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PubMed2004

Eye movements and behavioral responses to threatening and nonthreatening stimuli during visual search in phobic and nonphobic subjects.

Spider-phobic and nonphobic subjects searched for a feared/fear-relevant (spider) or neutral target (mushroom) presented in visual matrices of neutral objects (flowers). In half of the displays, the mushroom target was paired with a spider distractor, or a spider target was paired with a mushroom distractor. Although all subjects responded faster to the neutral target than to the feared/fear-relevant target, phobics were slower to respond than nonphobics when a mushroom target was presented with a spider distractor. Their eyes appeared to be drawn to the feared distractor before fixating neutral targets. A further experiment indicated no group differences when subjects merely judged the homogeneity of matrices. Thus, threat seems to capture the attention of phobics only when it is part of a background that subjects are explicitly instructed to ignore.

Adult↗

PubMed2005

A mechanism for impaired fear recognition after amygdala damage.

Ten years ago, we reported that SM, a patient with rare bilateral amygdala damage, showed an intriguing impairment in her ability to recognize fear from facial expressions. Since then, the importance of the amygdala in processing information about facial emotions has been borne out by a number of lesion and functional imaging studies. Yet the mechanism by which amygdala damage compromises fear recognition has not been identified. Returning to patient SM, we now show that her impairment stems from an inability to make normal use of information from the eye region of faces when judging emotions, a defect we trace to a lack of spontaneous fixations on the eyes during free viewing of faces. Although SM fails to look normally at the eye region in all facial expressions, her selective impairment in recognizing fear is explained by the fact that the eyes are the most important feature for identifying this emotion. Notably, SM's recognition of fearful faces became entirely normal when she was instructed explicitly to look at the eyes. This finding provides a mechanism to explain the amygdala's role in fear recognition, and points to new approaches for the possible rehabilitation of patients with defective emotion perception.

Adult↗

PubMed1998

Body posture during simulated tracheal intubation.

Seventeen experienced anaesthetists and 15 novices were filmed intubating the trachea of a training manikin. Measurements were made of the distance from manikin's chin to subject's nose and of the angles at the elbow, the shoulder and of the forearm with the horizontal. Trained subjects stood further back (trained: median 43 cm, interquartile range 41-56 cm; novices 35 cm, 26-38 cm; Mann-Whitney U, p < 0.01), with a straighter arm (trained elbow angle: 108 degrees, 99-121 degrees; novices': 92 degrees, 88-102 degrees; Mann-Whitney U, p < 0.01). Trained subjects tended to hold the laryngoscope closer to the hinge, with a pincer grip; novices were more likely to use a full grip of the handle. Trainers should consider giving novices explicit instructions on how to stand and how to hold the laryngoscope.

Anesthesiology↗

PubMed2005

Self-regulation after traumatic brain injury: a framework for intervention of memory and problem solving.

Self-regulation of behavior is mediated by the frontal lobes and commonly disrupted after a traumatic brain injury. The rehabilitation field is only now beginning to understand self-regulation as a set of dynamic relationships between metacognitive beliefs and knowledge, ongoing self-monitoring or self-assessment during activities, and self-control (i.e., strategy decisions). This article provides a framework for understanding self-regulated learning and problem solving, along with a summary of the existing intervention literature. We conclude by providing clinicians with principles that emphasize accurate self-monitoring and explicit instruction to connect self-monitoring to strategy decisions.

Amnesia↗

PubMed2002

Influence of tab and disk design on shade matching of dental porcelain.

STATEMENT OF PROBLEM: Given the complexity of tooth color, the variations of shade within each tooth, and translucency, it is difficult to view only one small area and select a shade match for restorations. PURPOSE: This study tested the effect of specimen design on porcelain shade matching, hypothesizing that flat disks would be matched to one another with more accuracy than tooth-shaped tabs to tabs. MATERIALS AND METHODS: All testing was conducted in a Macbeth SpectraLight booth with D65 illumination. Seventy-three senior dental students (25 women and 48 men; mean age, 27 years) were asked to match selected Vita porcelain disks and Vita shade tabs to like specimens. The design order, namely matching tabs or disks first, was alternated for each observer. The specimens were handed to the observer individually. No time limit for matching was imposed, although each observer was given explicit instructions related to the observation and handling of the specimens. Upon completion of the matching exercises, each student received his or her standardized test results and reviewed the matching results. The time for testing and review was approximately 20 minutes per observer. An analysis of variance, with gender and order as 2 factors that could affect matching scores, was performed (P <.05). RESULTS: The mean matching scores were 78.4% for disks and 73.6% for tabs (P=.119). Female observers matched 76.5% of the disks and 77.5% of the tabs, whereas male observers matched 79.4% of the disks and 71.6% of the tabs (P=.054). Matching disks before tabs yielded equivalent levels of shade matching (disks, 77.6%; tabs, 77.1%). When tabs were matched first, the scores were as follows: disks, 79.8%, and tabs, 67.3% (P=.010). CONCLUSIONS: Within the limitations of this study, there was no significant difference in shade-matching accuracy between the 2 shapes, although the order of design matching resulted in a difference in shade-matching ability. When tabs were matched first and disks second, improved matching was evident on the second test. The reverse was not true; no learning was demonstrated when the tabs were matched after the disks.

Adult↗

PubMed1992

The complex role of perceptual organization in visual display design theory.

Two experiments were performed to test and extend the current 'emergent features' approach to display design for dynamic failure detection tasks. It was predicted that a display whose emergent features were well-mapped to goal-relevant task invariants would lead to better failure detection performance than either of two alternative displays. Contrary to prediction. Experiment 1 showed no differences in failure detection speed or accuracy across displays. The reason for this may have been that subjects did not discover the mapping between the mathematical properties of the task and the emergent feature, so in Experiment 2 subjects were explicitly instructed about the mapping and were advised on how to use the display geometry to help their performance. A significant difference in failure detection speed emerged, but the display supporting fastest performance was not the one with the well-mapped emergent feature. These results suggest that alternative perceptual organizational factors were at work which overpowered the intended effect. The results also underscore the difficulty of developing a theory of display design, and their impact on current theories is outlined.

Adult↗

PubMed1980

Hypertensive emergencies: practical approach to treatment.

In a hypertensive crisis, an antihyprtensive agent must be able to reduce blood pressure to safe levels rapidly and predictably. Parenteral therapy is usually necessary, and in general, agents that can be infused and titrated are preferable to those that cannot. This article tells which drugs to use in specific situations and gives explicit instructions for intravenous and oral administration.

Administration, Oral↗

PubMed2006

Intention in motor learning through observation.

The purpose of this experiment was to assess whether learning an action through observation is enhanced by the intention to reproduce the observed behaviour. Two groups of participants observed a model practise a timing task and performed a 24-hour delayed retention test. Participants in the first group of observers were explicitly instructed that they would be required to execute the timing task that they had observed as accurately as possible during the delayed retention test. Observers in the second group were instructed that they would be required to describe as accurately as possible the behaviour that they had observed. A control group of participants, who did not observe the model, was also administered the delayed retention test. The results of the retention test indicated that absolute timing (parameterization) was learned by the observers to the same extent with or without intention to reproduce the task. Indeed, on the retention test absolute timing for the two groups of observers was as effective as that for the models. However, observing with an intention to reproduce the task was beneficial for learning the movement's relative timing structure. Results are discussed with respect to a potential mechanism by which intention enhances observation.

Adolescent↗

PubMed2001

Contextual dependencies in predictive learning.

Two experiments assessed contextual dependencies in a predictive-learning task. Subjects learned to associate each of four pictorial stimuli with the occurrence or non-occurrence of a specific outcome. Each of these stimuli, the intentional stimuli, was presented against one of two different visual (Experiment 1) or auditory (Experiment 2) context stimuli. These context stimuli were incidental: subjects were not explicitly instructed to pay any attention to them and each of them in isolation was not predictive of the outcome. During acquisition and testing, subjects expressed the expected relationship between intentional stimulus and outcome by an appropriate key press. At test, intentional stimuli were presented either with the same contextual stimulus as also present during acquisition (same trials), or with the other one (switched trials). The response latency was slower on switched trials than on same trials in each experiment, a result extending previous findings on the effect of environmental contextual stimuli on task performance. Results are discussed in the framework of contextual occasion setting and habituation to contextual stimuli.

Adolescent↗

PubMedDate not supplied

Directed remembering: subliminal cues alter nonconscious memory strategies.

Much research on memory function has focused on changes in recognition performance brought about by differences in the processes engaged during encoding. In most of this work, participants either receive explicit instructions to remember particular items or they perform orienting (i.e., encoding) tasks that support different levels of memory performance. In daily life, however, the retention or dismissal of information often occurs without conscious intent, thereby suggesting an alternative, nonconscious route through which purposive remembering and forgetting can occur. Based on this line of reasoning, we speculated that recognition performance in a standard item-based forgetting paradigm may be moderated by subliminal cues that trigger the automatic activation of different mnemonic strategies. We report the results of two experiments that supported this prediction. In each experiment, the basic item-based forgetting effect was replicated, but via the subliminal presentation of "remember" and "forget" cues. In addition, cue-dependent differences in memory performance were traced to the operation of a covert rehearsal mechanism during encoding. We consider the implications of these findings for the non-conscious#10; operation of memory processes in everyday life.

Adult↗

PubMed2002

The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening.

OBJECTIVE: To explore the acceptability of the self-collection of samples for human papillomavirus (HPV) testing in comparison with that of the Pap test. METHODS: The study population consisted of 1069 women 20 years and older who were eligible for coverage through the Mexican Institute of Social Security (IMSS). These women were randomly selected among participants in a larger study to evaluate the use of HPV testing as an alternative in cervical cancer screening. All participants provided a self-collected vaginal sample for HPV testing according to explicit instructions and underwent a Pap test. Afterwards, each woman was interviewed about her experience and opinion regarding the two procedures. Acceptability was measured by a calculated score based on discomfort, pain, embarrassment, privacy, perception of personal treatment during the Pap test, and understanding of how to perform the self-sampling method. RESULTS: Ninety-three percent of women experienced sufficient privacy with the Pap test, whereas 98% of women reported that privacy with the self-sampling procedure was acceptable. The Pap test consistently provoked more discomfort, pain, and embarrassment than self-sampling. Sixty-eight percent of the women who indicated a test preference chose self-sampling. Preference for this method was positively associated with monthly household income. Women reported a preference for self-sampling because it is more comfortable (71.2%) and causes less embarrassment (55.8%). CONCLUSIONS: Self-sampling is more acceptable than the Pap test and could improve coverage rates of early detection programs. The incorporation of self-collected samples to detect HPV could encourage participation in screening programs among those women who reject the Pap test because of the necessary pelvic examination.

Adult↗

PubMed1996

Influence of motivation of care providers on the incidence of postoperative hypoxaemia in the recovery room.

We have studied the influence of motivation of care providers on the incidence and duration of postoperative hypoxaemia in the recovery room. In a prospective, switch-back designed cohort study, we have compared the incidence of low pulse oximeter saturation values (SpO2) during pre-intervention, intervention and post-intervention phases. Low SpO2 values were classified as either hypoxaemia (SpO2 < or = 90%, minimum duration 1 min) or artefact. Pulse oximetry trend data from 1350 patients, 450 in each group, were analysed. During the intervention phase, motivation was increased by adding an explicit instruction to prevent and treat low SpO2 values and making personnel aware that they were being studied (Hawthorne effect). The incidence of hypoxaemia decreased significantly from 17.8% during the pre-intervention phase to 11.6% during the intervention phase (relative risk (RR) 0.65, 95% confidence interval (CI) 0.47-0.90; P < 0.01). The incidence of severe hypoxaemia (SpO2 < or = 85%, 1 min) decreased from 7.8% to 3.3% (RR 0.43, CI 0.24-0.76; P < 0.01). The number of patients who had severe hypoxaemia for more than 5 min decreased from 13 to 1 (RR 0.08, CI 0.02-0.36; P < 0.01). In the post-intervention period, the incidence of hypoxaemia returned to pre-intervention values. The results of this study suggest that motivation of care providers to prevent and treat low SpO2 is an important determinant of postoperative hypoxaemia in the recovery room.

Adolescent↗

PubMed2001

Prefrontal regions supporting spontaneous and directed application of verbal learning strategies: evidence from PET.

The prefrontal cortex has been implicated in strategic memory processes, including the ability to use semantic organizational strategies to facilitate episodic learning. An important feature of these strategies is the way they are applied in novel or ambiguous situations-failure to initiate effective strategies spontaneously in unstructured settings is a central cognitive deficit in patients with frontal lobe disorders. The current study examined strategic memory with PET and a verbal encoding paradigm that manipulated semantic organization in three encoding conditions: spontaneous, directed and unrelated. During the spontaneous condition, subjects heard 24 words that were related in four categories but presented in mixed order, and they were not informed of this structure beforehand. Any semantic reorganization was, therefore, initiated spontaneously by the subject. In the directed condition, subjects were given a different list of 24 related words and explicitly instructed to notice relationships and mentally group related words together to improve memory. The unrelated list consisted of 24 unrelated words. Behavioural measures included semantic clustering, which assessed active regrouping of words into semantic categories during free recall. In graded PET contrasts (directed > spontaneous > unrelated), two distinct activations were found in left inferior prefrontal cortex (inferior frontal gyrus) and left dorsolateral prefrontal cortex (middle frontal gyrus), corresponding to levels of semantic clustering observed in the behavioural data. Additional covariate analyses in the first spontaneous condition indicated that blood flow in orbitofrontal cortex (OFC) was strongly correlated with semantic clustering scores during immediate free recall. Thus, blood flow in OFC during encoding predicted which subjects would spontaneously initiate effective strategies during free recall. Our findings indicate that OFC performs an important, and previously unappreciated, role in strategic memory by supporting the early mobilization of effective behavioural strategies in novel or ambiguous situations. Once initiated, lateral regions of left prefrontal cortex control verbal semantic organization.

Acoustic Stimulation↗

PubMed1996

Evaluating the 'Labeled Magnitude Scale' for measuring sensations of taste and smell.

The Labeled Magnitude Scale (LMS) is a semantic scale of perceptual intensity characterized by a quasi-logarithmic spacing of its verbal labels. The LMS had previously been shown to yield psychophysical functions equivalent to magnitude estimation (ME) when gustatory, thermal and nociceptive stimuli were presented and rated together, and the upper bound of the LMS was defined as the 'strongest imaginable oral sensation'. The present study compared the LMS to ME within the more limited contexts of taste and smell. In Experiment 1, subjects used both methods to rate either taste intensity produced by sucrose and NaC1 or odor intensity produced by acetic acid and phenyl ethyl alcohol, with the upper bound of the LMS defined as either the 'strongest imaginable taste' or the 'strongest imaginable odor'. The LMS produced psychophysical functions equivalent to those produced by ME. In, Experiment 2 a new group of subjects used both methods to rate the intensity of three different taste qualities, with the upper bound of the LMS defined as the 'strongest imaginable [sweetness, saltiness, or bitterness]'. In all three cases the LMS produced steeper functions than did ME. Experiment 3 tested the hypothesis that the LMS yields data comparable to ME only when the perceptual domain under study includes painful sensations. This hypothesis was supported when the LMS again produced steeper functions that ME after subjects had been explicitly instructed to omit painful sensations (e.g. the 'burn' of hot peppers) from the concept of 'strongest imaginable taste'. We conclude that the LMS can be used to scale sensations of taste and smell when they are broadly defined, but that it should be modified for use in scaling specific taste (and probably odor) qualities. The implications of these results for theoretical issues related to ME, category-ratio scales and the size of the perceptual range in different sensory modalities are discussed.

Acetic Acid↗

PubMed1988

Probing prefrontal function in schizophrenia with neuropsychological paradigms.

In a recent series of studies we have attempted to clarify the nature of intellectual impairment in schizophrenia, and in particular, how patterns of dysfunction implicate specific neural systems. First, we found that acute psychotic adolescent patients displayed the same pattern of IQ scores (Performance less than Verbal) as adult chronic schizophrenic patients. We explored this deficit in problem solving by studying the performance of schizophrenic patients after receiving concrete and explicit instructions on how to do the Wisconsin Card Sorting Test, a task thought to be mediated by prefrontal cortex. We then studied the differential impact such a deficit in problem-solving strategies might have on a task thought to elicit both cognitive (prefrontal) and procedural or motor-skill (basal ganglia) processing. Procedural components appeared to be relatively more intact. We also addressed schizophrenic patients' ability to learn in other (extrafrontal) cognitive domains through verbal memory tasks and block design puzzles. Learning occurred under both conditions. We believe the overall pattern of deficit implicates primarily prefrontal neural systems, though a number of other neuropsychological functions are yet to be surveyed.

Frontal Lobe↗

PubMedDate not supplied

Evaluating content validity for children's self-report instruments using children as content experts.

BACKGROUND: The development and evaluation of instruments to index cognitive and emotional processes from the perspectives of children is a priority for pediatric nursing research. OBJECTIVE: To describe the procedures used in employing children as content validity experts in the development of a self-report instrument. METHODS: Following published recommendations for moving from qualitative research to quantitative measurement with adults and for maximizing content validity in self-report instruments, six children aged 8-16 years undergoing treatment for cancer constituted the panel of content experts for review of a measure of children's illness-related uncertainty derived from qualitative interviews. Children were provided with an explanation of the project, an explanation of their role as experts, and explicit instructions on how to evaluate the representativeness of individual items and the total scale. RESULTS: Generally, the children performed the review tasks effectively, although two children (ages 8 and 16 years) had initial difficulty in going beyond their own experience when considering the relevance of individual items. Twenty items were deemed acceptable by at least five out of the six children and two additional items were revised based on their input. DISCUSSION: Employing children as content validity experts adds a critical dimension to establishing psychometrically sound measures for studying the processes affecting the health of children and families.

Adolescent↗

PubMedDate not supplied

A statistical process control case study.

Statistical process control (SPC) charts can be applied to a wide number of health care applications, yet widespread use has not occurred. The greatest obstacle preventing wider use is the lack of quality management training that health care workers receive. The technical nature of the SPC guarantees that without explicit instruction this technique will not come into widespread use. Reviews of health care quality management texts inform the reader that SPC charts should be used to improve delivery processes and outcomes often without discussing how they are created. Conversely, medical research frequently reports the improved outcomes achieved after analyzing SPC charts. This article is targeted between these 2 positions: it reviews the SPC technique and presents a tool and data so readers can construct SPC charts. After tackling the case, it is hoped that the readers will collect their own data and apply the same technique to improve processes in their own organization.

Data Interpretation, Statistical↗

PubMed2003

Conversational fluency of children who use cochlear implants.

PURPOSE: Children who have significant hearing loss often experience difficulty in engaging in everyday conversations. They may spend an inordinate amount of time in communication breakdown or in silence. The purpose of the present investigation was to assess the oral conversation fluency of young cochlear implant users using both objective and subjective measuring procedures. Conversational fluency relates to how smoothly a conversation unfolds. The children's performance was compared with that of children who have normal hearing, and related to other measures of communication skill and other child variables. DESIGN: One hundred eighty-one cochlear implant users and 24 children with normal hearing engaged in conversations with a clinician, using an oral mode of communication. Audio-video tapes of the conversations were analyzed to yield the following measures: percent of time the child and clinician spent trying to repair a breakdown in communication, percent of time the two spent sitting in silence, and the ratio between the amount of time the child spoke and the amount of time the clinician spoke. In addition, for the cochlear implant users, 10 judges viewed excerpts of the tapes and gave their impressions and reactions to the children and their conversations, using five-point rating scales. The objective and subjective measures were related to the children's speech intelligibility, mean length utterance, and speech recognition in both an auditory-only and auditory-plus-vision condition. RESULTS: The cochlear implant users spent significantly more time in communication breakdown and in silence than the children with normal hearing, and children who are in an educational placement that emphasizes oral communication spent less time in breakdown than children who are in educational placement that use both speech and sign. Speech intelligibility and receptive language were the best predictors of communication breakdown. Judges perceived children who spent less time in communication breakdown more favorably than children who spent more time, and reacted to them more positively. Finally, there was a high correlation between the subjective measures of the conversation and the objective measures. CONCLUSIONS: Educational programs should provide explicit instruction to promote conversational fluency. The results show a need for communication therapy, and suggest that the children will be perceived and reacted to more favorably if they learn how to manage communication difficulties. The results also support the need for extensive speech-language therapy for these children. The objective measures employed in this investigation appear to be a valid and useful means for assessing conversational fluency.

Canada↗