Cognitive Barrier Research Articles

Reducing 30-Day Readmissions in Transplant Patients With a Multidisciplinary Team: Fruitful or Futile?

Introduction: Due to increased morbidity in patients readmitted post-kidney transplant, our institution implemented a protocol, Reducing Re-Admissions & Improving Sustained Compliance (RRISC), with the goal of reducing readmission rates by incorporating a multidisciplinary team approach to post transplant follow up care. Methods: A team was created consisting of a nephrologist, transplant social worker, post-transplant clinical coordinator, transplant pharmacist, and coordinator. Patients were identified based on the following criteria: hospital length of stay (LOS) >9 days, diabetes (uncontrolled, new onset, or new insulin requiring), drains or catheters present, cognitive barrier to learning, poor social support, HIV, delayed graft function, language barrier, history of substance abuse, re-transplant due to non-compliance, age < 25 or >70, discharged to a rehab facility, or financial constraints. After discharge, RRISC patients received daily phone calls by the coordinator until seen by a nephrologist, and twice weekly clinic visits (alternating specialty) in addition to standard of care. During each RRISC visit the patient's blood pressure, urine output, blood sugars, education (ability to follow medication list), compliance and social support was assessed. Patient progress and readmissions at 30 and 90 days were monitored by the RRISC team through weekly meetings. Readmissions were recorded and categorized. Results: During the first 6 months of 2013, 82 patients received a kidney transplant and 19 were enrolled in the RRISC protocol. All RRISC patients were seen by a transplant coordinator, 18 seen by a transplant pharmacist, and 18 seen by a transplant social worker. Readmission rates at 30 and 90 days over the 2 quarters were 20.7% and 29.2% while readmission rates for the 6 months prior were 23.8% and 34.3% respectively. Reasons for readmission included complication of transplant (53%), medical illness (22%), metabolic disorder (22%), and non-compliance (3%). Conclusion: We created a multidisciplinary team successful at following patients after transplantation. Readmissions continued to be present and were often for medical problems that may not have been preventable. Longer follow up is required to see if our multidisciplinary approach to higher risk patients will reduce long term readmission rates or affect patient or graft survival.

I Scratch and Sense But Can I Program?

This article reports an investigation into undergraduate student experiences and views of a visual or ‘blocks' based programming language and its environment. An additional and central aspect of this enquiry is to substantiate the perceived degree of transferability of programming skills learnt within the visual environment to a typical mainstream textual language. Undergraduate students were given programming activities and examples covering four basic programming concepts based on the Sense programming language which is intended to simplify programming. Sense programming statements are represented by blocks which only fit together in ways that produce a meaningful syntactic outcome, which may lower the cognitive barrier to learning. Students were also presented with concepts represented using an equivalent textual construct and asked to consider their understanding of these based on the graphical cases. They were finally asked to complete a short online survey. This paper presents the programming activities, the survey and an analysis of the results.

Barriers for early detection of cancer amongst Indian rural women.

Context:Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. Healthcare providers in developing countries regularly see women with advanced, incurable cancers. Health of a rural Indian women and her access to health facility is compromised due to sociocultural, economical, and environmental factors.Aims:To know the problems associated with early detection of cancers in rural women.Settings and Design:Rural area and cross-sectional.Subjects and Methods:Study subject: Women of 35 years and above. Exclusion criteria: Not willing to participate. Sample size: All eligible women of selected villages.Sampling Technique:Random selection of villages. Study duration: 2 months. Study tools: Pretested questionnaire.Statistical Analysis Used:Percentages, χ2 test, analysis of variance (ANOVA), multivariate analysis.Results:Awareness about symptoms, possibility of early detection, available tests, possibility of cure of disease was low. Main barrier for screening was cognitive, that is, ‘don’t know’ answer by 83.99% women for cancer cervix, 84.93%, for cancer breast, and 67.26% for oral cancer. Awareness score was significantly associated with age (χ2 = 17.77, P = 0.001), education (χ2 = 34.62, P = 0.000), and income (χ2 = 16.72, P = 0.002); while attitude score with age (χ2 = 16.27, P = 0.012) and education (χ2 = 25.16, P = 0.003). Practice score was significantly associated with age (χ2 = 11.28, P = 0.023), education (χ2 = 32.27, P = 0.003), and occupation (χ2 = 10.69, P = 0.03). Awareness, attitude, and practice score of women having history of cancer in family or relative was significantly high than women without history.Conclusions:Cognitive barrier was the important barrier which has to be taken care of.

Intravenous infusion of nerve growth factor‐secreting monocytes supports the survival of cholinergic neurons in the nucleus basalis of meynert in hypercholesterolemia brown‐norway rats

The recruitment of monocytes into the brain has been implicated in Alzheimer's disease and recent studies have indicated that monocytes can reduce amyloid plaque burden. Our previous investigations have shown that hypercholesterolemic rats develop cognitive, cholinergic, and blood-brain barrier dysfunction, but do not develop amyloid plaques. This study was designed to evaluate the effects of repeated intravenous (i.v.) infusion (via the dorsal penile vein) of primary monocytes on cognition, the cholinergic system, and cortical cytokine levels in hypercholesterolemia Brown-Norway rats. In addition, we also transduced the monocytes with nerve growth factor (NGF) to evaluate whether these cells could be used to deliver a neuroprotective agent to the brain. Our results indicate that repeated i.v. infused monocytes migrate into the brains of hypercholesterolemic rats; however, this migration does not translate into marked effects on learning. Animals receiving NGF-loaded monocytes demonstrate slightly improved learning and significantly elevated cholinergic neuron staining compared to treatment with monocytes alone. Furthermore, our data indicate that repeated infusion of monocytes does not lead to elevated cytokine secretion, indicating that no inflammatory response is induced. This study provides an experimental attempt to evaluate the effects of blood-derived primary monocytes in hypercholesterolemia rats.

The digital revolution in geologic mapping

Geologic field data collection, analysis, and map compilation are undergoing a revolution in methods, largely precipitated by global positioning system (GPS) and geographic information system (GIS) equipped mobile computers paired with virtual globe visualizations. Modern, ruggedized personal digital assistants (PDAs) and tablet PCs can record a wide spectrum of geologic data and facilitate iterative geologic map construction and evaluation on location in the field. Spatial data, maps, and interpretations can be presented in a variety of formats on virtual globes, such as Google Earth and NASA World Wind, given only a basic knowledge of scripting languages. As a case study, we present geologic maps assembled in Google Earth that are based on digital field data. Interactive features of these maps include (1) the ability to zoom, pan, and tilt the terrain and map to any desired viewpoint; (2) selectable, draped polygons representing the spatial extent of geologic units that can be rendered semi-transparent, allowing the viewer to examine the underlying terrain; (3) vertical cross sections that emerge from the subsurface in their proper location and orientation; (4) structural symbols (e.g., strike and dip), positioned at outcrop locations, that can display associated metadata; and (5) other data, such as digital photos or sketches, as clickable objects in their correct field locations. Google Earth–based interactive geologic maps communicate data and interpretations in a format that is more intuitive and easy to grasp than the traditional format of paper maps and cross sections. The virtual three-dimensional (3-D) interface removes much of the cognitive barrier of attempting to visualize 3-D features from a two-dimensional map or cross section. Thus, the digital revolution in geologic mapping is finally providing geosci entists with tools to present important concepts in an intuitive format understandable to the expert and layperson alike.

Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization

Targets for peritoneal dialysis (PD) utilization may be difficult to achieve because many older patients have contraindications to PD or barriers to self-care. The objectives of this study were to determine the impact that contraindications and barriers to self-care have on incident PD use, and to determine whether family support increased PD utilization when home care support is available. Consecutive incident dialysis patients were assessed for PD eligibility, offered PD if eligible and followed up for PD use. All patients lived in regions where home care assistance was available. The average patient age was 66 years. One hundred and ten (22%) of the 497 patients had absolute medical or social contraindications to PD. Of the remaining 387 patients who were potentially eligible for PD, 245 (63%) had at least one physical or cognitive barrier to self-care PD. Patients with barriers were older, weighed less and were more likely to be female, start dialysis as an inpatient and have a history of vascular disease, cardiac disease and cancer. Family support was associated with an increase in PD eligibility from 63% to 80% (P = 0.003) and PD choice from 40% to 57% (P = 0.03) in patients with barriers to self-care. Family support increased incidence PD utilization from 23% to 39% among patients with barriers to self-care (P = 0.009). When family support was available, 34% received family-assisted PD, 47% received home care-assisted PD, 12% received both family- and home care-assisted PD, and 7% performed only self-care PD. Incident PD use in an incident end-stage renal disease (ESRD) population was 30% (147 of the 497 patients). Contraindications, barriers to self-care and the availability of family support are important drivers of PD utilization in the incident ESRD population even when home assistance is available. These factors should be considered when setting targets for PD.

Creativity in Biological Research

During the past century, several biologists have studied the mental processes involved in creativity. In recent years psychologists have approached the subject experimentally. In one such study (Carson, Peterson, and Higgins 2003), creativity has been shown to originate in the subconscious mind and to be transmitted to the conscious mind as a result of a decrease in latent inhibition, an ordinarily strong cognitive barrier between the conscious mind and the subconscious. In my scientific work I have found evidence for creativity in the design of experiments, in which the addition of apparently superfluous controls has led to important discoveries.

Informing Parents About Expanded Newborn Screening: Influences on Provider Involvement

Expanded newborn screening (NBS) identifies some disorders for which clinical benefit is uncertain, as well as "incidental" findings (eg, carrier status), thus enhancing the need to inform parents about NBS before sample collection. A self-complete survey was sent to a cross-sectional, stratified, random sample of 5 provider groups in Ontario (obstetricians, midwives, family physicians, pediatricians, and nurses). Univariate and multivariate analyses were used to investigate the effects of core beliefs, perceived barriers, and demographic characteristics on the reported frequency of informing parents about NBS before sample collection. Virtually all of the midwives and almost half of the nurses reported discussing NBS with parents, whereas less than one sixth of the physicians did so. Providers who perceived a responsibility to inform parents were 3 times more likely to report doing so than those who did not perceive this responsibility (odds ratio: 2.9 [95% confidence interval: 2.1-4.1]). Those who lacked confidence to inform parents were 70% less likely to discuss NBS with parents compared with those who did not experience this cognitive barrier (odds ratio: 0.3 [95% confidence interval: 0.2-0.4]). Controlling for these covariates, family physicians and obstetricians were more likely than pediatricians to inform parents. These results provide guidance for capacity building among providers who are positioned to inform parents about NBS before sample collection. Our findings call for targeted educational interventions that consider patterns of provider practice related to prenatal and NBS care, seek to redress confidence limitations, and engage key provider groups in the importance of this professional responsibility.

The many levels of CSCL

Pierre Dillenbourg and Fabrice Hong bring our flash theme of scripting to a conclusion with a pedagogical design model for scripting classroom activities. Their theoretical framework for conceptualizing and structuring pedagogical scripts defines three primary social levels on which learning, interaction and knowledge building can take place: that of the individual student, the small workgroup and the class as a whole (including the teacher). An effective script not only works on a given level, but more importantly relates the activities at each level to each other to form an effective integrated pedagogical process. The authors propose their suggestive SWISH principle as a stimulus for collaborative learning. Collaboration, they argue, takes place most effectively in a relatively unconstrained small group process of peers working together to overcome some cognitive barrier to the shared accomplishment of a joint task. In order to set up the groups oriented to their tasks and to introduce the barriers without interfering with the self-directed nature of small-group collaboration, a script specifies how to form small groups and organize tasks while operating on the teacher-centered classroom level, and then “split when interaction should happen” (SWISH) onto the small-group level. Following the collaboration phase, the script then specifies individualand class-level activities to share, solidify and internalize the knowledge building that took place in the groups.While supporting the idea that small-group interaction is key to collaborative learning, the article stresses the essential role of integrating that interaction in coherent processes involving individual and class activities as well. This recognition represents a major step forward for CSCL theory. The article provides a detailed analytic framework for thinking about and supporting this complex and often overlooked need for an effective pedagogy that integrates across social levels. Computer-Supported Collaborative Learning (2008) 3:1–4 DOI 10.1007/s11412-007-9036-y

M2S maps: supporting real-world navigation with mobile VR

Mobile devices are becoming increasingly integrated into our society. In addition to entertaining people with applications like pervasive games, mobile devices can also help to address cognitive challenges people face in the real world. This paper, by drawing on research findings from cognitive psychology and geography, explores a design to use mobile VR to help people overcome one cognitive barrier in navigation, which is to establish the correspondence between 2D spatial information found in maps and 3D entities they perceive from the real world. The design offers users multi-format, multi-scale, and semantic (M2S) maps, ranging from 2D maps to 3D immersive environments, and helps users to connect 2D maps to the real world through 3D environments which are equipped with semantic representation and animation techniques. Consequently, users can apply various kinds of spatial knowledge, 2D or 3D, in understanding the real world as well as assisting in navigation. This research enhances the design repertoire of mobile VR, and suggests a way to integrate virtual environments into people’s real-world life by examining the cognitive implications of 3D models on users’ activities.

High-School Students' Attitudes Regarding Procedural Abstraction

During the last decade a new computer science curriculum has been taught in Israeli high schools. This curriculum introduces CS concepts and problem-solving methods independently of specific computers and programming languages, along with the practical implementation of those concepts and methods encountered in actual programming languages. The advanced study unit of the curriculum, Software Design, introduces the students to various aspects of software systems design through the use of abstract data types (ADTs). One main goal of the unit is to develop abstract thinking skills and problem-solving abilities. More specifically, the unit presents principles such as procedural abstraction, data abstraction, information hiding, modularity, efficiency, and reuse of code. We present the results of a preliminary study whose aim was to assess students' attitudes regarding procedural abstraction. The research population consisted of high-school students who attended the Software Design course (beginners), and a control group of undergraduate CS students (advanced). The results of the study clearly indicated a significant difference between the attitudes of the two groups. We found that the advanced students preferred algorithms that were formulated to some extent with high-level abstraction; however, they encountered a cognitive barrier when dealing with algorithms that they had evaluated as too abstract for them. However, beginners felt more comfortable with algorithms with low-level abstraction. Nevertheless they showed open-mindedness toward some degree of procedural abstraction. The results of the study were used to design scaffolding problem-solving tools for algorithm development, utilizing procedural abstraction techniques that can be adapted to various student populations (Haberman, B. (2002) SIGCSE Bulletin, 34(4), 60–64).

Reductive Reasoning: A Cognitive Barrier to Visual Literacy

The human mind, on its own, is easily overwhelmed by the multi-faceted relationships inherent in complicated management issues. Graphical displays are often used in an attempt to reduce cognitive overload. Results of an empirical investigation into the effectiveness of relational diagrams designed for use in the management of complexity are presented. These graphical displays provide a figurative, rather than literal, portrayal of reality. Their logic is based on inference rather than causality. We testedfirst-time viewer ability to interpret a modestly sized diagrammatic display of problem elements and their interrelationships. Results showed significant misinterpretation of the diagram. Study participants were highly schooled technically oriented individuals attending a mid-career course in management. Analysis of responses to questions about the meaning of the display indicated that participants were predisposed to reductive reasoning with emphasis on cause and effect as a principle mode of thought.

The effect of accuracy of perceptions of dietary-fat intake on perceived risk and intentions to change.

Consumption of excess fat increases risk for many health problems and diseases. In the present study, 188 undergraduate students were studied to understand self-perceptions of dietary-fat intake and the impact of those perceptions. Findings indicated that the majority of participants had inaccurate perceptions about the amount of fat in their diets. Further, compared to people who overestimated dietary-fat intake, people who underestimated fat intake had lower perceived risk of cancer, had lower intentions to change, and demonstrated less knowledge about the dietary-fat content of many foods. Findings suggest that this unrealistic underestimation of fat intake is a cognitive barrier to dietary change and people who underestimate dietary fat intake may require more intensive intervention to change their diets.

Artificial intelligence in power system operations

Power system operators often reach a cognitive barrier when information arrives too fast during a power system emergency. At such times it becomes difficult to reach a correct diagnosis of the problem or to formulate the correct decision when actions must be taken. Artificial Intelligence gives designers of Energy Management Systems a way to solve many of the diagnosis and decision problems so as to make the EMS more useful. This paper explores reasons why AI techniques, such as knowledge-based expert systems, are being used in EMS designs and the differences between knowledge-based expert systems and traditional numeric algorithm development. The differences between expert systems and the numeric approach extend to the basic conception and design of the applications. This is illustrated using a relay fault diagnosis system, showing both the traditional and rapid prototyping approaches to its development. Finally, issues concerned with the implementation of AI in EMS computers are explored along with the authors' predictions of possible AI applications to power system operations.

Overfamiliarity: A Cognitive Barrier in Teaching Composition

Overfamiliarity: A Cognitive Barrier in Teaching Composition

A method to break the cognitive barrier between a deaf child and a hearing parent.

A deaf child actively uses about 1000 concepts in common with the hearing world. The rest of his up to 10,000 concepts belong to sign language and cannot be accurately translated into written language. This makes it difficult for the deaf to understand a normal written text, especially its abstractions. We have developed a new communication system in order to break the barrier between the hearing and the deaf. In this system a deaf child speaks with a writing hand-piece terminal through an FM route to a small unlimited text-to-speech synthesizer carried by the parent. The parent answers similarly to a 48-grapheme alphanumerical display carried by the child on a rack in front of him. The parent's unit with a speech synthesizer weighs about 2 kg and its size is about 7 X 20 X 25 cm; the size of the child's unit is one half of that and it weighs, with the display, 2 kg. Even a 4-year-old child carries the apparatus easily; nevertheless a still lighter unit is under construction. The system takes the learning process to everyday situations and makes it possible for a deaf child to converse in the normal written and spoken language. Thus, his concept capacity in the spoken language can be increased.