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PubMedDate not supplied

Development of visual diagnostic expertise in pathology -- an information-processing study.

OBJECTIVE: To identify key features contributing to trainees' development of expertise in microscopic pathology diagnosis, a complex visual task, and to provide new insights to help create computer-based training systems in pathology. DESIGN: Standard methods of information-processing and cognitive science were used to study diagnostic processes (search, perception, reasoning) of 28 novices, intermediates, and experts. Participants examined cases in breast pathology; each case had a previously established gold standard diagnosis. Videotapes correlated the actual visual data examined by participants with their verbal "think-aloud" protocols. MEASUREMENTS: Investigators measured accuracy, difficulty, certainty, protocol process frequencies, error frequencies, and times to key diagnostic events for each case and subject. Analyses of variance, chi-square tests and post-hoc comparisons were performed with subject as the unit of analysis. RESULTS: Level of expertise corresponded with differences in search, perception, and reasoning components of the tasks. Several discrete steps occur on the path to competence, including development of adequate search strategies, rapid and accurate recognition of anatomic location, acquisition of visual data interpretation skills, and transitory reliance on explicit feature identification. CONCLUSION: Results provide the basis for an empirical cognitive model of competence for the complex tasks of microscopic pathology diagnosis. Results will inform the development of computer-based pedagogy tools in this domain

Analysis of Variance↗
PubMed1996

A successful university-school-district partnership to help San Francisco's K-12 students learn about science and medicine.

The Science and Health Education Partnership (SEP) is a program at the University of California, San Francisco, established in 1987 to support the San Francisco School District ("the District") in its efforts to improve science education in grades K-12. A large cadre of active biomedical scientists and health professionals and a core program staff provide support to 90-95% of the District's schools. The District's students are from a variety of racial and ethnic groups, including a large percentage from underrepresented minorities (URMs). The SEP program has numerous components, some designed to help teachers (e.g., a clinician or scientist forms an ongoing partnership with a teacher to enrich classroom instruction) and some involving direct work with students (e.g., a contest where teams of students design and present lessons on science or health to their peers; activities related specifically to the encouragement of URM students). The SEP's perspective has evolved from an emphasis on assisting individual teachers and students to one of supporting systemic change throughout the District (e.g., supporting full implementation of hands-on, inquiry-based science instruction throughout the District via professional development). During this evolution, the kinds of issues facing program staff have changed and a great deal has been learned about fostering successful partnership activities. For example, (1) having a coordinator is crucial to make such a program work well; (2) it is easier to find start-up funding than to find continuing funding for ongoing activities that are working; and (3) it is important to work with the volunteering scientists and the teachers to help them understand what each has to offer the partnership and to encourage explicit dialogue about roles and expectations. The author concludes with advice for starting a new partnership: think big but start small, and work toward a long-term association based on communication and trust.

Adolescent↗
PubMed1999

What a tangled web we weave: discriminating between malingering and anosmia.

Two groups of normosmic subjects were instructed to feign a total olfactory loss when tested with the Olfactory Confusion Matrix (OCM). One of the groups was given specific instructions as to the number of odorants and trials in the test, as well as the number of items that might be expected to be correctly identified by chance. The responses of both groups of malingerers were compared with responses gathered from a group of anosmic patients. The groups did not differ in terms of performance level (percent correct). In spite of the similarity in terms of accuracy level, an analysis of the pattern of OCM responses to an irritant allowed the anosmic patients to be distinguished from subjects attempting to feign a loss. Subjects were given explicit details about the test performed at the same level as those simply told to feign a loss. These results suggest that the OCM is an effective tool in separating malingering from anosmia.

Adult↗
PubMed1997

Training and transfer-of-learning effects in disabled and normal readers: evidence of specific deficits.

Two experiments were conducted to assess the specificity of training and transfer deficits in disabled readers, aged 7 to 9 years. Forty-eight children (reading disabled, age-matched normal controls, and reading-level-matched normal controls) participated in both a reading and a nonreading (music) acquisition paradigm. Children received instruction in grapheme-phoneme and symbol-note correspondence patterns, respectively. Posttraining tests (one day and one week) following rule training compared performance on trained exemplar items with performance on untrained transfer items. Results revealed that normal readers were able to transfer their rule knowledge in both the reading and nonreading (music) acquisition paradigms, while disabled readers were proficient only in the music task, and thus demonstrated transfer deficits specific to learning printed language. Transfer was optimally facilitated for all readers when training procedures included not only presentation of exemplars, but also cues for rule derivation and explicit statement of pattern invariances.

Child↗
PubMed1991

Implicit and explicit knowledge bases in artificial grammar learning.

Two experiments examined the claim for distinct implicit and explicit learning modes in the artificial grammar-learning task (Reber, 1967, 1989). Subjects initially attempted to memorize strings of letters generated by a finite-state grammar and then classified new grammatical and nongrammatical strings. Experiment 1 showed that subjects' assessment of isolated parts of strings was sufficient to account for their classification performance but that the rules elicited in free report were not sufficient. Experiment 2 showed that performing a concurrent random number generation task under different priorities interfered with free report and classification performance equally. Furthermore, giving different groups of subjects incidental or intentional learning instructions did not affect classification or free report.

Adult↗
PubMed1979

Memory for medical information.

The frequency with which patients fail to recall advice presented by their doctors is discribed. The amount forgotten is shown to be a linear function of the amount presented, to be correlated with the patient's medical knowledge, anxiety level and possibly age, but not with intelligence. It is probable that instructions and advice are more often forgotten than other information, and that this is the result of their low perceived importance, and their being presented late in the series of statements presented-there being (a) a primacy effect in recall of medical information, and (b) a tendency for statements perceived as more important to be better recalled. Experiments to control the content and amount of forgetting are described. Control of content can be obtained by use of the primacy and importance effects, while control of amount forgotten can be achieved by use of (a) simpler language, (b) explicit categorization, (c) repetition, and (d) concrete-specific rather than general-abstract advice statements.

Adult↗
PubMed2001

Suppression of valid inferences and knowledge structures: the curious effect of producing alternative antecedents on reasoning with causal conditionals.

These studies looked at the difficulty that reasoners have in accepting conditional ("If P then Q") major premises that are not necessarily true empirically, as a basis for deductive reasoning. Preliminary results have shown that when reasoners are asked to produce possible alternate antecedents to the major premise ("If A then Q"), they paradoxically tend to deny the modus ponens (MP) inference ("If P is true, then Q is true"). Three studies further explored these results. The first study gave university students paper-and-pencil tests in which instructions to "suppose that the major premise is true" was followed by a request to determine the next number in a sequence, to retrieve information unrelated to the premises, or to retrieve a possible case of "If A then Q." Relative to a control group, reasoners asked to produce an alternative antecedent showed a significant tendency to deny the MP inference, whereas no such tendency was observed for the two other tasks used. A second study compared performance on a condition in which reasoners were asked to produce an alternative antecedent with that when they were given an explicit alternative. Premises used in this study were such that the latter alternative antecedent was also spontaneously produced by over 70% of reasoners. Results showed that the tendency to refuse the MP premise could not be accounted for by the specific nature of the alternative produced. A third study found that the tendency to refuse the MP inference after producing an alternative antecedent was affected by the number of "disabling conditions" (i.e., conditions that allow "P to be true" and "Q to be false") available for the major premise. These results are interpreted as being consistent with a model that supposes that logical reasoning requires selective inhibition of real-world knowledge.

Adult↗
PubMed1996

The legislative and litigation history of special education.

Between the mid 1960s and 1975, state legislatures, the federal courts, and the U.S. Congress spelled out strong educational rights for children with disabilities. Forty-five state legislatures passed laws mandating, encouraging, and/or funding special education programs. Federal courts, interpreting the equal protection and due process guarantees of the Fourteenth Amendment to the U.S. Constitution, ruled that schools could not discriminate on the basis of disability and that parents had due process rights related to their children's schooling. Congress, in legislation now retitled the Individuals with Disabilities Education Act (IDEA), laid out detailed procedural protections regarding eligibility for special educational services, parental rights, individualized education programs (IEPs), the requirement that children be served in the least restrictive environment, and the need to provide related (noneducational) services. Decisions on instructional matters such as curricula and the elements of the IEP remain the province of local and state authorities. Advocates for students with disabilities have continually sought separate (categorical) funding for special education services. Current movements toward block grants rather than categorical programs and toward greater inclusion of special education students in general education classrooms raise concerns in some quarters about whether students with disabilities will continue to have full access to the special services they need. While the cost of special services may be an unexpressed criterion in many decisions made by school districts, nowhere does the IDEA explicitly allow cost to be considered. Where a service is necessary for an individual child, cost considerations would not allow a school district to escape its obligations to the child. However, in instances where more than one appropriate configuration of services is available to meet a child's needs, the school district may be allowed to consider the cost of different alternatives.

Adolescent↗
PubMed1997

Prior knowledge and reading comprehension ability of deaf adolescents.

Fifty-one severely to profoundly deaf students (mean dB hearing loss = 89) were randomly assigned to two groups that differed by the type of probes (short or long) used to elicit prior knowledge (PK). PK scores were used to predict reading comprehension (RC), which was assessed by students' responses to three types of questions: test-explicit (TE), text-implicit (TI), and script-implicit (SI). Multiple regression models with PK scores and scores from a standardized achievement test (Stanford Achievement Test - Hearing Impaired Version, reading subtest) were also used to predict RC. The regression model showed that, for the group pretested with an in-depth, or long, probe of PK, the best predictor of RC was the ability to answer TE and SI questions. We present discussions of the observed differences in comprehension as a function of long and short knowledge probes and the use of three question types, together with implications for instruction.

Journal Article↗
PubMed1987

Behavioral treatment of adherence to therapeutic exercise by children with hemophilia.

Behavioral treatment of adherence to therapeutic exercise by ten children (aged 8 to 15) with hemophilia was investigated during a one-year period. During a one-week baseline phase, adherence to exercise performance was 55%. A 12-session behavioral physical therapy program was then implemented emphasizing individualized instruction in progressive strengthening exercises with weights. Endurance activities such as stationary bicycling and swimming, as well as noncontact sports (which provide optimal musculoskeletal conditioning without potentiating a joint or muscle bleed), were also included. Within a contingency contract format, designated points were given for adherence and exchanged for reinforcers. Adherence parameters included the percentage of prescribed therapeutic exercises performed, the percentages of exercise record forms returned, and the percentage of sessions attended. During the treatment phase, therapeutic adherence averaged 94% across the three parameters. Adherence declined during the follow-up phases from 84% to 66% across these parameters, as explicit reinforcement decreased.

Adolescent↗
PubMed2003

In search of counter-examples: deductive rationality in human reasoning.

Dual-process theories come in many forms. They draw on the distinction between associative, heuristic, tacit, intuitive, or implicit processes (System 1) and rule-based, analytic, explicit processes (System 2). We present the results of contextual manipulations that have a bearing on the supposed primacy of System 1 (Stanovich & West, 2000). Experiment 1 showed that people who evaluated logically valid or invalid conditional inferences under a timing constraint (N=56), showed a smaller effect of logical validity than did people who were not placed under a timing constraint (N= 44). Experiment 2 similarly showed that stressing the logical constraint that only inferences that follow necessarily are to be endorsed (N = 36) increased the size of the validity effect, as compared to that of participants (N=33) given the standard instruction to make "logical" inferences. These findings concur with the thesis in dual-processing frameworks that "Rationality-2 processes" (Evans & Over, 1996), "test procedures" (Chater & Oaksford, 1999), or "conclusion validation processes" (Johnson-Laird & Byrne, 1991; Schroyens, Schaeken, & d'Ydewalle, 2001) serve to override the results of System 1 processes.

Adolescent↗
PubMed1992

On the consistency of tapping to repeated noise.

Repeated noise at 1-4 cycles per second evokes an effortless heard rhythmic sensation which is often heard as "clanks" and "rasping." Tapping in synchrony with the period of the perceived structure is easy and consistent within one presentation. The present study addresses the question of whether the tapping to presentations at different times is consistent across presentations and across subjects. Nine listeners from three countries were presented with repeated Gaussian noise samples in 300 separate cyclical presentations. Nine samples of Gaussian noise with sample lengths ranging from 500 to 700 ms were used. In each of the presentations, one of these samples was selected at random and presented cyclically with transientless juxtapositions. The listeners were instructed to tap in synchrony with the perceived structure (i.e., once per period). Tapping to later presentations of a given sample was found to be consistent with prior tapping to the same sample: In most cases, one or two different tapping points per noise sample could be reproduced in different presentations. In the case of two possible tapping points in different presentations, the two points are usually far away from each other (most likely half a period away). The correlation between subjects is noticeable, although not perfect. The correlation between subjects of the same country is not significantly higher. The noise generating algorithm is given explicitly to allow subsequent studies to use exactly the same noises.

Attention↗
PubMed2005

Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project.

PURPOSE: This article considers the question if measurable improvements are achieved in the quality of care in stroke services by using a Breakthrough collaborative quality improvement model. CONTEXT OF CASE: Despite the availability of explicit criteria, evidence based guidelines, national protocols and examples of best practices; stroke care in the Netherlands did not improve substantially yet. For that reason a national collaborative started in 2002 to improve integrated stroke care in 23 self selected stroke services. DATA SOURCES: Characteristics of sites, teams, aims and changes were assessed by using a questionnaire and monthly self-reports of teams. Progress in achieving significant quality improvement has been assessed on a five point Likert scale (IHI score). CASE DESCRIPTION: The stroke services (n=23) formed multidisciplinary teams, which worked together in a collaborative based on the IHI Breakthrough Series Model. Teams received instruction in quality improvement, reviewed self reported performance data, identified bottlenecks and improvement goals, and implemented "potentially better practices" based on criteria from the Edisse study, evidence based guidelines, own ideas and expert opinion. CONCLUSION AND DISCUSSION: Quality of care has been improved in most participating stroke services. Eighty-seven percent of the teams have improved their care significantly on at least one topic. About 34% of the teams have achieved significant improvement on all aims within the time frame of the project. The project has contributed to the further development and spread of integrated stroke care in the Netherlands.

Journal Article↗
PubMed2004

A positron emission tomography study of the neural basis of informational and energetic masking effects in speech perception.

Positron emission tomography (PET) was used to investigate the neural basis of the comprehension of speech in unmodulated noise ("energetic" masking, dominated by effects at the auditory periphery), and when presented with another speaker ("informational" masking, dominated by more central effects). Each type of signal was presented at four different signal-to-noise ratios (SNRs) (+3, 0, -3, -6 dB for the speech-in-speech, +6, +3, 0, -3 dB for the speech-in-noise), with listeners instructed to listen for meaning to the target speaker. Consistent with behavioral studies, there was SNR-dependent activation associated with the comprehension of speech in noise, with no SNR-dependent activity for the comprehension of speech-in-speech (at low or negative SNRs). There was, in addition, activation in bilateral superior temporal gyri which was associated with the informational masking condition. The extent to which this activation of classical "speech" areas of the temporal lobes might delineate the neural basis of the informational masking is considered, as is the relationship of these findings to the interfering effects of unattended speech and sound on more explicit working memory tasks. This study is a novel demonstration of candidate neural systems involved in the perception of speech in noisy environments, and of the processing of multiple speakers in the dorso-lateral temporal lobes.

Acoustic Stimulation↗
PubMedDate not supplied

Comparisons of learning ease and transfer propensity in poor and average readers.

Assisted and unassisted performance of 14 average readers (7 boys and 7 girls between 9.67 and 13 years of age) and 14 children with learning disabilities (10 boys and 4 girls between 10.8 and 13 years of age) were compared on a reading comprehension task--stating the main idea in expository paragraphs in which the topic sentence was either first, last, or missing. Children were trained to find the main idea in one- and two-paragraph texts and took pre- and posttests in which they were asked to write the main ideas contained in one-, and six- to eight-paragraph texts. The main ideas contained in these texts either were explicitly stated (topic sentence first or last) or were implicit (topic sentence missing). Children's performance improved from pre- to posttest, although the effect of topic sentence placement was evident at both test times (performance on topic-sentence-first paragraphs was better than on topic-sentence-last paragraphs, which was, in turn, better than performance on topic-sentence-missing paragraphs). Although average achieving children and children with learning disabilities did not differ on static pre- and posttest measures, they did differ in how easily they learned to find the main idea under different topic sentence placement conditions. Children with learning disabilities required significantly more instruction than average readers to reach mastery criterion on nonideal text structures. Implications of the findings are discussed from both assessment and pedagogical perspectives.

Achievement↗
PubMed1997

Explicit speech segmentation and syllabic onset structure: developmental trends.

Recent applications of the hierarchical theory of the syllable to the development of explicit speech segmentation are critically examined. One particular prediction, that an initial consonant is more easily isolated when it constitutes the complete onset of a syllable than when it is part of a cluster onset, was tested on children with grade levels ranging from kindergarten to second grade. At each level, two independent groups of children worked with either CVCC (first consonant complete onset) or CCVC (part of cluster onset) syllables. First- and second-graders performed better on the CVCC than on the CCVC material in an initial consonant deletion task, but not when the task was comparison on the basis of that consonant. With the same instructions as the older children, kindergarten children performed at floor level on both tasks with both materials. However, in a new experiment in which the deletion task was presented as a puppet game, and with pretraining and selection on vowel deletion, a significantly higher level of success was achieved by the children working with the CVCC material. These results are consistent with the notion of developmental precedence of onset segmentation on phoneme segmentation. On the other hand, the results of the first and second graders show that onset superiority is not specific for the pre-reading stage.

Child↗
PubMed2006

Inappropriate drug use by Portuguese elderly outpatients--effect of the Beers criteria update.

OBJECTIVE: To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population. SETTING: Twelve community pharmacies in different districts of Lisbon-Portugal. METHOD: Observational cross-sectional survey, in a sample of 213 elderly outpatients (age>or=65-years-old) presenting a prescription with two or more drugs, for their own use. MAIN OUTCOME MEASURES: Drug use pattern and prevalence of potentially inappropriate medication. RESULTS: We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity. CONCLUSIONS: The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.

Aged↗
PubMed2000

How to eliminate illusions in quantified reasoning.

The mental model theory postulates that reasoners build models of situations described in premises. These models normally make explicit only what is true according to the premises. The theory has an unexpected consequence. It predicts the existence of illusions in inferences: Certain inferences should have compelling but erroneous conclusions. Previous studies have corroborated the existence of such illusions. The present study reports the first effective antidote to them. For example, most people incorrectly answer "yes" to the following problem: Only one of the following statements is true ... /At least some of the plastic beads are not red./None of the plastic beads are red./Is it possible that none of the red beads are plastic? In two experiments, we progressively eliminated this fallacy and others by using instructions designed to overcome the bias toward truth. The difference between the illusory and the control problems disappeared when the participants were instructed to work out both the case in which the first premise was true and second premise was false and the case in which the second premise was true and the first premise was false.

Attention↗