Mean Confidence Rating Research Articles

You better listen to yourself: studying metacognitive efficiency in emotion recognition by voice

PurposeMetacognition, or the ability to monitor the performance of oneself, is known for its fundamental importance for human behavior adjustments. However, studies of metacognition in social behaviors focused on emotion recognition are relatively scarce. In the current study, we aimed to examine the effectiveness of metacognition, measured by self-rated confidence in voice emotion recognition tasks within healthy individuals.MethodsWe collected 180 audio-recorded lexical sentences portraying discrete emotions: anger, happiness, sadness, fear, surprise, and neutrality expressions. Upon listening to voice stimuli, participants (N = 100; 50 females, 50 males) completed the perception task of recognition of emotion. After each trial, a confidence rating (CR) was assigned.ResultsA series of one-tailed t-tests showed that the differences in mean CRs assigned to correct and incorrect performances were significant for all emotions and neutral expression.ConclusionsOur preliminary results demonstrate efficiency in metacognition of emotion recognition by voice. Theoretically, our results support the difference between accuracy in metacognition, measured by CR, and efficiency in metacognition, as it specified the CR between correct and incorrect performance. To gain better insights into practical issues, further studies are needed to examine whether and what are the differences between accuracy and efficiency in metacognition, as part of social communication.

O.2.2-10 Preventing and managing injuries in social sport programs

Abstract Purpose Safety is critical to participant recruitment and retention in social sport programs targeting insufficiently active (IA) people as their lack of fitness and limited previous exposure to physical activity likely places them at a higher risk of injury. This study sought to understand the injury prevention/management qualifications, knowledge, confidence and practices of program deliverers (coaches or instructors) across four social sport/active recreation programs targeting insufficiently active women. Methods Between 2021 and 2022, we sent an online survey via text message to 83 program deliverers in Victoria, Australia after they had delivered their social sport/active recreation programs to 1674 insufficiently active women. Delivers were asked their: age and gender; years delivering sport/physical activity programs targeting insufficiently active adults; injury prevention/management qualifications; and what injury prevention/management measures they undertook during programs. They also rated their knowledge of injury prevention/management measures (0 = none; 10 = comprehensive); and their confidence incorporating such measures into a program (0 = none; 10 = extremely). We analysed data using descriptive statistics. Results Sixty-eight program deliverers (response rate 82%) completed the deliverer survey. Their experience in delivering programs to insufficiently active participants was limited (62% < two years) but nearly all (90%) reported providing some form of injury prevention/management advice to program participants — warm up or cool down, activity recovery, skill or technique, and/or corrective footwear were most common, but the type of advice provided differed across the programs. Forty percent reported no formal injury prevention/management qualifications. Their mean self-rated knowledge of injury prevention/management measures was 5.7 out of 10 and their mean confidence rating for incorporating such measures into programs was 6.0. Nearly half (46%) reported low confidence (≤5 out of 10;). Conclusions While most program deliverers lacked formal qualifications, had limited injury prevention/management knowledge and/or low confidence, they provided some form of injury prevention/management advice to participants. Program delivers would benefit from increased injury prevention/management knowledge, capacity and/or capability to assist with the program experience, reduce injury risk for IA participants, and hopefully improve deliverer confidence. Advice given by deliverers with limited knowledge and experience should be monitored. Support/Funding Source Victorian Health Promotion Foundation (VicHealth).

Mixed-reality visualization in shoulder arthroplasty: is it better than traditional preoperative planning software?

Preoperative traditional software planning (TSP) is a method used to assist surgeons with implant selection and glenoid guide-pin insertion in shoulder arthroplasty. Mixed-Reality (MR) is a new technology that uses digital holograms of the preoperative plan and guide-pin trajectory projected into the operative field. The purpose of this study was to compare TSP to MR in a simulated surgical environment involving insertion of guide-pins into models of severely deformed glenoids. Eight surgeons inserted guide-pins into eight randomized three-dimensional-printed severely eroded glenoid models in a simulated surgical environment using either TSP or MR. In total, 128 glenoid models were used and statistically compared. The outcomes compared between techniques included procedural time, difference in guide-pin start point, difference in version and inclination, and surgeon confidence via a confidence rating scale. When comparing traditional preoperative software planning to MR visualization as techniques to assist surgeons in glenoid guide pin insertion, there were no statistically significant differences in terms of mean procedure time (P=0.634), glenoid start-point (TSP = 2.2 ± 0.2 mm , MR = 2.1 ± 0.1 mm; P=0.760), guide-pin orientation (P=0.586), or confidence rating score (P=0.850). The results demonstrate that there were no significant differences between traditional preoperative software planning and MR visualization for guide-pin placement into models of eroded glenoids. A perceived benefit of MR is the real-time intraoperative visibility of the surgical plan and the patient’s anatomy; however, this did not translate into decreased procedural time or improved guide-pin position. Level of evidence: Basic Science Study; Biomechanics.

BOLD fMRI and DTI fiber tracking for preoperative mapping of eloquent cerebral regions in brain tumor patients: impact on surgical approach and outcome.

Task-based BOLD fMRI and DTI-fiber tracking have become part of the routine presurgical work-up of brain tumor patients in many institutions. However, their potential impact on both surgical treatment and neurologic outcome remains unclear, in despite of the high costs and complex implementation. We retrospectively investigated whether performing fMRI and DTI-ft preoperatively substantially impacted surgical planning and patient outcome in a series of brain tumor patients. We assessed (i) the quality of fMRI and DTI-ft results, by using a scale of 0-2 (0 = failed mapping; 1 = intermediate confidence; 2 = good confidence), (ii) whether functional planning substantially contributed to defining the surgical strategy to be undertaken (i.e., no surgery, biopsy, or resection, with or without ESM), the surgical entry point and extent of resection, and (iii) the incidence of neurological deficits post-operatively. Twenty-seven patients constituted the study population. The mean confidence rating was 1.9/2 for fMRI localization of the eloquent cortex and lateralization of the language function and 1.7/2 for DTI-ft results. Treatment strategy was altered in 33% (9/27) of cases. Surgical entry point was modified in 8% (2/25) of cases. The extent of resection was modified in 40% (10/25). Onepatient (1/25, 4%) developed one new functional deficit post-operatively. Functional MR mapping - which must not be considered an alternative to ESM - has a critical role preoperatively, potentially modifying treatment strategy or increasing the neurosurgeons' confidence in the surgical approach hypothesized based on conventional imaging.

Stability and consistency of metamemory judgments within a session.

There has been much interest in assessing individual and group differences in metamemory skills. These endeavors require or would benefit from enhanced knowledge about the stability and consistency of metamemory judgments over successive trials. However, few studies have examined these aspects. Thus, the present study investigated and compared the within-session stability and consistency of three major types of metamemory judgment: judgment of learning (JOL), feeling-of-knowing judgment (FOK), and retrospective confidence judgment (RCJ), using a single-task paradigm. A total of 38 healthy young adults (17 males, 21 females) completed three trials of a face–scene associative learning task designed to assess metamemory. In each trial, participants rated their JOLs while studying a new set of face–scene pairs, and then rated their FOKs and RCJs while their memory was being tested. The stability and consistency of the mean confidence ratings and the relationships between confidence rating and memory performance, indexed by two gamma estimates, were analyzed and compared across types of metamemory judgments. Over trials, there was a significant decrease in the mean rating for JOL but not for FOK or RCJ. Also, the gamma scores of JOL, but not that of FOK or RCJ, significantly improved with practice. Furthermore, for each type of metamemory judgment, the mean confidence rating showed excellent consistency across trials. Depending on the judgment type and gamma estimation method, the consistency of gamma scores ranged from poor to excellent. Thus, the present study clarified the temporal dynamics of various types of metamemory judgments and the consistency of metamemory measures.

Sprinting technique and hamstring strain injuries: A concept mapping study

ObjectiveThe aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). DesignMixed-method research design. MethodsThe Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. ResultsTwenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: “low exposure to maximal sprint running” located in the cluster “Training prescription” received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. ConclusionThe five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

Monitoring the Own Spatial Thinking in Second Grade of Primary Education in a Spanish School: Preliminary Study Analyzing Gender Differences

Previous studies on metacognitive performance have explored children’s abilities during primary school (7–11 years) in abstract and mathematical reasoning tasks. However, there have been no studies evaluating the metamemory processes with spatial tasks in primary school children, and even more generally, only a few studies have explored spatial metacognition in adults. Taking as a preliminary study a Spanish school, the present work explores the validity of the confidence judgment model when thinking about one’s own performance in a spatial test, for boys and girls in Second Year of Primary Education (mean age of 7 years). A total of 18 boys and 15 girls applied a 4-point scale to evaluate, item by item, the confidence of their responses in the Spatial aptitude test “E” of the EFAI-1 (Factorial Assessment of Intellectual Abilities to mentally process visual stimuli). Accessibility and Accuracy Indexes were calculated for each item of the spatial task. The effect of gender was analyzed too. The tasks were administered in small groups; at the end examiners interviewed each participant, performing the confidence judgment task, item by item, of the EFAI-1 previously answered. The results (analyses carried out by SPSS) showed a high mean confidence (3 mean points out of a maximum of 4), without finding any significant differences either in the spatial performance or in the mean confidence rating between boys and girls. A significant relationship between confidence judgments and spatial task performance accuracy was found. The relationship between confidence judgments and spatial performance cannot be confirmed. The procedure adapted for testing spatial judgments about the own responses has been useful for showing the well calibrated perception about performance at this stage. The implications of the results of this exploratory study and the potential of the application of the procedure to promote thought about one’s own spatial performance and the development of strategies that modulate the effective approach of this type of spatial tasks are discussed within an educational approach.

Infectious diseases and antimicrobial prescribing: Online spaced education for junior doctors

BackgroundInappropriate antimicrobial prescribing may harm patients and drive antimicrobial resistance. Junior doctors’ knowledge of infectious diseases and antimicrobial prescribing is inadequate. Online spaced case-based learning can improve knowledge. ObjectiveTo develop infectious diseases and antimicrobial prescribing course content for online spaced education and assess its effectiveness and feasibility for junior doctors. MethodsInfectious diseases and antimicrobial course content was developed for an online spaced education platform (Qstream Inc., Burlington, MA). Junior doctors (postgraduate years 1–3) at two tertiary teaching hospitals in Sydney participated in the study. Course content was provided with Qstream at one hospital and at the other hospital via two face-to-face (FTF) tutorials from August to October 2017. Knowledge and self-confidence were compared before and after training within and between both cohorts. ResultsParticipation in the course was higher in the Qstream cohort with 48/127 (37.8%) completing the course compared with 44/110 (40%) attending one or both FTF sessions, of whom 22/110 (20%) attended both. Improvement in mean knowledge score from 69.7% to 81.5% in the Qstream cohort was significantly greater than the FTF cohort's minimal improvement from 67.6% to 67.9% (95% CI 2.79–20.33; P=0.01). In the Qstream cohort mean confidence rating (0–10) improvement from 5.14 to 6.55 was greater than the FTF group improvement from 5.37 to 5.85 (95% CI 0.132–1.171; P=0.02). Qstream feedback was very positive. ConclusionsOnline spaced education in infectious diseases and antimicrobial prescribing was feasible, acceptable and effective for junior doctors. It has potential to reduce inappropriate antimicrobial prescribing and warrants further investigation.

Metacognition across sensory modalities: Vision, warmth, and nociceptive pain

The distinctive experience of pain, beyond mere processing of nociceptive inputs, is much debated in psychology and neuroscience. One aspect of perceptual experience is captured by metacognition—the ability to monitor and evaluate one’s own mental processes. We investigated confidence in judgements about nociceptive pain (i.e. pain that arises from the activation of nociceptors by a noxious stimulus) to determine whether metacognitive processes contribute to the distinctiveness of the pain experience. Our participants made intensity judgements about noxious heat, innocuous warmth, and visual contrast (first-order, perceptual decisions) and rated their confidence in those judgements (second-order, metacognitive decisions). First-order task performance between modalities was balanced using adaptive staircase procedures. For each modality, we quantified metacognitive efficiency (meta-d’/d’)—the degree to which participants’ confidence reports were informed by the same evidence that contributed to their perceptual judgements—and metacognitive bias (mean confidence)—the participant’s tendency to report higher or lower confidence overall. We found no overall differences in metacognitive efficiency or mean confidence between modalities. Mean confidence ratings were highly correlated between all three tasks, reflecting stable inter-individual variability in metacognitive bias. However, metacognitive efficiency for pain varied independently of metacognitive efficiency for warmth and visual perception. That is, those participants who had higher metacognitive efficiency in the visual task also tended to have higher metacognitive efficiency in the warmth task, but not necessarily in the pain task. We thus suggest that some distinctive and idiosyncratic aspects of the pain experience may stem from additional variability at a metacognitive level. We further speculate that this additional variability may arise from the affective or arousal aspects of pain.

Examining the knowledge base and level of confidence of early childhood educators in physical literacy and its application to practice

ABSTRACT Early childhood is an opportune time to develop physical literacy, acquire movement skills, and promote physical activity. Little is known about early childhood educators’ competence (ECEs) and confidence in physical literacy knowledge and its application to practice. The purpose of this research was to examine the competence and confidence of ECEs in physical literacy, and to determine whether exposure to information in this area influences their confidence level. A total of 85 participants completed an online survey. Physical activity knowledge was high; however, error detection and correction knowledge was lower, with high variability in responses. Mean confidence rating (out of 10) was lowest for locomotor skill error detection and correction (6.4 ± 1.8) and highest for physical activity promotion (7.7 ± 1.6). Confidence in movement skill development decreased significantly pre- to post-survey (p < 0.001); highlighting a potential ‘topic exposure’ effect. These findings demonstrate the need for physical literacy training for ECEs.

Case Reporting, Competence, and Confidence: A Discrepancy in the Numbers

The Accreditation Council for Graduate Medical Education (ACGME) continues to play an integral role in accreditation of surgical programs. The institution of case logs to demonstrate competency of graduating residents is a key component of evaluation. This study compared the number of vascular cases a surgical resident has completed according to the ACGME operative log to their operative proficiency, quality of anastomosis, operative experience, and confidence in both a simulation and operative setting. General surgery residents ranging from PGY 1 to 5 participated in a simulation laboratory in which they completed an end-to-side vascular anastomosis. Each participant was given a weighted score based on technical proficiency and anastomosis quality using a previously validated Global Rating Scale (Duran et al, 2014). These scores were correlated to the General Surgery Milestones. Participants completed preoperative and postoperative surveys assessing resident operative experience using the 4-level Zwisch scale (DaRosa et al., 2013), confidence with vascular procedures and confidence performing simulated anastomoses. Confidence was assessed on a scale from 1 to 9 (not confident to extremely confident). Case logs were recorded for each participant. An IRB approved questionnaire was distributed to assess preoperative and postoperative roles of both the resident physician and faculty, with a defined goal. Univariate and multivariate analysis was performed. Twenty-one general surgery residents were evaluated in the simulation laboratory and 8 residents were assessed intraoperatively. The residents were evenly distributed throughout clinical years. Groups of residents were divided into quartiles based upon the number of vascular cases recorded in the ACGME database. No correlation was found between number of cases, Milestones score and the weighted score (p = 0.94). No statistical significance was found between confidence and quality of anastomosis (p = 0.1). Resident operative experience per the Zwisch scale was categorized most commonly as "Smart Help" by both the trainee and attending surgeon, despite mean resident confidence ratings of 6.67 (± 1.61) with vascular procedures. ACGME case logs, which are utilized to assess readiness for completion of general surgery residency, may not be indicative of a resident's operative competency and technical proficiency. Confidence is not correlated with technical ability. Faculty and resident insight as to their role in a procedure differ, as faculty feel that they are providing less help than the resident perceives. Careful examination of resident operative technique is the best measure of competency.

CONFIDENCE IN PERFORMING PEDIATRIC MUSCULOSKELETAL EXAMINATIONS IN CANADIAN PEDIATRIC RESIDENTS

BACKGROUND: Pediatric Musculoskeletal (pMSK) complaints are common and lead to important diagnostic considerations. However, international studies suggest that pediatric health providers (residents and consultants) are not confident in their pMSK assessments. At present, little is known about the confidence of Canadian pediatric residents in performing MSK examinations. OBJECTIVES: Our study evaluates the confidence of Canadian pediatric residents in performing pMSK examinations. In a subgroup of residents, we assessed changes in confidence after targeted training. DESIGN/METHODS: All pediatric residents enrolled in an accredited Canadian pediatric residency during the 2015-2016 academic year were invited to participate in an anonymous nationwide questionnaire. Survey respondents rated their confidence in performing pMSK examinations alone and in comparison to other body systems using a 10-point Likert scale. Pediatric residents enrolled in two centers participated in a one-day standardized pMSK examination workshop to learn the pediatric Gait, Arms, Legs, and Spine exam, a validated screening tool to facilitate pediatric joint examination; focused regional joint examinations were also reviewed. A follow-up confidence questionnaire was distributed immediately and six months’ after the intervention. RESULTS: 143 pediatric residents from 14 Canadian residency programs responded to the nationwide survey. Of the respondents, 56% (n=80) were previously taught the pMSK examination yet only 14% (n=20) reported routinely examining a child’s musculoskeletal system as part of a complete physical examination. The vast majority of respondents were “somewhat confident” with their pMSK examination, with an average confidence level of 4.6 (95%CI 4.3-4.9; 1=No confidence, 10=Very confident). Confidence was lower in comparison to cardiovascular, respiratory, and abdominal exams, but higher in comparison to peripheral nervous system and ophthalmologic examinations. In our subgroup analyses (n=50), we found an average increase in confidence by 2.1 points immediately after the intervention, from an initial confidence level of 4.9 (95% CI 4.5-5.4) to 7.1 (95% CI 6.6-7.5). This increase was sustained with a mean confidence rating of 6.9 (95% CI 6.1-7.7) six months post-workshop. The most frequently reported barriers to musculoskeletal examination confidence were limited practice (n=34,68%) and limited training opportunities (n=19,38%). CONCLUSION: Few Canadian pediatric trainees perform a pMSK examination as part of a complete examination, and self-rated confidence in pMSK examination was evaluated as “average” by the majority. We demonstrate that a standardized educational intervention can lead to increased confidence in performing pMSK examinations, but a decline in confidence is observed with time and without consistent practice.

Metacognition and abstract reasoning.

The nature of people's meta-representations of deductive reasoning is critical to understanding how people control their own reasoning processes. We conducted two studies to examine whether people have a metacognitive representation of abstract validity and whether familiarity alone acts as a separate metacognitive cue. In Study 1, participants were asked to make a series of (1) abstract conditional inferences, (2) concrete conditional inferences with premises having many potential alternative antecedents and thus specifically conducive to the production of responses consistent with conditional logic, or (3) concrete problems with premises having relatively few potential alternative antecedents. Participants gave confidence ratings after each inference. Results show that confidence ratings were positively correlated with logical performance on abstract problems and concrete problems with many potential alternatives, but not with concrete problems with content less conducive to normative responses. Confidence ratings were higher with few alternatives than for abstract content. Study 2 used a generation of contrary-to-fact alternatives task to improve levels of abstract logical performance. The resulting increase in logical performance was mirrored by increases in mean confidence ratings. Results provide evidence for a metacognitive representation based on logical validity, and show that familiarity acts as a separate metacognitive cue.

Development of a behaviour change communication tool for medical students: The ‘Tent Pegs’ booklet

ObjectiveTo describe the development and validation of a behaviour change communication tool for medical students. MethodsBehaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the ‘Tent Pegs’ booklet) and validated using discriminant content validity methods with 11 expert judges. ResultsOne-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p≤0.002). Only BCTs within the ‘empowering people to change’ domain were not significantly different from the value zero (mean confidence rating=1.2, p>0.05); these BCTs were most frequently allocated to the ‘addressing thoughts and emotions’ domain instead. ConclusionBCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the ‘empowering people to change’ domain. Practice implicationsThe existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients.

Confidence and accuracy of lineup selections and rejections: Postdicting rejection accuracy with confidence

Correlation and calibration approaches show meaningful, positive confidence-accuracy relations for witnesses making selections from lineups, but rarely for rejections (Brewer & Wells, 2006; Sauerland & Sporer, 2009). This disparity may reflect the difference between selecting a single photo versus rejecting a set of photos. Participants (N=101) in two experiments made selections from and rejections of lineups in situations requiring either a single confidence rating about a single face (typical of “choosers”) or a single confidence rating about multiple faces (typical of “nonchoosers”). Mean confidence ratings were significantly higher for accurate versus inaccurate decisions for both selections and rejections when decisions were based on single faces. Single decisions about multiple faces produced no significant difference in confidence between correct and incorrect rejections but a significant difference for selections.

Speech-language pathologists’ knowledge of genetics: Perceived confidence, attitudes, knowledge acquisition and practice-based variables

The purpose of this study was to determine (a) the general knowledge bases demonstrated by school-based speech-language pathologists (SLPs) in the area of genetics, (b) the confidence levels of SLPs in providing services to children and their families with genetic disorders/syndromes, (c) the attitudes of SLPs regarding genetics and communication disorders, (d) the primary sources used by SLPs to learn about genetic disorders/syndromes, and (e) the association between general knowledge, confidence, attitudes, the number of years of experience working as an SLP, and the number of children currently provided services with genetic disorders/syndromes on SLPs’ caseloads. Survey data from a nationwide sample of 533 SLPs was analyzed. Results showed SLPs earned a median knowledge score about genetics of 66% correct responses. Their mean confidence and attitude ratings were in the “unsure” categories while they reported they learned about genetics from three main sources, (a) self-study via web and internet-based searches, (b) on-the-job training and (c) popular press magazines and newspapers. Analyses revealed that Confidence summary scores, Attitude Summary scores, the number of children with genetic disorders/syndromes on SLPs’ caseloads are positively associated with the ratings of participants with the highest Knowledge scores.Learning outcomes: Readers will be able to (a) explain the important links between developmental and communication disabilities and genetics, (b) describe the associations between knowledge about genetics and confidence, attitudes, and the number of children with genetic disorders/syndromes on their caseloads, and (c) outline the clinical and theoretical implications of the results from this study.

A NOVEL SIMULATION MODEL FOR MINIMALLY INVASIVE SPINE SURGERY

Minimally invasive spine surgery (MISS) is among the fastest growing technologies in general neurosurgical practice. In addition, great demand exists to teach these skills to neurosurgery residents. With newly enforced work hour restrictions, opportunities to acquire these skills are limited, necessitating development of alternative strategies of education. We describe a novel simulation model for MISS supplemented by resident self-assessment analysis and evaluation. The simulator was constructed using a nontransparent Plexiglas frame supplemented with a modified halo frame on which to affix spine specimens. Interchangeable copper tubing was affixed to a 360-degree pivot system to replicate a working portal. Deer skulls and spines were then collected and prepared accordingly. Laboratory exercises were based on the resident's level of training with emphasis on proper drilling techniques. Eight neurosurgery residents were asked to complete the exercises and complete a self-assessment survey regarding their competence level on a scale of 0 to 5, both before and after completing the skill sets. Additionally, they were asked to complete an exit survey that was used to assess the simulation exercises. All exercises were completed successfully with the exception of placing 2 separate pedicle screws through the same portal, which posed difficulty on some specimens because of the of lack of lordosis of the specimens, leading to unfavorable trajectories using a free-hand technique. With regard to the resident self-assessment analysis, the mean confidence rating for performing an MISS laminectomy improved by a difference of 1.25 points (n = 8; 95% confidence interval, 0.66-1.84; P = 0.0015), from 2.50 to 3.75 before and after simulation exercises, respectively, and reached statistical significance. For the senior-level residents, the mean confidence rating for performing MISS placement of pedicle screws using a free-hand technique improved by a difference of 1.00 (n = 3; 95% confidence interval, -1.48-3.48; P = 0.225), from 3.33 to 4.33 before and after simulation exercises, respectively. Results of the exit survey were encouraging. The MISS simulator is a feasible, inexpensive, and reproducible adjunct to neurosurgery resident training and provides a new teaching method for spine surgery. Further investigation of this technology is warranted, although multicenter, randomized, controlled trials assessing its validity may not be practical because of ethical constraints with regard to patient safety.

Anchoring effects in the judgment of confidence: Semantic or numeric priming?

Over the last decade, researchers have debated whether anchoring effects are the result of semantic or numeric priming. The present study tested both hypotheses. In four experiments involving a sensory detection task, participants first made a relative confidence judgment by deciding whether they were more or less confident than an anchor value in the correctness of their decision. Subsequently, they expressed an absolute level of confidence. In two of these experiments, the relative confidence anchor values represented the midpoints between the absolute confidence scale values, which were either explicitly numeric or semantic, nonnumeric representations of magnitude. In two other experiments, the anchor values were drawn from a scale modally different from that used to express the absolute confidence (i.e., nonnumeric and numeric, respectively, or vice versa). Regardless of the nature of the anchors, the mean confidence ratings revealed anchoring effects only when the relative and absolute confidence values were drawn from identical scales. Together, the results of these four experiments limit the conditions under which both numeric and semantic priming would be expected to lead to anchoring effects.

質問紙評定過程における参照情報―他者行動の評定―

Participants (N = 153) rated intentionality (with a confidence rating) of 10 behaviors from the observer's perspective. There were three conditions of behaviors: behavior-only, behavior with-reason, or behavior with-cause conditions. Significant differences between the means for all of the behavior conditions were found for both intentionality and confidence ratings, and interactions of Condition x Behavior also significant. When the intentionality values were transformed with a V-shaped function, the means of the transformed values significantly increased along with the mean confidence rating in the with-reason and with-cause conditions. In addition, the across-participant correlations between intentionality and confidence for each behavior were negative when the intentionality mean was near the minimum, and the correlations were positive when the intentionality mean was large; this trend was close to a linear function. These findings suggest that the intentionality rating was based on both a binary judgment and a confidence value.

Acute Appendicitis: Added Diagnostic Value of Coronal Reformations from Isotropic Voxels at Multi–Detector Row CT

To assess retrospectively the added value of coronal reformations from isotropic voxels obtained with 16-section multi-detector row computed tomography (CT) of the abdomen and pelvis in patients with suspected acute appendicitis. This study was approved by the institutional review board, and informed consent was waived. One hundred consecutive patients (21 men, 79 women; mean age, 38 years) with suspected appendicitis underwent 16-section multi-detector row CT (section thickness, 0.625 mm; pitch, 1.75; table speed, 35 mm/sec [17.5 mm per rotation, two rotations]; and gantry speed, 0.5 second per rotation), with coronal reformations. Twenty-four patients had appendicitis; 76 did not. Protocol included 150 mL oral iopamidol administered at 3 mL/sec. Transverse scans were reconstructed with 5-mm-thick sections at 5-mm intervals and 0.625-mm-thick sections at 0.625-mm intervals. The second data set was reformatted coronally, with 3-mm-thick sections at 5-mm intervals. Three independent blinded readers interpreted transverse scans alone and then coronal scans; confidence in visualization of any portion of appendix, entire appendix, wall thickening, distention, inflammation, fluid, and appendicitis was scored with 1-5 scale. Sensitivity and specificity were determined for each reader and compared by means of signed rank test. Agreement between readers was determined with kappa statistic. Differences in mean confidence ratings for each finding were determined with Wilcoxon signed rank test. Mean sensitivity and specificity for all three readers together were 96% and 95% for transverse reformations alone and 95% and 94% for combined transverse and coronal reformations (not significant), respectively. Visualization rates for portion or all of appendix were higher for combined transverse and coronal reformations than for transverse reformations alone (higher mean confidence scores: 0.23 higher [P < .009] and 0.51 higher [P < .001], respectively). In patients without appendicitis, transverse and coronal reformations together enhanced confidence in exclusion of wall thickening, distention, and fluid (lower confidence scores: 0.21 lower [P < .001], 0.17 lower [P < .01], 1.00 lower [P < .001], respectively). Combined transverse and coronal reformations enhanced confidence in identification of appendix in mean of 57 patients. Combined transverse and coronal scans helped exclude appendicitis in mean of 38 patients and aided diagnosis of it in 15. Sixteen-section multi-detector row CT transverse and coronal reformations are equally sensitive and specific for diagnosis of appendicitis. Coronal reformations improve confidence in visualization of appendix (whether diseased or normal) and in diagnosis or exclusion of appendicitis.