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PubMed2000

Effects of attention on dichotic listening: an 15O-PET study.

The present study investigated the effect of attention on brain activation in a dichotic listening situation. Dichotic listening is a technique to study laterality effects in the auditory sensory modality. Two different stimuli were presented simultaneously, one in each ear. Twelve subjects listened to lists of consonant-vowel syllables, or short musical instrument passages, with the task of detecting a "target" syllable or musical instrument by pressing a button. The target stimulus appeared an equal number of times in the left and right ear. The subjects were instructed to either concentrate on the stimuli presented in both ears, or only on the left or right ear stimulus. Brain activation was measured with 15O-PET, and significant changes in regional normalized counts (rNC) were evaluated using statistical parametric mapping (SPM96) software. Concentrating on either the right or left ear stimulus significantly decreased activity bilaterally in the temporal lobes compared to concentrating on both ear stimuli, at the expense of an increased activation in the right posterior and inferior superior parietal lobe. The CV-syllables activated areas corresponding to the classic language areas of Broca and Wernicke. The musical instrument stimuli mainly activated areas in visual association cortex, cerebellum, and the hippocampus. An interpretation of the findings is that attention has a facilitating effect for auditory processing, causing reduced activation in the primary auditory cortex when attention is explicitly recruited. The observed activations in the parietal lobe during the focused attention conditions could be part of a modality non-specific "attentional network".

Adult↗
PubMed1992

Modal reasoning, models, and Manktelow and Over.

Manktelow and Over (1991) argue that their studies of Wason's selection task favor explanations of deontic reasoning based on mental models, but that such theories need to incorporate utilities. This theoretical note proposes a simpler explanation of the phenomena: subjects in the selection task consider only those cards that are explicitly represented in their models of the conditional, and so insight into the task depends on constructing fully explicit models. Such models for modal conditionals of the form, If p occurs then q may occur are: [formula: see text] Each line denotes a separate model, and the models represent either what is possible, or, in the deontic interpretation, what is permissible. A deontic rule is accordingly violated by the contingency: [symbol: see text] p and q, for example the rule, "If you spend more than 100 pounds, then you may take a free gift" is violated by taking the free gift (q) but not spending more than 100 pounds ([symbol: see text] p). If the rule is interpreted as a bi-conditional, then the second of the models, p and [symbol: see text] q, is also now a violation, for example spending more than 100 pounds (p) but not getting the free gift ([symbol: see text] q). Manktelow and Over's instructions lead subjects to focus on one or other of the two sorts of violations of the rule. There is accordingly no need to introduce utilities into models in order to explain the phenomena.

Adult↗
PubMed2003

Steering a virtual blowfly: simulation of visual pursuit.

The behavioural repertoire of male flies includes visually guided chasing after moving targets. The visuomotor control system for these pursuits belongs to the fastest found in the animal kingdom. We simulated a virtual fly, to test whether or not experimentally established hypotheses on the underlying control system are sufficient to explain chasing behaviour. Two operating instructions for steering the chasing virtual fly were derived from behavioural experiments: (i) the retinal size of the target controls the fly's forward speed and, thus, indirectly its distance to the target; and (ii) a smooth pursuit system uses the retinal position of the target to regulate the fly's flight direction. Low-pass filters implement neuronal processing time. Treating the virtual fly as a point mass, its kinematics are modelled in consideration of the effects of translatory inertia and air friction. Despite its simplicity, the model shows behaviour similar to that of real flies. Depending on its starting position and orientation as well as on target size and speed, the virtual fly either catches the target or follows it indefinitely without capture. These two behavioural modes of the virtual fly emerge from the control system for flight steering without implementation of an explicit decision maker.

Animals↗
PubMed2003

Profile of on-line anatomy information resources: design and instructional implications.

This study is based on a review of 40 on-line anatomy web resources compiled from sites selected from our own searches as well as sites reviewed and published by an external group (Voiglio et al., 1999, Surg. Radiol. Anat. 21:65-68; Frasca et al., 2000, Surg. Radiol. Anat. 22:107-110). The purpose of our survey was to propose criteria by which anatomy educators could judge the characteristics of the currently available web-based resources for incorporation into the courses they teach. Each site was reviewed and scored based on a survey matrix that included four main categories: 1). site background information, 2). content components, 3). interactivity features, and 4). user interface design components. The average score of the reviewed sites was 3.3 of the total possible score of 10, indicating the limited use of computer-based design features by the majority of sites. We found, however, a number of programs in each of the survey categories that could serve as prototypes for designing future on-line anatomy resources. From the survey we conclude that various design features are less important than the comprehensiveness, depth, and logical organization of content. We suggest that the content should be sufficient for supporting explicitly defined educational objectives, which should target specific end-user populations. The majority of anatomy programs currently accessible on-line fall short of these requirements. There is a need for a coordinated and synergistic effort to generate a comprehensive anatomical information resource that is of sufficient quality and depth to support higher levels of learning beyond the memorization of structure names. Such a resource is a prerequisite for meaningful on-line anatomy education.

Anatomy↗
PubMed1998

Effects of color on perceptual and conceptual tests of implicit memory.

Two experiments are reported that explore why recent investigations of implicit memory failed to find any effects of color information on test performance. In the first experiment, participants studied colored pictures as well as words printed in colored ink without any memory instructions. During the test phase, a verbal and a pictorial version of a color-choice task (a conceptual priming test) were compared to two perceptual tests (word-stem completion and picture-fragment identification). Similar and significant amounts of priming to color occurred in both color-choice tasks. The perceptual tests were found to be sensitive to changes in the stimulus-presentation mode from study to test, but stimuli remaining the same color and those changed to black-and-white did not differ in the priming scores. In the second experiment, a mild division of attention was introduced in the study phase. Once again, priming to color was observed only in the verbal version of a color-choice test and not in the word-stem completion test. Dividing attention did not decrease performance on both implicit tests, whereas an explicit test of color recall for studied pictures suffered from dividing attention at encoding. It is concluded that a perceptual attribute such as color may be represented and coded by conceptual processing. Furthermore, automatic (or not attention-demanding) encoding processes may suffice for later conceptual tests of implicit memory. Previous failures to find any effects of color information on implicit performance are attributed to the use of perceptual priming tests.

Color Perception↗
PubMed2006

Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.

BACKGROUND: The balance between the benefits and the risks of pulmonary-artery catheters (PACs) has not been established. METHODS: We evaluated the relationship of benefits and risks of PACs in 1000 patients with established acute lung injury in a randomized trial comparing hemodynamic management guided by a PAC with hemodynamic management guided by a central venous catheter (CVC) using an explicit management protocol. Mortality during the first 60 days before discharge home was the primary outcome. RESULTS: The groups had similar baseline characteristics. The rates of death during the first 60 days before discharge home were similar in the PAC and CVC groups (27.4 percent and 26.3 percent, respectively; P=0.69; absolute difference, 1.1 percent; 95 percent confidence interval, -4.4 to 6.6 percent), as were the mean (+/-SE) numbers of both ventilator-free days (13.2+/-0.5 and 13.5+/-0.5; P=0.58) and days not spent in the intensive care unit (12.0+/-0.4 and 12.5+/-0.5; P=0.40) to day 28. PAC-guided therapy did not improve these measures for patients in shock at the time of enrollment. There were no significant differences between groups in lung or kidney function, rates of hypotension, ventilator settings, or use of dialysis or vasopressors. Approximately 90 percent of protocol instructions were followed in both groups, with a 1 percent rate of crossover from CVC- to PAC-guided therapy. Fluid balance was similar in the two groups, as was the proportion of instructions given for fluid and diuretics. Dobutamine use was uncommon. The PAC group had approximately twice as many catheter-related complications (predominantly arrhythmias). CONCLUSIONS: PAC-guided therapy did not improve survival or organ function but was associated with more complications than CVC-guided therapy. These results, when considered with those of previous studies, suggest that the PAC should not be routinely used for the management of acute lung injury. (ClinicalTrials.gov number, NCT00281268.).

Analysis of Variance↗
PubMed2004

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Delphi Technique↗
PubMed1994

Determining functional/health status and its relation to disability in stroke survivors.

BACKGROUND AND PURPOSE: Determining the functional/health status of stroke survivors poses special difficulties because of cognitive impairments that frequently result from stroke. A possible means of assessing the status of stroke survivors who are cognitively impaired is getting proxy responses from a family member or other caregiver. Proxy agreement was evaluated for two measures of functional/health status, the Frenchay Activities Index (FAI) and the Health Status Questionnaire (HSQ), and a measure of disability, the Functional Independence Measure (FIM). METHODS: Thirty-eight stroke survivors were administered the measures at follow-up (median time since the stroke, 6 months). Caregivers were instructed to answer as proxies for the stroke survivors in their care. Demographics on age, sex, race, marital status, educational level, side of lesion, and relation of stroke survivor to caregiver were collected. RESULTS: Proxy agreement was excellent for the FAI (intraclass correlation, .85) and the FIM (.87), but poor for the HSQ scales (average proxy agreement, .32). Patients' scores were low and positively skewed for the FAI but high and negatively skewed for the FIM. Although Spearman rho coefficients between the measures were fairly high for both stroke survivors and proxy respondents, the correlation of scores was substantially weaker when the group of less severely impaired survivors (as established by FIM ratings) was considered separately. CONCLUSIONS: The FAI and the FIM are useful for assessing the functional/health status of stroke survivors because answers can be obtained by proxy. Future studies should examine the relations between disability and functional/health status, with explicit attention paid to variations in the level of disability in the stroke survivors.

Activities of Daily Living↗
PubMed2005

Definitions and goals of "self-directed learning" in contemporary medical education literature.

INTRODUCTION: Self-directed learning (SDL) has been an essential issue in medical education due to the expansion of knowledge, accessibility to information and greater emphasis on reflection. If SDL in educational research lacks a clear definition, terminological confusion may hinder the application of the results to practice. The aim of this study was to review and categorise the various forms of SDL described in the contemporary literature. METHODS: A search of Medline was conducted using the key word "self-directed learning". Articles published between 2000 and 2004 were extracted. Review articles, letters and articles from health profession education other than medical education, were excluded. Sixty-three articles were analysed in 2 stages: first, whether the definition of SDL is explicitly described was investigated and next, contents in the articles on SDL were qualitatively analysed using a framework approach. The concept of a compassionate-empathic physician, as developed by Carmel and Glick (1996), was used as the framework. RESULTS: Only 5 articles (8.0%) had an explicit and concrete definition of SDL. Content analysis showed that 26 (50.0%) of the 52 articles dealt with SDL only in the scientific-technical dimension, 3 (5.8%) dealt with that only in the socio-emotional dimension and 23 (44.2%) did so in both dimensions. CONCLUSION: Although many researchers use the term "self-directed learning", only a few clearly defined it to avoid semantic confusion. Scientific-technical goals tended to be discussed more frequently in SDL. From a patient-centred viewpoint, socio-emotional goals should be stressed more.

Education, Medical↗
PubMed1993

Cancer by another name: a randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients.

PURPOSE: In this study we tested some assumptions about the use of euphemism in communicating with cancer patients. Does an explicit statement about the diagnosis of cancer cause patients to respond with greater anxiety than when uncertainty or ambiguity is allowed to persist? Do patients believe they cope better with cancer when the diagnosis is explicit? METHODS: A heterogeneous sample of 165 cancer patients completed a new measure of emotional adjustment to cancer using random assignment among four testing variables: agent (self-report v interview), terminology (the words cancer v illness), identification (patient identified v anonymous), and supervision (clinic v home). Internal consistency (Cronbach's alpha) for the 39-item set was 0.74 and face and content validity were determined using the focus-group technique and preliminary factor analysis. After answering the adjustment measures, subjects completed the Spielberger State-Trait Anxiety Inventory (STAI). RESULTS: Overall anxiety levels were significantly lower in the sample than published norms for general medical and surgical patients. Exposure to the word cancer as distinct from illness increased anxiety, but did not alter adjustment scores. Supervision and agent conditions did not affect anxiety, but reported adjustment was poorer in the interview condition compared with the self-report condition. Ambiguous instructions, such as asking patients to complete the questionnaire anonymously but return it in person to staff in the clinic, resulted in poorer adjustment, which was reversed by the consistent instruction to complete the questionnaire anonymously at home and return it by mail. CONCLUSION: Use of the word cancer generated anxiety to levels similar to those reported in general medical and surgical patients, but did not produce any distortion in reported adjustment. However, any ambiguity associated with the conditions under which adjustment is assessed may lead to distortion and an increase in the patient's reported psychologic distress.

Adult↗
PubMed1987

Reorienting attention across the horizontal and vertical meridians: evidence in favor of a premotor theory of attention.

Stimuli presented in a non-attended location are responded to much slower than stimuli presented in an attended one. The hypotheses proposed to explain this effect make reference to covert movement of attention, hemifield inhibition, or attentional gradients. The experiment reported here was aimed at discriminating among these hypotheses. Subjects were cued to attend to one of four possible stimulus locations, which were arranged either horizontally or vertically, above, below, to the right or left of a fixation point. The instructions were to respond manually as fast as possible to the occurrence of a visual stimulus, regardless of whether it occurred in a cued or in a non-cued location. In 70% of the cued trials the stimulus was presented in the cued location and in 30% in one of the non-cued locations. In addition there were trials in which a non-directional cue instructed the subject to pay attention to all four locations. The results showed that the correct orienting of attention yielded a small but significant benefit; the incorrect orienting of attention yielded a large and significant cost; the cost tended to increase as a function of the distance between the attended location and the location that was actually stimulated; and an additional cost was incurred when the stimulated and attended locations were on opposite sides of the vertical or horizontal meridian. We concluded that neither the hypothesis postulating hemifield inhibition nor that postulating movement of attention with a constant time can explain the data. The hypothesis of an attention gradient and that of attention movements with a constant speed are tenable in principle, but they fail to account for the effect of crossing the horizontal and vertical meridians. A hypothesis is proposed that postulates a strict link between covert orienting of attention and programming explicit ocular movements. Attention is oriented to a given point when the oculomotor programme for moving the eyes to this point is ready to be executed. Attentional cost is the time required to erase one ocular program and prepare the next one.

Attention↗
PubMed2000

A regulated telemedicine system for day to day application in remote areas.

The NIVEMES project creates an international network of Health Service providers which offer Telemedicine-Teleconsultation services to Remote, Isolated places and to ship vessels for both routine and emergency situations. The base of the system is the powerful Multimedia Health Record, with the ability to manage conventional data, images, videos and biosignals, acquired directly from the medical device. National and international medical codification schemata are employed such as ICD-X and WHO standards. Telemedicine and Computing in Health Care are rapidly covering a pending gap, not fulfilled by current bureaucratic and telematic procedures. However even from the first test fields conducted during the past year, it is obvious that a variety of new training needs has arisen. The users of such systems need to be instructed new ways of conducting their business, of taking advantage of the services, even a new way of perceiving health care provision. The user interface of the software is kept simple, thus getting acquainted with it requires minimum effort; however there are other issues on which training is required to best exploit the advantages the system offers. The telemedical networks spawned in each country must be co-ordinated, and the user needs to know where and how he/she will acquire the necessary support. Home-cared patients will have to operate medical devices and telemedical software, a task which although made easy from today's technology, it still requires some basic training, specially as far as elderly users are concerned. The NIVEMES system uncovers a set of new training needs, but it offers at the same time a vehicle for educating the professional health-carers. The Health Record comprises a multimedia, explicit account of the patient history, which can be used for detailed and integrated study from trainee health carers of all levels (as well as from officers on board, people taking care of home-confined patients and others), on real data or in a simulated environment. At the same time the telemedicine facilities may increase the effectiveness of junior doctors working in remote areas and enhance the confidence residents have about their local health centres. Systems like NIVEMES prove that new user needs arise nowadays and employment of modern tools requires training in modern methods and in a new way of thinking.

Europe↗
PubMed2000

Neurocognition of auditory sentence comprehension: event related fMRI reveals sensitivity to syntactic violations and task demands.

The present study investigates the sensitivity of distinct brain regions to the syntactic processing of running speech. Experimental conditions varied the grammaticality of sentence types (correct vs. incorrect). Moreover, two different groups of subjects listened to the same sentence material, but followed two different task instructions. All participants were asked to listen to the auditory stimuli and to perform in a grammaticality judgment-task, whereas only half of the subjects were instructed to additionally repair incorrect sentences covertly. Significantly increased brain responses occurred in several left temporal areas as a function of sentences' grammaticality, particularly, in the 'pure' judgment-group. Spatial extent as well as the strength of focal brain activation changed as a function of grammaticality and task demand. A generally enhanced pattern of local blood supply to the right peri-sylvian cortex could be observed when individuals additionally realized the repair-task. In particular, the right inferior frontal gyrus (pars opercularis and pars triangularis) and the right temporal transverse gyrus (Heschl's gyrus) were more strongly affected by the repair-task demand. In contrast, an anterior portion of the superior temporal gyrus (planum polare) displayed increased activation bilaterally. Although left hemisphere activation varied clearly as a function of a sentence's grammaticality, the present findings demonstrate an involvement of the right peri-sylvian cortex, in particular, when task demands explicitly require an on-line repair. The results as a whole suggest a reconsideration of the notion that auditory language comprehension is restricted to the left hemisphere. The underlying mechanisms and the respective roles of both the left and the right hemisphere during speech processing are discussed.

Acoustic Stimulation↗
PubMed2000

Testing memory for self-generated items in dementia: method makes a difference.

OBJECTIVE: To learn how pAD (probable Alzheimer's disease), PD+ ("Parkinson's Plus" syndrome), and control subjects remember internally generated material under different conditions. BACKGROUND: "Self-discovered," or internally generated knowledge, prized by educators and therapists, can bring about considerable behavioral change. Both parietal-temporal-limbic (pAD) and frontal-subcortical dementia (e.g. PD+) cause dysmemory, but may cause different internal-external memory bias. pAD subjects, confusing internal and external information (confabulation) and reporting internal information during memory testing (intrusions), may be biased to remember internal material. PD+ subjects, impaired at generative tests, may be externally biased. METHODS: Ten pAD, 5 PD+, and 10 control subjects generated words in a category without instruction to remember (INR), and took a list-learning test of incidental memory for internally and externally generated words. To test how INR influences memory, subjects then generated and attempted to recall four more words. RESULTS: All three subject groups remembered more internally generated than externally provided words without INR. Recall versus recognition of internally generated words differed by group, with PD+ subjects showing greatest improvement with recognition. The pAD subjects performed worse with INR than without INR, had the most intrusion errors, and, rather than demonstrating a release from proactive inhibition, recalled fewer words outside the category. Groups differed in overall recall/recognition improvement (p = 0.015). CONCLUSIONS: Aged subjects preferentially retained internally generated material. However, among demented subjects, memory for internally generated words was influenced by the testing method used. PD+ subjects have poor internal recall, but excellent internal recognition. In pAD, memory for internally generated words may exceed external memory, but only when subjects are not explicitly trying to remember.

Aged↗
PubMed1995

Anatomy of the clinical simulation.

Computer-based clinical simulations have been used in medical education for the past 25 years. During this period, the technology has evolved from mainframe computers to microcomputers to multimedia. All designers of simulations must decide which elements of reality to include explicitly in a simulated case, which to leave to the user's imagination, and when to intervene for educational purposes. Once these decisions are made, developers of simulations have many options for structuring the simulation itself. They can develop simulations with single or multiple patient encounters, with menu or natural-language requests for data, with varying levels of volunteered information about the simulated patient, with interpreted or uninterpreted clinical findings, with deterministic or probablistic evolution of the case, with various ways to give users feedback about their progress through the case, and with manual or automated creation of specific cases. Simulations derive their specific character from how these options are implemented.

Computer Simulation↗
PubMed2005

Establishing the computer-patient working alliance in automated health behavior change interventions.

Current user interfaces for automated patient and consumer health care systems can be improved by leveraging the results of several decades of research into effective patient-provider communication skills. A research project is presented in which several such "relational" skills - including empathy, social dialogue, nonverbal immediacy behaviors, and other behaviors to build and maintain good working relationships over multiple interactions - are explicitly designed into a computer interface within the context of a longitudinal health behavior change intervention for physical activity adoption. Results of a comparison among 33 subjects interacting near-daily with the relational system and 27 interacting near-daily with an identical system with the relational behaviors ablated, each for 30 days indicate, that the use of relational behaviors by the system significantly increases working alliance and desire to continue working with the system. Comparison of the above groups to another group of 31 subjects interacting with a control system near-daily for 30 days also indicated a significant increase in proactive viewing of health information.

Adult↗
PubMed2006

Re-designing scanning to reduce learning demands: the performance of typically developing 2-year-olds.

Children with severe motor impairments who cannot use direct selection are typically introduced to scanning as a means of accessing assistive technology. Unfortunately, it is difficult for young children to learn to scan because the design of current scanning techniques does not always make explicit the offer of items from the selection array; furthermore, it does not provide explicit feedback after activation of the switch to select the target item. In the current study, scanning was redesigned to reduce learning demands by making both the offer of items and the feedback upon selection more explicit through the use of animation realized through HTML and speech output with appropriate intonation. Twenty typically developing 2-year-olds without disabilities were randomly assigned to use either traditional scanning or enhanced scanning to select target items from an array of three items. The 2-year-olds did not learn to use traditional scanning across three sessions. Their performance in Session 3 did not differ from that in Session 1; they did not exceed chance levels of accuracy in either session (mean accuracy of 20% for Sessions 1 and 3). In contrast, the children in the enhanced scanning condition demonstrated improvements in accuracy across the three 10-20-min sessions (mean accuracies of 22 and 48% for Sessions 1 and 3, respectively). There were no reliable differences between the children's performances with the two scanning techniques for Session 1; however, by Session 3, the children were more than twice as accurate using the enhanced scanning technique compared to the traditional design. Results suggest that by redesigning scanning, we may be able to reduce some of the learning demands and thereby reduce some of the instructional time required for children to attain mastery. Clinical implications, limitations, and directions for future research and development are discussed.

Child, Preschool↗
PubMedDate not supplied

A randomized comparison of alternative formats for clinical simulations.

Computer-based clinical simulations for medical education vary widely in structure and format, yet few studies have examined which formats are optimal for particular educational settings. This study is a randomized comparison of the same simulated case in three formats: a "pedagogic" format offering explicit educational support, a "high-fidelity" format attempting to model clinical reasoning in the real world, and a "problem-solving" format that requires students to express specific diagnostic hypotheses. Data were collected from rising third-year medical students using a posttest, attitudinal questionnaire, students' write-ups of the case, and log files of students' progress through the simulation. Student performances on all measures differed significantly by format. In general, students using the pedagogic format were more proficient but less efficient. They acquired more information but were able to do proportionately less with it. The results suggest that the format of computer-based simulations is an important educational variable.

Attitude↗