Different Patterns Of Performance Research Articles

A Resident-Led Initiative to Increase Documentation of Surrogate Decision Makers for Hospitalized Patients.

Identification of surrogate decision makers (SDMs) is an important part of advance care planning for hospitalized patients. Despite its importance, the best methods for engaging residents to sustainably improve SDM documentation have not been identified. We implemented a hospital-wide quality improvement initiative to increase identification and documentation of SDMs in the electronic health record (EHR) for hospitalized patients, utilizing a Housestaff Quality and Safety Council (HQSC). EHR documentation of SDMs for all adult patients admitted to a tertiary academic hospital, excluding psychiatry, were tracked and grouped by specialty in a weekly run chart during the intervention period (July 2015 through April 2016). This also continued postintervention. Interventions included educational outreach for residents, monthly plan-do-study-act cycles based on performance feedback, and a financial incentive of a one-time payment of 0.75% of a resident's salary put into the retirement account of each resident, contingent on meeting an SDM documentation target. Comparisons were made using statistical process control and chi-square tests. At baseline, SDMs were documented for 11.1% of hospitalized adults. The intervention period included 9146 eligible admissions. Hospital-wide SDM documentation increased significantly and peaked near the financial incentive deadline at 48% (196 of 407 admissions, P < 001). Postintervention, hospital-wide SDM documentation declined to 30% (134 of 446 admissions, P < .001), but remained stable. This resident-led intervention sustainably increased documentation of SDMs, despite a decline from peak rates after the financial incentive period and notable differences in performance patterns by specialty admitting service.

Semantic and phonological aspects of lexical retrieval in bilingual aphasia

Semantic and phonological aspects of lexical retrieval in bilingual aphasia

Cognitive Contributors to Multiple Errands Test (MET) Performance

The Multiple Errands Test (MET) was designed to measure the effect of executive dysfunction on everyday life activities, but little is known about the cognitive requirements for successful performance. This study's objective was to investigate cognitive functions associated with successful MET performance, specifically, the Baycrest-MET. Correlation analysis examined relationships between Baycrest-MET performance and neuropsychological functioning in participants with acquired brain injury (ABI; N = 27). The association of tasks omitted with executive function (EF) accounted for 15.2%-42.3% of the variance; the association of tasks omitted with attention and processing speed, for 16.8%-24.0%; and the association of tasks omitted and total rule breaks with visuospatial memory, for 18.5%-31.4%. Poor performance on the Baycrest-MET in people with ABI is associated with impairments of EF, attention, memory, and processing speed. Different patterns of performance may arise from different constellations of impairments.

Stimulus similarity affects patterning discrimination learning.

In four experiments, participants' performance on a variety of nonlinear patterning discriminations was assessed using a predictive learning task and visual patterns. Between groups, the similarity of the stimuli that composed these visual patterns was manipulated. When the stimuli were of low similarity, participants' performance was consistent with the predictions of one version of Pearce's (1987, 1994, 2002) configural theory of learning (Kinder & Lachnit, 2003); they were better able to discriminate between different patterns when they shared few, rather than many, stimuli. This effect was not observed when the similarity of the stimuli was high. Under these conditions, the results were more consistent with predictions of elemental theories of learning (e.g., Rescorla & Wagner, 1972; Wagner, 2003). This is the first time that these different patterns of performance on complex patterning discriminations have been shown within a single stimulus modality in the same experiment. The overall pattern of results is difficult to reconcile with either elemental or configural models of associative learning. (PsycINFO Database Record

Context processing during irony comprehension in right-frontal brain-damaged individuals

ABSTRACTThe aim of the present study was to investigate whether the degree of incongruity between contextual information and a target sentence influences the extent to which irony is understood in individuals with right-frontal-hemisphere damage (RHD). A psycholinguistic paradigm was used, allowing us to assess whether impairment in irony understanding is likely to be due to insensitivity (i.e. difficulty in capturing or detecting relevant contextual information) to relevant contextual information or to difficulties in integrating contextual information. Twenty individuals with RHD and 20 healthy control (HC) participants were tested on their understanding of a speaker’s ironic intent and their executive functions. The main results revealed that individuals with RHD exhibit different patterns of performance, some of them being able to understand irony while in others this ability was impaired. The present study gives support to the hypothesis that difficulties in adequately using contextual information may account for pragmatic impairment of individuals with RHD. More importantly, the results suggested that these difficulties are related to a lack of sensitivity to contextual information instead of difficulty integrating it along with the ironic utterance. A subgroup of individuals with RHD processed the speaker’s utterance without any reference to contextual information, which led them to a literal interpretation of the utterance.

Differential patterns of performance on the DKEFS in the presence of pediatric mood disturbances

Differential patterns of performance on the DKEFS in the presence of pediatric mood disturbances

Differential impairments of upper and lower limb movements influence action verb processing in Parkinson disease

Theories of grounded cognition emphasize the role of the motor system in the processing of action concepts. The present study investigated whether persons with Parkinson disease (PD) who have greater upper versus greater lower limb motor impairments show different patterns of performance when processing action verbs. PD patients and controls made action decisions on upper-limb (reach), lower-limb (kick), and psych verbs (think). The primary result was an interaction between PD motor dominance (PD upper vs lower limb motor impairments) and verb type (upper- vs lower-limb verbs). PD patients with greater upper limb impairments took longer to respond to upper-limb than to lower-limb verbs, whereas those with greater lower limb impairments performed similarly on the two verb types. Our results add to recent studies and theories that highlight the complexity of verb impairments in PD, semantic task effects, effector-specific sensorimotor cortex engagement, and fine-grained semantic features and their possible interactions with effector-specific impairments.

Intercenter validation of a knowledge based model for automated planning of volumetric modulated arc therapy for prostate cancer. The experience of the German RapidPlan Consortium

PurposeTo evaluate the performance of a model-based optimisation process for volumetric modulated arc therapy applied to prostate cancer in a multicentric cooperative group. The RapidPlan (RP) knowledge-based engine was tested for the planning of Volumetric modulated arc therapy with RapidArc on prostate cancer patients. The study was conducted in the frame of the German RapidPlan Consortium (GRC).Methods and materials43 patients from one institute of the GRC were used to build and train a RP model. This was further shared with all members of the GRC plus an external site from a different country to increase the heterogeneity of the patient’s sampling. An in silico multicentric validation of the model was performed at planning level by comparing RP against reference plans optimized according to institutional procedures. A total of 60 patients from 7 institutes were used.ResultsOn average, the automated RP based plans resulted fully consistent with the manually optimised set with a modest tendency to improvement in the medium-to-high dose region. A per-site stratification allowed to identify different patterns of performance of the model with some organs at risk resulting better spared with the manual or with the automated approach but in all cases the RP data fulfilled the clinical acceptability requirements. Discrepancies in the performance were due to different contouring protocols or to different emphasis put in the optimization of the manual cases.ConclusionsThe multicentric validation demonstrated that it was possible to satisfactorily optimize with the knowledge based model patients from all participating centres. In the presence of possibly significant differences in the contouring protocols, the automated plans, though acceptable and fulfilling the benchmark goals, might benefit from further fine tuning of the constraints. The study demonstrates that, at least for the case of prostate cancer patients, it is possibile to share models among different clinical institutes in a cooperative framework.

The impact of memory load and perceptual cues on puzzle learning by 24-month olds.

Early childhood is characterized by memory capacity limitations and rapid perceptual and motor development [Rovee-Collier (1996). Infant Behavior & Development, 19, 385-400]. The present study examined 2-year olds' reproduction of a sliding action to complete an abstract fish puzzle under different levels of memory load and perceptual feature support. Experimental groups were compared to baseline controls to assess spontaneous rates of production of the target actions; baseline production was low across all experiments. Memory load was manipulated in Exp. 1 by adding pieces to the puzzle, increasing sequence length from 2 to 3 items, and to 3 items plus a distractor. Although memory load did not influence how toddlers learned to manipulate the puzzle pieces, it did influence toddlers' achievement of the goal-constructing the fish. Overall, girls were better at constructing the puzzle than boys. In Exp. 2, the perceptual features of the puzzle were altered by changing shape boundaries to create a two-piece horizontally cut puzzle (displaying bilateral symmetry), and by adding a semantically supportive context to the vertically cut puzzle (iconic). Toddlers were able to achieve the goal of building the fish equally well across the 2-item puzzle types (bilateral symmetry, vertical, iconic), but how they learned to manipulate the puzzle pieces varied as a function of the perceptual features. Here, as in Exp. 1, girls showed a different pattern of performance from the boys. This study demonstrates that changes in memory capacity and perceptual processing influence both goal-directed imitation learning and motoric performance.

Summary statistics in the attentional blink.

We used the attentional blink (AB) paradigm to investigate the processing stage at which extraction of summary statistics from visual stimuli ("ensemble coding") occurs. Experiment 1 examined whether ensemble coding requires attentional engagement with the items in the ensemble. Participants performed two sequential tasks on each trial: gender discrimination of a single face (T1) and estimating the average emotional expression of an ensemble of four faces (or of a single face, as a control condition) as T2. Ensemble coding was affected by the AB when the tasks were separated by a short temporal lag. In Experiment 2, the order of the tasks was reversed to test whether ensemble coding requires more working-memory resources, and therefore induces a larger AB, than estimating the expression of a single face. Each condition produced a similar magnitude AB in the subsequent gender-discrimination T2 task. Experiment 3 additionally investigated whether the previous results were due to participants adopting a subsampling strategy during the ensemble-coding task. Contrary to this explanation, we found different patterns of performance in the ensemble-coding condition and a condition in which participants were instructed to focus on only a single face within an ensemble. Taken together, these findings suggest that ensemble coding emerges automatically as a result of the deployment of attentional resources across the ensemble of stimuli, prior to information being consolidated in working memory.

Investigating the Effect of Self-, Peer-, and Teacher Assessment in Second Language Writing over Time: A Multifaceted Rasch Approach

This study investigated the accuracy of scores assigned by self-, peer-, and teacher assessors over time. Thirty-three English majors who were taking paragraph development course at Vali-e-Asr University of Rafsanjan and two instructors who had been teaching essay writing for at least two years at university, participated in the study. After receiving instructions on paragraph development, participants were trained for a session on how to rate the paragraphs. For three sessions the students were given topics to write about and were asked to rate their own and one of their peers’ papers for mechanics, grammar and choice of words, content development, and organization. The teachers also rated the paragraphs according to the same criteria. Multifaceted Rasch measurement was employed to analyze the data. The results showed different patterns of performance for the subjects rated by different raters at the beginning of the experiment. However, rater bias showed significant decrease across time. The results of the study have useful implications for language teachers especially in portfolio assessment where self and peer assessment provide invaluable help.

Relationship between mode of sport training and general cognitive performance

PurposeTo investigate whether athletes who engage in different modes of sports training correspondingly exhibit different patterns of performance on general cognition tasks. MethodsSixty participants were recruited into an endurance, motorically complex, or control group, and were administered a series of physical tests and neuropsychological assessments. ResultsAthletes in the endurance group demonstrated the highest levels of cardiovascular fitness and those in the motorically complex group exhibited the highest levels of motor fitness. Nonetheless, no differences in cognitive performance were observed between the 3 groups. ConclusionThese findings indicate that the mode of sport training, which results in either high cardiovascular or high motor fitness, bears no relationship to measures of general cognition in elite athletes. The present findings suggest that coaches and athletic trainers should be encouraged to monitor athletes' stress levels during training in order to maximize the beneficial effects of such training on general cognitive performance.

Are anxiety and fear separable emotions in driving? A laboratory study of behavioural and physiological responses to different driving environments

Research into anxiety and driving has indicated that those higher in anxiety are potentially more dangerous on the roads. However, simulator findings suggest that conclusions are mixed at best. It is possible that anxiety is becoming confused with fear, which has a focus on more clearly defined sources of threat from the environment, as opposed to the internal, thought-related process associated with anxiety. This research aimed to measure feelings of fear, as well as physiological and attentional reactions to increasing levels of accident risk. Trait anxiety was also measured to see if it interacted with levels of risk or its associated reactions. Participants watched videos of driving scenarios with varying levels of accident risk and had to rate how much fear they would feel if they were the driver of the car, whilst skin conductance, heart rate, and eye movements were recorded. Analysis of the data suggested that perceptions of fear increased with increasing levels of accident risk, and skin conductance reflected this pattern. Eye movements, when considered alongside reaction times, indicated different patterns of performance according to different dangerous situations. These effects were independent of trait anxiety, which was only associated with higher rates of disliking driving and use of maladaptive coping mechanisms on questionnaires. It is concluded that these results could provide useful evidence in support for training-based programmes; it may also be beneficial to study trait anxiety within a more immersive driving environment and on a larger scale.

Lexicality judgements in healthy aging and in individuals with Alzheimer's disease

Neighbourhood density (N) has been shown to influence how lexical stimuli are accessed. In young adults, a large N is facilitatory for words but inhibitory for pseudowords in English. While there is a paucity of studies probing N as people age, results to date point towards changes in lexical processing that occur with aging. We are not aware of any studies that have sought to investigate N in Alzheimer’s disease (AD) in English. Results from the lexical decision task reported here support previous N findings for young adults. However, older adults and those with AD showed a different pattern of performance. Both were slower to respond to and made more errors to high versus low N pseudowords but, unlike young adults, older adult groups showed a decrease in sensitivity to N for words. Results suggest that the aging process may change how N is processed; older individuals are no longer as sensitive to N and this appears to be further altered by AD. In the context of the multiple read-out model of lexical processing, this change may be due to a longer time required to activate lexical neighbours which, in turn, results in differential N effects for words and pseudowords.

La diffusione dei servizi online come indicatore della qualità del settore pubblico

This paper focuses on the role of public sector in shaping the competitiveness of national economic systems and proposes an alternative measure of the quality of public administrations based on the availability of public eService. Using the Eiburs-Taips database, which allows a comparative analysis of the diffusion of four typologies of public eService (eGovernment, Intelligent Transport Systems, eHealth, and eProcurement), different patterns of performance are highlighted across PAs at the national and local (city) levels in UE15. The use of novel e-service based indicators confirms that Mediterranean countries, including Italy, lag behind the best performers of Northern Europe. Over and above national differences, the degree of specialisation in service categories largely varies also within countries and across large cities in Europe, suggesting that public policies should be fine tuned in this respect. Italy exhibits a rather weak performance overall, and in the areas of Infomobility and eProcurement in particular, which appear to be the most urgent areas wherein a competitive gap must be filled relative to other UE countries.

A new modified listening span task to enhance validity of working memory assessment for people with and without aphasia

Deficits in working memory (WM) are an important subset of cognitive processing deficits associated with aphasia. However, there are serious limitations to research on WM in aphasia largely due to the lack of an established valid measure of WM impairment for this population. The aim of the current study was to address shortcomings of previous measures by developing and empirically evaluating a novel WM task with a sentence-picture matching processing component designed to circumvent confounds inherent in existing measures of WM in aphasia. The novel WM task was presented to persons with (n=27) and without (n=33) aphasia. Results demonstrated high concurrent validity of a novel WM task. Individuals with aphasia performed significantly worse on all conditions of the WM task compared to individuals without aphasia. Different patterns of performance across conditions were observed for the two groups. Additionally, WM capacity was significantly related to auditory comprehension abilities in individuals with mild aphasia but not those with moderate aphasia. Strengths of the novel WM task are that it allows for differential control for length versus complexity of verbal stimuli and indexing of the relative influence of each, minimizes metalinguistic requirements, enables control for complexity of processing components, allows participants to respond with simple gestures or verbally, and eliminates reading requirements. Results support the feasibility and validity of using a novel task to assess WM in individuals with and without aphasia.Learning outcomes: Readers will be able to (1) discuss the limitations of current working memory measures for individuals with aphasia; (2) describe how task design features of a new working memory task for people with aphasia address shortcomings of existing measures; (3) summarize the evidence supporting the validity of the novel working memory task.

Music as a mnemonic to learn gesture sequences in normal aging and Alzheimer's disease.

Strong links between music and motor functions suggest that music could represent an interesting aid for motor learning. The present study aims for the first time to test the potential of music to assist in the learning of sequences of gestures in normal and pathological aging. Participants with mild Alzheimer’s disease (AD) and healthy older adults (controls) learned sequences of meaningless gestures that were either accompanied by music or a metronome. We also manipulated the learning procedure such that participants had to imitate the gestures to-be-memorized in synchrony with the experimenter or after the experimenter during encoding. Results show different patterns of performance for the two groups. Overall, musical accompaniment had no impact on the controls’ performance but improved those of AD participants. Conversely, synchronization of gestures during learning helped controls but seemed to interfere with retention in AD. We discuss these findings regarding their relevance for a better understanding of auditory–motor memory, and we propose recommendations to maximize the mnemonic effect of music for motor sequence learning for dementia care.

Patients with impaired verb-tense processing: do they know that yesterday is past?

This paper begins with a focus on the task of stem inflection, where participants are given a verb stem and asked to produce the verb's past-tense form, which can produce a neuropsychological double dissociation with respect to regular versus irregular verbs. Two differing theoretical interpretations are outlined: one is based on specifically morphological and separate brain mechanisms for processing regular versus irregular verbs; the other argues that the two sides of the dissociation can arise from one procedure, which is not specifically morphological, and which relies to differing extents on phonological versus semantic information for regular versus irregular verbs. We then present data from a different version of the task, in which patients were given past-tense forms and asked to produce the present-tense or stem forms (talked → talk and ate → eat). This change yielded a very different pattern of performance in four non-fluent aphasic patients as a function of the regular-irregular manipulation, an outcome which is argued to be more compatible with the single- than the dual-mechanism account. Finally, we present a small amount of data from a task in which the patient was asked to judge whether spoken regular and irregular verb stems and past-tense forms indicated actions occurring today or yesterday. This task produced an even more different and intriguing pattern of performance suggesting a deficit in morpho-syntactic knowledge: not how to produce past-tense forms but what such forms mean and how that understanding interacts with verb regularity. The paper concludes with a discussion of how the research field of acquired disorders of tense processing might advance as a result of new approaches, in particular those informed by studies of developmental disorders.

The two sides of spatial representation in neglect patients: The same spatial distortion for different patterns of performance

Patients with neglect show disorders in horizontal space perception. It has been argued that these disorders may depend on a distortion of space that takes the form of a left–right relaxation of the representational medium that becomes progressively “relaxed” toward the contralesional space and progressively “compressed” toward the ipsilesional space (the space anisometry hypothesis). In the present paper we tested this hypothesis by using the Oppel–Kundt illusion that consists of the perception of a filled space as larger than an empty space of the same size. Two experiments were carried out with 14 brain-damaged patients with neglect, 9 brain-damaged patients without neglect and 12 healthy subjects. In the first experiment participants were requested to bisect and read words with different letter spacing simulating the way space is thought to be distorted in neglect. In the second experiment we asked the participants to physically and numerically bisect numerical intervals. The results of the two experiments are in line with the predictions of the space anisometry hypothesis. Specifically, with a background resembling the space distortion proposed by the space anisometry hypothesis, neglect signs are ameliorated in reading words and in numerically bisect numerical intervals, while they are worsened in bisecting words and physically bisect numerical intervals. These results support the idea that the abnormalities observed in typical neglect tests are due to a distorted internal representation of the outside world that takes the form of a mental continuum logarithmically distorted along the horizontal dimension.

Growing Up with Asperger’s Syndrome: Developmental Trajectory of Autobiographical Memory

Autobiographical memory (AM) and social cognition share common properties and both are affected in autism spectrum disorders (ASD). So far, most of the scant research in ASD has concerned adults, systematically reporting impairment of the episodic component. The only study to be conducted with children concluded that they have poorer personal semantic knowledge than typical developing children. The present study explores the development of both components of AM in an 8-year-old boy diagnosed with Asperger’s syndrome, based on three examinations in 2007, 2008, and 2010. On each occasion, he underwent a general neuropsychological assessment including theory of mind (ToM) tasks, and a specially designed AM task allowing us to test both the semantic and the episodic components for three lifetime periods (current year, previous year, and earlier years). We observed difficulties in strategic retrieval and ToM, with a significant improvement between the second and third examinations. Regarding AM, different patterns of performance were noted in all three examinations: (1) relative preservation of current year personal knowledge, but impairment for the previous and earlier years, and (2) impairment of episodic memory for the current and previous year, but performances similar to those of controls for the earlier years. The first pattern can be explained by abnormal forgetting and by the semanticization mechanism, which needs verbal communication and social interaction to be efficient. The second pattern suggests that the development of episodic memory only reached the stage of “event memory.” This term refers to memory for personal events lacking in details or spatiotemporal specificity, and is usually observed in children younger than five. We conclude that the abnormal functioning of social cognition in ASD, encompassing social, and personal points of view, has an impact on both components of AM.