of incorporating these approaches into an allied health curriculum are offered along with sample student learning activities.

Curriculum↗
PubMed1999

Simple CPR: A randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation.

STUDY OBJECTIVE: Despite the proven efficacy of cardiopulmonary resuscitation (CPR), only a small fraction of the population knows how to perform it. As a result, rates of bystander CPR and rates of survival from cardiac arrest are low. Bystander CPR is particularly uncommon in the African American community. Successful development of a simplified approach to CPR training could boost rates of bystander CPR and save lives. We conducted the following randomized, controlled study to determine whether video self-instruction (VSI) in CPR results in comparable or better performance than traditional CPR training. METHODS: This randomized, controlled trial was conducted among congregational volunteers in an African American church in Atlanta, GA. Subjects were randomly assigned to receive either 34 minutes of VSI or the 4-hour American Heart Association "Heartsaver" CPR course. Two months after training, blinded observers used explicit criteria to assess CPR performance in a simulated cardiac arrest setting. A recording manikin was used to measure ventilation and chest compression characteristics. Participants also completed a written test of CPR-related knowledge and attitudes. RESULTS: VSI trainees displayed a comparable level of performance to that achieved by traditional trainees. Observers scored 40% of VSI trainees competent or better in performing CPR, compared with only 16% of traditional trainees (absolute difference 24%, 95% confidence interval 8% to 40%). Data from the recording manikin confirmed these observations. VSI trainees and traditional trainees achieved comparable scores on tests of CPR-related knowledge and attitudes. CONCLUSION: Thirty-four minutes of VSI can produce CPR of comparable quality to that achieved by traditional training methods. VSI provides a simple, quick, consistent, and inexpensive alternative to traditional CPR instruction, and may be used to extend CPR training to historically underserved populations.

Adult↗
PubMed1985

Reporting presence or absence of named objects by a language-trained dolphin.

Referential "reporting" was defined as the transmission of information about the presence or absence of symbolically-referenced real-world objects. In Experiment 1 two bottlenosed dolphins (Tursiops truncatus), trained in earlier studies to carry out instructions conveyed by imperative sentences expressed in artificial gestural or acoustic languages, each gave spontaneous indications that an object referenced in an imperative was absent from their tank. In Experiment 2 the dolphin tutored in the gestural language was taught to make explicit reports of object absence by pressing a "No" paddle in response to imperatives referencing an absent object. Absence was reported correctly on 84% of 97 missing-object probes inserted at random intervals among 598 sentences referring to objects that were present. Reports were typically made after active search of the tank for an average of 15.0 sec. False reports, that objects present were absent, were few (7.5%). In Experiment 3, the dolphin was taught an interrogative sentence form that enabled us to ask direct questions about the presence or absence of specific objects. Responses by the dolphin on the No paddle indicated absence, while responses on a "Yes" paddle indicated presence. From one to three objects were shown the dolphin and then placed in the tank in a discrete-trial procedure. In response to the interrogative, reports or object presence or absence were better than 91% correct with a single object in the tank and either that object or some other object referenced; accuracy declined to 72-78% correct with three objects present, but was still well above chance. Several lines of evidence suggested that the dolphin was attempting to remember which objects it had been shown, rather than conducting an active environmental search as in Experiment 2. The memory strategy became less efficient as the number of objects to be remembered increased. Overall, the results evidenced the language-trained dolphin's understanding of references to present or absent objects, its ability to inventory its environment to seek information about those objects, and its ability to report its obtained knowledge to others.

Animal Communication↗
PubMed2004

Teaching, digression, and implicit curriculum.

BACKGROUND: Although medicine resides within contexts that have historical, cultural, and societal determinants, these are rarely addressed explicitly in current medical teaching. SUMMARY: The article describes a method of teaching in which mainstream biomedical learning is linked to digressions, which serve as the medium for considering the contexts of medicine, unmasking hidden messages, and broadening the scope of medical instruction. CONCLUSION: Teaching by digression encourages students to learn core clinical science while considering such otherwise neglected areas such as medical values, contexts, habits, and history. Integrating this consideration of the hidden assumptions of medical practice into mainstream medical learning allows students to understand modern biomedicine as a system that is historically, culturally, and socially conditioned.

Clinical Clerkship↗
PubMedDate not supplied

Integrating values education into an allied health curriculum. Part I.

Values education involves the explicit attempt to teach individuals about values and the process of valuing. An overview of popular approaches to values education includes inculcation, value clarification, moral development, and value analysis. Each approach will be presented by detailing the purpose, teaching methods, and an instructional model. Methods of incorporating these approaches into an allied health curriculum are offered along with sample student learning activities.

Allied Health Personnel↗
PubMed1996

Heightened interference on implicit, but not explicit, tests of negative transfer: evidence from patients with unilateral temporal lobe lesions and normal old people.

The present research investigated alternative explanations of heightened interference in AB-AC learning in individuals with memory loss related to medial temporal lobe dysfunction. In Experiment 1, patients with left or right temporal lobectomy and control subjects were administered the standard AB-AC test. Relative to the other groups, left temporal patients exhibited significant negative transfer that was characterized by large numbers of response intrusion errors. In Experiment 2, groups of community-dwelling old and young adults were administered the standard test and an implicit version in which, during AC testing, subjects were instructed to provide the first word that comes to mind in response to stimulus words. There were no differences between groups on either version. Of particular interest was that both groups made significantly more intrusion errors on the implicit test and did not differ on this measure. It was concluded that exaggerated interference in AB-AC learning, as reflected by response intrusion errors, is related to the use of implicit memory processes rather than a failure of inhibitory mechanisms. Memory-impaired individuals, who have a selective loss of explicit memory, are vulnerable on this task because they rely excessively on implicit memory processes.

Adolescent↗
PubMed1995

Contraception update: implantable and injectable methods.

There are currently more options available to pediatricians caring for sexually active adolescents who wish to prevent pregnancy. The two progestin-only methods, levonorgestrel subdermal implants and DMPA injections, minimize or entirely remove the obstacle of patient compliance from contraceptive efficacy. Adolescents considering a progestin-only method of contraception should be counseled explicitly about the likelihood of menstrual irregularity with use. Perhaps more importantly, adolescents should be reminded that hormonal methods of contraception do not provide protection from sexually transmitted disease. Thus, male condom use should not only be recommended, but also concrete discussion and instruction on appropriate use should be given.

Adolescent↗
PubMed1998

Randomized, controlled trial of video self-instruction versus traditional CPR training.

STUDY OBJECTIVE: We conducted a prospective, randomized, controlled trial to test the hypothesis that a 34-minute video self-instruction (VSI) training program for adult CPR would yield comparable or better CPR performance than the current community standard, the American Heart Association Heartsaver course. METHODS: Incoming freshman medical students were randomly assigned to VSI or the Heartsaver CPR course. Two to 6 months after training, we tested subjects to determine their ability to perform CPR in a simulated cardiac arrest setting. Blinded observers used explicit criteria to assess our primary outcome, CPR performance skill. In addition, we assessed secondary outcomes including sequential performance of individual skills, ventilation and chest compression characteristics, and written tests of CPR-related knowledge and attitudes. RESULTS: VSI trainees displayed superior overall performance compared with traditional trainees. Twenty of 47 traditional trainees (43%) were judged not competent in their performance of CPR, compared with only 8 of 42 VSI trainees (19%; absolute difference, 24%; 95% confidence interval, 5% to 42%). CONCLUSION: In a group of incoming freshman medical students, we found that a half-hour of VSI resulted in superior overall CPR performance compared with that in traditional trainees. If validated by further research, VSI may provide a simple, quick, and inexpensive alternative to traditional CPR instruction for health care workers and, perhaps, the general population.

Adult↗
PubMed1998

Learning with technology: use of case-based physical and computer simulations in professional education.

This paper describes a multimedia technology project in midwifery education and how it is being developed to improve student learning experiences and outcomes. The role of the university providing quality education relevant to today's world and professional practice is emphasised. A collaborative (Royal Melbourne Institute of Technology and Australian Catholic University) interdisciplinary project 'Pregnancy Simulator: Developing and Enhancing Student Learning of Pregnancy Assessment Skills' was developed with university and direct Commonwealth support. This project consists of a physical simulation of a pregnant woman at term and case-based multimedia computer simulations designed to develop and enhance student learning of abdominal assessment skills. A key feature of the development has been to design a learning experience explicitly on an authoritative theory-based view of teaching, in this case Diana Laurillard's 'Conversational Framework'.

Computer Simulation↗
PubMed2000

Medical students' essay-writing skills: criteria-based self- and tutor-evaluation and the role of language background.

OBJECTIVES: An exercise is described which aimed to make clear to first-year undergraduate medical students the expected writing skills required for an essay examination in one discipline. SUBJECTS: Many students were from a non-English speaking background and over one-third of students, regardless of language background, had limited experience in this type of essay writing. PROCEDURE: For this exercise, a practice essay was written by each student for formative assessment. The essay was rated by a tutor and by the student according to well-defined criteria. This allowed for comparisons to be made in a structured and objective way between the judgements of the student and the assessor. RESULTS: Students found the exercise to be very useful, although whether essay writing skills actually improved could not be established. Students from non-English speaking backgrounds tended to be most harsh in their self-evaluations, yet tutor-evaluations generally showed these students to have better writing skills than other students. Indeed, correlations between self- and tutor-evaluations were quite low. CONCLUSIONS: It is evident that students and their educators may be unclear about each others' expectations. By making explicit the requirements of an exercise, misunderstandings may be minimized and it is possible that student performance could improve, though further research is required to verify these hypotheses. It is suggested that students should be encouraged to evaluate their own work and should be instructed in writing skills throughout their medical degree education.

Education, Medical, Undergraduate↗
PubMed2006

Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention.

Postural control in everyday life is generally accompanied by posture-unrelated cognitive activity. Thus, mild forms of dual-tasking postural control are the norm rather than the exception. Based on this consideration and available evidence, we propose and empirically examined, in young and old adults, a non-monotonic, U-shaped relation between the efficacy of postural control and concurrent cognitive demands that reflect opposing trends of the effects of attention focus and attentional resource competition. When instructed to perform an easy cognitive task that presumably shifted the focus of attention away from posture control, the center of body pressure (COP) excursions decreased both in young and older adults relative to a single-task baseline where the focus of attention was explicitly directed towards the postural control task itself. However, when performing more demanding cognitive tasks, older adults showed increased COP displacements, in line with the predicted U-shape function, whereas young adults did not. We outline mechanisms linking postural control to cognitive demand and suggest routes for future investigation.

Adult↗