Out of sight, out of mind: why doesn't widespread clinical quality failure command our attention?
(17/1546)
This paper examines the tolerance by all stakeholders of increasingly well documented evidence of serious and widespread clinical quality failure in the United States. Using research evidence from psychology, it describes specific cognitive and motivational impediments to the perception of quality failure-those shared by all stakeholders and those particularly relevant to patients and their families and to health care professionals. The authors endorse efforts by the National Quality Forum and others to make quality failure more publicly visible. They also point to the pivotal role of health care industry leaders in sustaining focus on a problem that inherently resists visibility. (+info)
Hierarchical processing in spoken language comprehension.
(18/1546)
Understanding spoken language requires a complex series of processing stages to translate speech sounds into meaning. In this study, we use functional magnetic resonance imaging to explore the brain regions that are involved in spoken language comprehension, fractionating this system into sound-based and more abstract higher-level processes. We distorted English sentences in three acoustically different ways, applying each distortion to varying degrees to produce a range of intelligibility (quantified as the number of words that could be reported) and collected whole-brain echo-planar imaging data from 12 listeners using sparse imaging. The blood oxygenation level-dependent signal correlated with intelligibility along the superior and middle temporal gyri in the left hemisphere and in a less-extensive homologous area on the right, the left inferior frontal gyrus (LIFG), and the left hippocampus. Regions surrounding auditory cortex, bilaterally, were sensitive to intelligibility but also showed a differential response to the three forms of distortion, consistent with sound-form-based processes. More distant intelligibility-sensitive regions within the superior and middle temporal gyri, hippocampus, and LIFG were insensitive to the acoustic form of sentences, suggesting more abstract nonacoustic processes. The hierarchical organization suggested by these results is consistent with cognitive models and auditory processing in nonhuman primates. Areas that were particularly active for distorted speech conditions and, thus, might be involved in compensating for distortion, were found exclusively in the left hemisphere and partially overlapped with areas sensitive to intelligibility, perhaps reflecting attentional modulation of auditory and linguistic processes. (+info)
Cigarette smoking and cognitive decline in midlife: evidence from a prospective birth cohort study.
(19/1546)
OBJECTIVES: The authors investigated the effects of cigarette smoking on midlife cognitive performance. METHODS: Multiple regression was used to test the association between cigarette smoking and changes in cognitive test scores among male and female members of the British 1946 birth cohort aged between 43 and 53 years. RESULTS: Smoking was associated with faster declines in verbal memory and with slower visual search speeds. These effects were largely accounted for by individuals who smoked more than 20 cigarettes per day and were independent of sex, socioeconomic status, previous (adolescent) cognitive ability, and a range of health indicators. CONCLUSIONS: The present results show that heavy smoking is associated with cognitive impairment and decline in midlife. Smokers who survive into later life may be at risk of clinically significant cognitive declines. (+info)
Informed consent in a clinical trial of a novel treatment for rheumatoid arthritis.
(20/1546)
OBJECTIVE: To evaluate the informed consent process for a clinical trial of intravenous doxycycline for rheumatoid arthritis. METHODS: Participants completed a self-administered questionnaire about the consent process at baseline and 16 weeks following enrollment in a clinical trial. RESULTS: Respondents (n = 30) affirmed voluntary participation in the parent trial. Participants acknowledged hope and altruism as reasons for entering the trial more than expectation of personal benefit or outside influences. Many respondents did not understand randomization (14/30), placebos (15/30), or risks of study medications; 11/30 respondents believed that the study drug was completely safe. CONCLUSION: Respondents generally understood the experimental nature of the trial and confirmed their participation was voluntary. However, gaps existed in participants understanding of trial design, raising the question of whether they were adequately informed about the research study prior to enrollment. Further education of potential participants in clinical trials may be required to achieve valid informed consent. (+info)
The unique ethical challenges of conducting research in the rehabilitation medicine population.
(21/1546)
BACKGROUND: The broad topic of research ethics is one which has been relatively well-investigated and discussed. Unique ethical issues have been identified for such populations as pediatrics, where the issues of consent and assent have received much attention, and obstetrics, with concerns such as the potential for research to cause harm to the fetus. However, little has been written about ethical concerns which are relatively unique to the population of patients seen by the practitioner of rehabilitation medicine. DISCUSSION: This paper reviews unique ethical concerns in conducting research in this population, including decision-making capacity, communication, the potential for subject overuse, the timing of recruitment, hope for a cure and therapeutic misconception and the nature of the health care provider-research subject relationship. SUMMARY: Researchers in the area of rehabilitation medicine should be aware of some of the unique ethical challenges posed by this patient population and should take steps to address any potential concerns in order to optimize subject safety and ensure that studies meet current ethical guidelines and standards. (+info)
The impact of gender on high-stakes dental evaluations.
(22/1546)
The purpose of this study was to determine whether gender affects high-stakestest performance among dental students. Our sample consisted of 128 women and 323 men from six consecutive dental classes for which we recorded AADSAS overall and science predental GPAs; Dental Admission Test (DAT) scores; National Board Dental Examination (NBDE) I and II scores and pass/fail status; North East Regional Board of Dental Examiners (NERB) pass/fail status; and cumulative GPAs following the spring quarter of year two and summer quarter of year four of dental school. DAT scores, when controlled for previous academic performance, revealed that men significantly outperformed women in all areas except reading comprehension and biology, where the women's scores significantly exceeded the men's and were comparable, respectively. NBDE I results favored men and approached significance (p = 0.066), while for Part II men significantly outscored women. NBDE I and II and NERB pass rates showed no significant differences. These board results were also controlled for previous academic performance. Although we found that differences existed between genders, which appear to be the ramification of the classic high-stakes dilemma (women do as well as men in the classroom and on course-related tests, but less well on gatekeeper board exams), the context mitigates their operational effects. DAT differences are likely reduced by most admissions processes, but may be problematic when selected predictive algorithms are used. Practically, the NBDE I and II results are unlikely to meaningfully influence women's academic progress in dental school or postgraduate education admissions due to their magnitude and timing. (+info)
Using video modeling and reinforcement to teach perspective-taking skills to children with autism.
(23/1546)
We evaluated video modeling and reinforcement for teaching perspective-taking skills to 3 children with autism using a multiple baseline design. Video modeling and reinforcement were effective; however, only 2 children were able to pass an untrained task, indicating limited generalization. The findings suggest that video modeling may be an effective technology for teaching perspective taking if researchers can continue to develop strategies for enhancing the generalization of these new skills. (+info)
The promise of new ideas and new technology for improving teaching and learning.
(24/1546)
There have been enormous advances in our understanding of human learning in the past three decades. There have also been important advances in our understanding of the nature of knowledge and new knowledge creation. These advances, when combined with the explosive development of the Internet and other technologies, permit advances in educational practices at least as important as the invention of the printing press in 1460. We have built on the cognitive learning theory of David Ausubel and various sources of new ideas on epistemology. Our research program has focused on understanding meaningful learning and on developing better methods to achieve such learning and to assess progress in meaningful learning. The concept map tool developed in our program has proved to be highly effective both in promoting meaningful learning and in assessing learning outcomes. Concept mapping strategies are also proving powerful for eliciting, capturing, and archiving knowledge of experts and organizations. New technology for creating concept maps developed at the University of West Florida permits easier and better concept map construction, thus facilitating learning, knowledge capture, and local or distance creation and sharing of structured knowledge, especially when utilized with the Internet. A huge gap exists between what we now know to improve learning and use of knowledge and the practices currently in place in most schools and corporations. There are promising projects in progress that may help to achieve accelerated advances. These include projects in schools at all educational levels, including projects in Colombia, Costa Rica, Italy, Spain, and the United States, and collaborative projects with corporate organizations and distance learning projects. Results to date have been encouraging and suggest that we may be moving from the lag phase of educational innovation to a phase of exponential growth. (+info)