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ERP indicators of learning in adults.

This study investigated learning-related changes in the brain activity of young adults. A group of 29 undergraduate students (18-24 years) participated in a learning study that included a pretest, a training session, and a posttest. Each trial involved presentation of a complex visual stimulus and its spoken "name." Auditory event-related potentials (ERPs) were recorded in response to matching and mismatching names. In the pretest, the participants guessed whether the names were matching the figures. During training they learned the names of a set of simple elements making up the complex figures and were required to master a simple rule for combining the visual and auditory stimuli. The posttest included presentation of the combinations learned during training as well as novel pairings of the same elements. Following training the number of correct responses for learned items doubled and the amplitudes of the auditory ERPs to learned and rule transfer stimuli were more positive than brain waves to the not learned or novel items over most of the analysis window. The ERPs further differentiated between a familiarity response (late positive shift) and learning-specific changes (N2-P3 range). Overall, the findings suggest that ERPs can be a useful tool for learning assessment and offer new insights in the study of individual differences associated with the learning process.

Acoustic Stimulation↗

The drug resistance strategies intervention: program effects on substance use.

This study evaluates the Drug Resistance Strategies (DRS) project, a culturally grounded, communication-based substance use prevention program implemented in 35 middle schools in Phoenix, Arizona. The intervention consisted of 10 lessons taught by the classroom teacher that imparted the knowledge, motivation, and skills needed to resist drug offers. The evaluation used growth modeling to analyze significant differences in average postintervention substance use (alcohol, cigarettes, and marijuana) and growth of use over the course of the study. The study involved 6,298 seventh graders (65% Mexican/Mexican American) who responded to at least 1 of 4 questionnaires (1 pretest and 3 follow-up measures). When compared to a control group, the DRS intervention appeared to significantly limit the increase in the number of students reporting recent substance use, especially alcohol and marijuana use. The multicultural version of the curriculum proved most broadly effective, followed by the version targeting Mexican American youth. The development of a culturally grounded prevention curriculum for Mexican American youth expands the population being served by interventions. Moreover, the success of the multicultural curriculum version, which has the broadest application, provides particular promise, and the article demonstrates how a growth modeling approach can be used to evaluate a communication-based intervention by analyzing changes over time rather than differences between the pretest and posttest scores.

Adolescent↗

Exploring human interaction and diet effects on the behavior of dogs in a public animal shelter.

This study examined the effects of 2 manipulations--a brief, regular period of human contact and diet--on the behavior of dogs confined in a public animal shelter. A behavioral battery designed to assess reactions to novel situations, and a test of responsiveness to an unfamiliar human were administered both prior to (pretest) and immediately following (posttest) the 8-week intervention period. Overall, the regular periods of increased human contact together with a diet that contained augmented levels of digestible protein, fat, calories, and animal-derived ingredients reduced signs of behavioral reactivity from pretest to posttest. In some cases, the comparison diet appeared more effective, but only for dogs receiving minimal human interaction. The results indicate that a combination of human interaction and high quality diet may positively affect the behavior of dogs in animal shelters.

Animal Welfare↗

Intervention program for obese school children.

The purpose of this study was to implement and evaluate a program for obese school children. A pretest-posttest design was utilized. Data was collected related to weight status, skinfold measurements, self-esteem, and nutritional knowledge. A convenience sample of 26 children, in the fourth to sixth grades, completed this 9-week program. The results indicate that self-esteem increased significantly (p less than .001) between the pretest and posttest interval. Weight status and nutritional knowledge showed no improvement. Exercise was difficult to assess on self-report, therefore no conclusions were were drawn in relation to this variable. Future research will be directed toward refining this intervention program.

Child↗

Evaluating critical thinking skills in a scenario-based community health course.

This study evaluated the influence of a scenario-based community health course on the ability of senior nursing students (N = 54) to address complex problems seen in the community health setting. In addition, we examined whether students' scores on the Watson-Glaser Critical Thinking Appraisal (WGCTA) questionnaire would differ depending on the size of the educational institution they attended before enrollment in a school of nursing and whether the types of electives (liberal arts or science) previously taken would influence the scores. Sign ficant improvements were seen on the Interpretation and Evaluation subscales and on the total critical thinking score from pretest to posttest for students who completed the course. Also students who completed nursing prerequisites in midsized, 4-year universities (10,000 to 30,000 students) had higher pretest mean scores on the majority of WGCTA subscales than did other students.

Adult↗

Utilizing the child abuse potential inventory in a community health nursing prevention program for child abuse.

The objectives of this study were to: (a) Determine the potential for child abuse among the Joint New Parent Support Program Hawaii (Joint NPSP) client population, (b) Determine whether client participation in this program can reduce the potential for child abuse, and (c) Determine what client demographics correlate with the potential for child abuse. Joint NPSP is a prevention program for child abuse, screening all pregnant military families in Hawaii. The instrument used in this study was the Child Abuse Potential Inventory (CAP), a reliable and valid instrument used in the screening of physical child abuse. The CAP was completed by 142 pregnant Joint NPSP patients, ages 13-40 years, at the beginning of service provision and approximately 16 months later. Statistical measures used in analyzing the data were the t test and analysis of variance (ANOVA). Paired t tests were used to compare pre- and postprogram scores. Relations between the demographic profile information and CAP scores were analyzed with multiple regression analysis to identify risk factors for high child abuse. Out of 142 surveyed, 77 scored > 166 (signal detection) on the pretest abuse scale, and 65 scored < 166. In the > 166 group the pretest mean was a score of 257, and the posttest mean was 137. T-test results in the > 166 group were highly significant at .0001 on the scales of abuse, distress, rigidity, unhappiness, problems with family, and problems with others. ANOVA results in the > 166 group revealed a significant difference between an elevated abuse scale and patients with psychiatric problems (.0485), relationship problems (.0452), and past or present spouse abuse (.0421). This study validated that Joint NPSP is servicing a population at risk for child abuse potential. After intense home visitation by the community health nurses, the scores for child abuse potential decreased. A major limitation was the lack of a control group, the problem of maturation and history, and the possibility of regression toward the mean in scores. These limitations should be addressed in future studies with the use of 2 treatment modalities. Results highlight the need for focusing on relationship and spouse abuse issues in a military population.

Analysis of Variance↗

Solomon design analysis of multiple-choice Rorschach animal content.

The Solomon four-group design was used to study the effects of a persuasive message on a selected multiple-choice Rorschach index--animal content. The independent variable elicited behavior in a predictable manner. Pretesting as a main effect was not significant, but as an interactional effect obviated the effect of the persuasive message. Although knowledge of test rationale can elicit behavior that conforms to experimental demand characteristics, some subjects nonetheless acted in defiance of such information. A condition for defiance in this experimental arrangement, however, was pretesting. Other possibilities regarding the study of compliance behavior and the use of pathognomonic indicators were suggested. Ethical issues were raised.

Journal Article↗

Development and implementation of an objective structured teaching exercise (OSTE) to evaluate improvement in feedback skills following a faculty development workshop.

BACKGROUND: Faculty development programs focusing on teaching have become widespread. PURPOSE: Despite the popularity of such programs, evidence as to their effectiveness is limited. This article reports on the development of an objective structured teaching exercise (OSTE) and its pilot implementation in an evaluation of a faculty development program module. A written test intended to measure feedback skills was also developed and pilot tested. METHODS: A separate-sample, pretest-posttest design was used to pilot test both instruments. RESULTS: The results showed some evidence of significant differences between groups tested preworkshop and postworkshop. Higher scores were observed for the posttest group compared to the pretest group only for OSTE items focusing on prioritizing and limiting the amount of feedback given at one time and on action planning. CONCLUSIONS: Results suggest that an OSTE may be sensitive to changes in preceptor skill level for skills that are relatively easy to incorporate immediately into practice. Lack of differences in other skill areas may be due to lack of sensitivity of the measure or to need for practice and reflection before changes in performance on other feedback skills are evident.

Education, Medical↗

A comparison of faculty-led small group learning in combination with computer-based instruction versus computer-based instruction alone on identifying simulated pulmonary sounds.

BACKGROUND: Computer-based learning has gained widespread acceptance in medical curricula, but can it replace faculty-led teaching. PURPOSE: To investigate the effectiveness of independent computer-based learning of pulmonary auscultation alone and in combination with faculty-led teaching. METHODS: The first method involved independent computer-based instruction (CBI; Group 1) of 113 second-year medical students. The second method involved a combination of faculty-led instruction and independent CBI (Group 2) of 79 second-year medical students. A pretest-posttest method of assessment was used. RESULTS: The pretest showed recognition rates of 48% for Group 1 and 46% for Group 2, whereas the posttest showed recognition rates of 81% for Group 1 and 88% for Group 2. The posttest clinical correlation scores were identical with both groups scoring 93 percent. CONCLUSIONS: The study demonstrates that student learning of pulmonary auscultation is similar whether a computer-based independent instructional approach is used alone or in combination with faculty-led sessions.

Auscultation↗

Using structured debate to teach a controversial topic: mammography for women in their 40s.

BACKGROUND: Screening mammography for women in their 40s is controversial, and counseling patients about it can be challenging. Debate is an educational tool that lends itself to teaching about controversial topics and improving communication skills but is underused in medical education. PURPOSE: The purpose of this intervention was to improve residents' willingness to discuss mammography with patients. METHODS: Second-year internal medicine residents participated in a 3-hr structured debate on screening mammography for women in their 40s. The intervention's effect was measured using pretest and posttest questionnaires. RESULTS: A total of 33 residents participated in 6 debates between January and June of 2003. Comparison of pretest and posttest questionnaires showed that participants became more comfortable discussing mammography screening and were more likely to discuss it with their patients after the debate. CONCLUSIONS: A structured debate resulted in residents reporting increased comfort level and willingness to discuss mammography with women in their 40s.

Adult↗

Promoting informed decision making: evaluating a community-based prostate health awareness program.

BACKGROUND: For health educators, the controversy surrounding routine prostate cancer screening provides curriculum development and delivery challenges. The purpose of this study was to evaluate a community-based prostate health awareness program. METHODS: Using a pretest-posttest design, participants were recruited from community-based organizations to assess the effectiveness of the program in the areas of knowledge gain, short-term intentions, and changing prostate health behaviors. RESULTS: Many of the participants reported having been tested for prostate cancer, yet there was a lower than expected pretest knowledge base. There were significant increases in knowledge on the posttest and some impact on short-term intentions and behavior. DISCUSSION: A community-based prostate health awareness program prior to the patient-physician encounter can assist health-care professionals in the education process and give men the tools to make an informed decision.

Adult↗

Intracranial sites regulating the biphasic action of progesterone in estrogen-primed golden hamsters.

Diencephalic and mesencephalic neural sites regulating the biphasic effect of progesterone (P) were investigated using the hormone implantation technique in ovariectomized female golden hamsters primed with estrogen. Double barreled cannulae were implanted unilaterally and bilaterally in the medial preoptic area, anterior hypothalamus, ventromedial hypothalamus (VMH), central gray, or interpeduncular nucleus. Testing was conducted using a sequential paradigm; facilitation tests commenced after 44 h of estrogen priming. P-filled cannulae placed in the VMH region facilitated lordosis behavior in 42% and 60% of unilaterally and bilaterally implanted females, respectively. In the anterior hypothalamus, only P implants adjacent to the VMH area effectively promoted receptivity. Lordosis behavior was also observed in 20-36% of females with P implants in the medial preoptic area. P implants in central gray and interpeduncular nucleus regions had no significant facilitating effect on sexual behavior. Tests for inhibition occurred 24 h after facilitation testing and consisted of a pretest, followed by systemic P administration and a behavioral test 4-5 h later. During the pretest for inhibition, females that were receptive in the facilitation test attacked males more rapidly than previously nonreceptive animals and showed decrements in lordosis scores after systemic P delivery. This biphasic effect of P completely inhibited receptivity among several animals in the VMH group. Additional experiments, however, investigating the biphasic effect of P implants in the VMH suggested that the occurrence of copulation in the facilitation test may have been involved in mediating the subsequent increase in aggressive behavior and the suppression of sexual responsiveness in the inhibition test. Nevertheless, a final experiment showed that when P was implanted sequentially in the VMH, facilitation and, more importantly, a later reduction in lordosis behavioral scores occurred even when copulation was eliminated in the facilitation test. P implants in mesencephalic regions exerted no significant inhibitory effect on receptivity. These findings demonstrate that the biphasic action of P in the female hamster is regulated by nerve cells located in the diencephalon, especially in the VMH region.

Animals↗

The effect of spectrum bias on the utility of magnetic resonance imaging and evoked potentials in the diagnosis of suspected multiple sclerosis.

BACKGROUND: Spectrum bias is the tendency for the effectiveness of a test (or treatment) to vary as a function of clinical, pathologic, or comorbid variables including disease severity. Our null hypothesis was that within the population of suspected multiple sclerosis (MS) patients, there would be no difference in MRI and evoked potential (EP) sensitivity and specificity between those with mild MS versus those with more severe clinical signs of the disease, i.e., that spectrum bias is not a factor. METHODS: Three hundred three patients with suspected MS were evaluated by a board-certified neurologist, then scanned with MRI. Two hundred four patients also received EP testing. RESULTS: The sensitivity of MRI in patients with suspected MS was 58 percent with a false-positive rate of 9%. The overall sensitivity was 64% in the probable and 45% in the possible group. In the low pretest probability group sensitivity was 20%, and it was 70% in the high pretest probability group. These differences in sensitivity are statistically significant (p < 0.03). In contrast, the specificity between groups did not differ significantly. EP sensitivity was 69% in the high probability subgroup and 5% in the low probability subgroup. (p < 0.01). CONCLUSION: In this study, both EP and MRI results demonstrated an association between disease frequency, disease severity, and test sensitivity with greater disease frequency and intensity suggesting more impressive diagnostic test performance. The distorting effect of the variable clinical severity on MRI and EP sensitivity in suspected MS underscores that diagnostic tests perform differently in different groups of patients.

Bias↗

An EEG should not be obtained routinely after first unprovoked seizure in childhood.

OBJECTIVE: To quantify and analyze the value of expected information from an EEG after first unprovoked seizure in childhood. BACKGROUND: An EEG is often recommended as part of the standard diagnostic evaluation after first seizure. METHODS: A MEDLINE search from 1980 to 1998 was performed. From eligible studies, data on EEG results and seizure recurrence risk in children were abstracted, and sensitivity, specificity, and positive and negative predictive values of EEG in predicting recurrence were calculated. Linear information theory was used to quantify and compare the expected information from the EEG in all studies. Standard test-treat decision analysis with a treatment threshold at 80% recurrence risk was used to determine the range of pretest recurrence probabilities over which testing affects treatment decisions. RESULTS: Four studies involving 831 children were eligible for analysis. At best, the EEG had a sensitivity of 61%, a specificity of 71%, and an expected information of 0.16 out of a possible 0.50. The pretest probability of recurrence was less than the lower limit of the range for rational testing in all studies. CONCLUSIONS: In this analysis, the quantity of expected information from the EEG was too low to affect treatment recommendations in most patients. EEG should be ordered selectively, not routinely, after first unprovoked seizure in childhood.

Adolescent↗

Evaluation of a program to prevent head and spinal cord injuries: a comparison between middle school and high school.

This study was designed to test whether the Oregon THINK FIRST-Head and Spinal Cord Injury Prevention Program, developed for the high school audience and previously shown to have a beneficial effect, would have the same effect on students in middle school. During the spring of 1989, four schools (two high schools and two middle schools) participated. Two weeks before and after the presentation of the THINK FIRST program, 830 student questionnaires were distributed in classrooms. Questionnaire items were designed to measure knowledge, attitude, behavior, and demographic features. There was a significant difference between high school and middle school students on pretest knowledge (P = 0.0001). The average knowledge increase among all students was 0.81 correct responses (95% confidence interval: +/- 0.22) among 15 questions. The increment in knowledge did not differ significantly (P = 0.37) between high school and middle school students. One-way analysis of variance revealed no significant differences in pretest knowledge or knowledge increase associated with membership in Students Against Drunk Driving or acquaintance with someone having sustained a head or spinal cord injury. After the program, students were more likely to believe that there were actions they could take to keep from getting injured (P less than 0.0001). However, there was no change in self-reported seat belt use and most students reported that they "never" wore a bike helmet. The findings suggest that the THINK FIRST program is appropriate and beneficial for viewing by middle school-aged students.

Adolescent↗

Effect of neuromuscular electrical stimulation on foot/ankle volume during standing.

PURPOSE: The purpose of this study was to assess whether the increase in foot and ankle volume after 30 min of motionless standing in healthy subjects could be minimized by neuromuscular electrical stimulation (NMES). METHODS: A crossover, counterbalanced design was used where foot and ankle volume in 20 healthy subjects was measured using water volumetry before and after 30 min of motionless standing and standing with NMES applied to the lower leg muscles. The NMES produced repeated tetanic contractions of the gastrocnemius and tibialis anterior muscles causing slight ankle dorsi- and plantar-flexion. RESULTS: Posttest foot and ankle volume was significantly greater than pretest volume after 30 min of motionless standing (t = -7.093, P < 0.001), but no significant differences were found after 30 min of standing with NMES (t = -1.374, P = 0.185). The mean volume changes from pretest to posttest in the conditions without NMES and with NMES were significantly different (51 +/- 32 mL and 12 +/- 39 mL, respectively; t = 3.905, P = 0.001). CONCLUSION: This study demonstrates the potential uses of NMES as a means to reduce swelling in the lower limbs for individuals who do not fully activate the musculo-venous pump. The activation of the musculo-venous pump by NMES-induced muscle contraction may have minimized the increase in foot and ankle volume by increasing venous return, reducing venous stasis, increasing lymph flow, and increasing interstitial hydrostatic pressure, which would reduce capillary filtration and assist fluid reabsorption.

Adult↗

Impact of stretch-shortening cycle rest interval on in vivo muscle performance.

INTRODUCTION: Overuse and overtraining models have implicated both metabolic and mechanical disturbances as contributors to muscle damage and performance decrement but have produced equivocal results. The purpose of the present study was to investigate the impact of rest interval between sets of stretch-shortening cycles (SSC) on static and dynamic muscle performance METHODS: Animals were randomly assigned to groups (N = 8 per group) of 10-s, 1-min, or 5-min rest between sets of isometric contractions (10-s, 1-min, or 5-min CON), or SSC (10-s, 1-min, or 5-min INJ). The dorsiflexor muscles were exposed in vivo to either seven sets of 10 SSC (500 degrees . s) or seven sets of isometric contractions. Performance was characterized by isometric exertions and positive, negative, and net work, at pretest, during the sets of SSC, and 48 h postexposure RESULTS: The isometric force at 48 h after the 10-s and 5-min INJ groups were statistically different from the 1-min group (P < 0.05), whereas there was no difference in the CON groups. Negative work of the INJ groups were statistically lower at 48 h than pretest values (P < 0.05), whereas there was no change in positive work. Of the real-time parameters, there was a difference in minimum force and positive work (P < 0.05) with treatment with the 10-s INJ group being most affected. CONCLUSION: SSC conducted at shorter work-rest cycles resulted in a more profound isometric force decrement 48 h postexposure, and in real-time changes in isometric prestretch force and positive work. These results indicate that short rest intervals between athletic or vocational tasks of heightened physical exertion (i.e., high intensity) may adversely affect performance and increase injury susceptibility.

Animals↗

An evaluation of the effects of a manual on management of HIV/AIDS symptoms.

The purposes of this study were to develop a symptom management manual for persons living with HIV disease and to evaluate the effects of the manual on symptom management and quality of life. After a careful review of the research literature and integrating related findings, a manual for managing HIV/AIDS symptoms was developed. A one-group pretest-posttest design was used with 31 HIV/AIDS patients recruited from one hospital in Taiwan that provides care for people with HIV/AIDS. Subjects were instructed on use of the manual, and completed the Chinese version of the Sign and Symptom Checklist for Persons with HIV and the HIV/AIDS Targeted Quality of Life Instrument for the pretest and two posttests (at one month and three months after the initial session). Results indicated that these participants' symptom intensity was significantly improved at posttest, but their quality of life did not show significant changes at either posttest. Based on the results of this study, the symptom management manual can be used as a teaching tool for clinical health-care providers to decrease these patients' symptom distress.

Adult↗