ResearchPad - cognitive-psychology https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[What makes an effective grants peer reviewer? An exploratory study of the necessary skills]]> https://www.researchpad.co/article/elastic_article_13869 This exploratory mixed methods study describes skills required to be an effective peer reviewer as a member of review panels conducted for federal agencies that fund research, and examines how reviewer experience and the use of technology within such panels impacts reviewer skill development. Two specific review panel formats are considered: in-person face-to-face and virtual video conference. Data were collected through interviews with seven program officers and five expert peer review panelists, and surveys from 51 respondents. Results include the skills reviewers’ consider necessary for effective review panel participation, their assessment of the relative importance of these skills, how they are learned, and how review format affects skill development and improvement. Results are discussed relative to the peer review literature and with consideration of the importance of professional skills needed by successful scientists and peer reviewers.

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<![CDATA[Women’s empowerment as self-compassion?: Empirical observations from  India]]> https://www.researchpad.co/article/elastic_article_13876 Although ICPD brought about an international consensus on the centrality of women’s empowerment and gender equity as desired national goals, the conceptualization and measurement of empowerment in demography and economics have been largely understood in a relational and in a family welfare context where women’s altruistic behaviour within the household is tied either to developmental or child health outcomes. The goals of this study were twofold: (1) to offer an empirical examination of the household level empowerment measure through the theoretical construct of self-compassion and investigate its association with antenatal health, and (2) to ensure robust psychometric quality for this new measure. Drawing data from the nationally representative, multi-topic dataset of 42, 152 households, India Human Development Survey, IHDS II (2011–2012), the study performed a confirmatory factor analysis followed by an OLS estimation to investigate the association between a self-compassionate based empowerment and antenatal care. Empowerment was shown to be positively and significantly associated with antenatal care with significant age and education gradient. A woman’s married status, her relation to the household head and joint family residence created conditions of restricted freedom in terms of her mobility, decision making and sociality. The empowerment measure showed inconsistent associations with social group affiliations and household wealth. The study provided an intellectual starting point to rethink the traditional formulations of empowerment by foregrounding its empirical measure within the relatively unexplored area of social psychology. In the process it addressed measurement gaps in the empowerment-health debate in India and beyond.

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<![CDATA[The effects of age and sex on cognitive impairment in schizophrenia: Findings from the Consortium on the Genetics of Schizophrenia (COGS) study]]> https://www.researchpad.co/article/elastic_article_13860 Recently emerging evidence indicates accelerated age-related changes in the structure and function of the brain in schizophrenia, raising a question about its potential consequences on cognitive function. Using a large sample of schizophrenia patients and controls and a battery of tasks across multiple cognitive domains, we examined whether patients show accelerated age-related decline in cognition and whether an age-related effect differ between females and males. We utilized data of 1,415 schizophrenia patients and 1,062 healthy community collected by the second phase of the Consortium on the Genetics of Schizophrenia (COGS-2). A battery of cognitive tasks included the Letter-Number Span Task, two forms of the Continuous Performance Test, the California Verbal Learning Test, Second Edition, the Penn Emotion Identification Test and the Penn Facial Memory Test. The effect of age and gender on cognitive performance was examined with a general linear model. We observed age-related changes on most cognitive measures, which was similar between males and females. Compared to controls, patients showed greater deterioration in performance on attention/vigilance and greater slowness of processing social information with increasing age. However, controls showed greater age-related changes in working memory and verbal memory compared to patients. Age-related changes (η2p of 0.001 to .008) were much smaller than between-group differences (η2p of 0.005 to .037). This study found that patients showed continued decline of cognition on some domains but stable impairment or even less decline on other domains with increasing age. These findings indicate that age-related changes in cognition in schizophrenia are subtle and not uniform across multiple cognitive domains.

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<![CDATA[The Language of Innovation]]> https://www.researchpad.co/article/elastic_article_10245 Predicting innovation is a peculiar problem in data science. Following its definition, an innovation is always a never-seen-before event, leaving no room for traditional supervised learning approaches. Here we propose a strategy to address the problem in the context of innovative patents, by defining innovations as never-seen-before associations of technologies and exploiting self-supervised learning techniques. We think of technological codes present in patents as a vocabulary and the whole technological corpus as written in a specific, evolving language. We leverage such structure with techniques borrowed from Natural Language Processing by embedding technologies in a high dimensional euclidean space where relative positions are representative of learned semantics. Proximity in this space is an effective predictor of specific innovation events, that outperforms a wide range of standard link-prediction metrics. The success of patented innovations follows a complex dynamics characterized by different patterns which we analyze in details with specific examples. The methods proposed in this paper provide a completely new way of understanding and forecasting innovation, by tackling it from a revealing perspective and opening interesting scenarios for a number of applications and further analytic approaches.

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<![CDATA[Breeding practices and trait preferences of smallholder farmers for indigenous sheep in the northwest highlands of Ethiopia: Inputs to design a breeding program]]> https://www.researchpad.co/article/elastic_article_7865 The aim of this study was to identify breeding practices and trait preferences for indigenous sheep in three districts (Estie, Farta and Lay Gayient) located in the northwest highlands of Ethiopia. Questionnaire survey and choice experiment methods were used to collect data from 370 smallholder farmers. Respondents were selected randomly among smallholder farmers who own sheep in the aforementioned districts. A generalized multinomial logit model was employed to examine preferences for sheep attributes, while descriptive statistics and index values were computed to describe sheep breeding practices. Having the highest index value of 0.36, income generation was ranked as the primary reason for keeping sheep, followed by meat and manure sources. The average flock size per smallholder farmer was 10.21 sheep. The majority of the smallholder farmers (91%) have the experience of selecting breeding rams and ewes within their own flock using diverse criteria. Given the highest index value of 0.34, body size was ranked as a primary ram and ewe selection criteria, followed by coat color. Furthermore, choice modeling results revealed that tail type, body size, coat color, growth rate, horn and ear size have shown significant influences on smallholder farmers’ preference for breeding rams (P<0.01). The part-worth utility coefficients were positive for all ram attributes except ear size. For breeding ewes, mothering ability, coat color, body size, lambing interval, growth rate, tail type and litter size have shown significant effects on choice preferences of smallholder farmers (P<0.05). Moreover, significant scale heterogeneity was observed among respondents for ewe attributes (P<0.001). Overall, the results implied that sheep breeding objectives suitable for the northwest highlands of the country can be derived from traits such as linear body measurement, weight and survival at different ages, and lambing intervals. However, selection decisions at the smallholder level should not only be based on estimated breeding values of traits included in the breeding objective but instead, incorporate ways to address farmers’ preference for qualitative traits.

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<![CDATA[Participant and informant memory-specific cognitive complaints predict future decline and incident dementia: Findings from the Sydney Memory and Ageing Study]]> https://www.researchpad.co/article/elastic_article_7842 Subjective Cognitive Complaints (SCCs) may represent one of the earliest stages of preclinical dementia. The objective of the present study was to extend previous work by our group to examine the relationship between participant-reported and informant-reported memory and non-memory SCCs, cognitive decline and incident dementia, over a six-year period. Participants were 873 community dwelling older adults (Mage = 78.65, SD = 4.79) without dementia and 843 informants (close friends or family) from the Sydney Memory and Ageing Study. Comprehensive neuropsychological testing and diagnostic assessments were carried out at baseline and biennially for six years. Linear mixed models and Cox proportional hazard models were performed to determine the association of SCCs, rate of cognitive decline and risk of incident dementia, controlling demographics and covariates of mood and personality. Participant and informant memory-specific SCCs were associated with rate of global cognitive decline; for individual cognitive domains, participant memory SCCs predicted decline for language, while informant memory SCCs predicted decline for executive function and memory. Odds of incident dementia were associated with baseline participant memory SCCs and informant memory and non-memory SCCs in partially adjusted models. In fully adjusted models, only informant SCCs were associated with increased risk of incident dementia. Self-reported memory-specific cognitive complaints are associated with decline in global cognition over 6-years and may be predictive of incident dementia, particularly if the individual is depressed or anxious and has increased neuroticism or decreased openness. Further, if and where possible, informants should be sought and asked to report on their perceptions of the individual’s memory ability and any memory-specific changes that they have noticed as these increase the index of diagnostic suspicion.

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<![CDATA[Juvenile hormone suppresses aggregation behavior through influencing antennal gene expression in locusts]]> https://www.researchpad.co/article/elastic_article_7742 A behavioral change from shy solitarious individuals to highly social gregarious individuals is critical to the formation of disastrous swarms of locusts. However, the underlying molecular mechanism of behavioral plasticity regulated by hormones is still largely unknown. Here, we investigated the effect of juvenile hormone (JH) on the behavioral transition in fourth-instar gregarious and solitarious locusts. We found that JH induced the behavioral shift of the gregarious locust from attraction to repulsion to the volatiles of gregarious locusts. The solitarious locust significantly decreased repulsion behavior after deprivation of JH by precocene or knockdown of JHAMT, a key enzyme to synthesize JH. JH application on gregarious locusts caused significant expression alteration of genes, especially the olfactory genes TO and CSP in the antennae. We further demonstrated that the JH signaling pathway suppressed aggregation behavior in gregarious locusts by increasing TO1 expression and decreasing CSP3 expression at the same time. Our results suggested that internal physiological factors can directly modulate periphery olfactory system to produce behavioral plasticity.

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<![CDATA[Adaptation to unstable coordination patterns in individual and joint actions]]> https://www.researchpad.co/article/elastic_article_7665 Previous research on interlimb coordination has shown that some coordination patterns are more stable than others, and function as attractors in the space of possible phase relations between different rhythmic movements. The canonical coordination patterns, i.e. the two most stable phase relations, are in-phase (0 degree) and anti-phase (180 degrees). Yet, musicians are able to perform other coordination patterns in intrapersonal as well as in interpersonal coordination with remarkable precision. This raises the question of how music experts manage to produce these unstable patterns of movement coordination. In the current study, we invited participants with at least five years of training on a musical instrument. We used an adaptation paradigm to address two factors that may facilitate producing unstable coordination patterns. First, we investigated adaptation in different coordination settings, to test the hypothesis that the lower coupling strength between individuals during joint performance makes it easier to achieve stability outside of the canonical patterns than the stronger coupling during individual bimanual performance. Second, we investigated whether adding to the structure of action effects may support achieving unstable coordination patterns, both intra- and inter-individually. The structure of action effects was strengthened by adding a melodic contour to the action effects, a measure that has been shown to improve the acquisition of bimanual coordination skills. Adaptation performance was measured both in terms of asynchrony and variability thereof. As predicted, we found that producing unstable patterns benefitted from the weaker coupling during joint performance. Surprisingly, the structure of action effects did not help with achieving unstable coordination patterns.

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<![CDATA[Emotional facial perception development in 7, 9 and 11 year-old children: The emergence of a silent eye-tracked emotional other-race effect]]> https://www.researchpad.co/article/elastic_article_7635 The present study examined emotional facial perception (happy and angry) in 7, 9 and 11-year-old children from Caucasian and multicultural environments with an offset task for two ethnic groups of faces (Asian and Caucasian). In this task, participants were required to respond to a dynamic facial expression video when they believed that the first emotion presented had disappeared. Moreover, using an eye-tracker, we evaluated the ocular behavior pattern used to process these different faces. The analyses of reaction times do not show an emotional other-race effect (i.e., a facility in discriminating own-race faces over to other-race ones) in Caucasian children for Caucasian vs. Asian faces through offset times, but an effect of emotional face appeared in the oldest children. Furthermore, an eye-tracked ocular emotion and race-effect relative to processing strategies is observed and evolves between age 7 and 11. This study strengthens the interest in advancing an eye-tracking study in developmental and emotional processing studies, showing that even a “silent” effect should be detected and shrewdly analyzed through an objective means.

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<![CDATA[Valence-Specific Modulation in the Accumulation of Perceptual Evidence Prior to Visual Scene Recognition]]> https://www.researchpad.co/article/5989d9efab0ee8fa60b6dd7f

Visual scene recognition is a dynamic process through which incoming sensory information is iteratively compared with predictions regarding the most likely identity of the input stimulus. In this study, we used a novel progressive unfolding task to characterize the accumulation of perceptual evidence prior to scene recognition, and its potential modulation by the emotional valence of these scenes. Our results show that emotional (pleasant and unpleasant) scenes led to slower accumulation of evidence compared to neutral scenes. In addition, when controlling for the potential contribution of non-emotional factors (i.e., familiarity and complexity of the pictures), our results confirm a reliable shift in the accumulation of evidence for pleasant relative to neutral and unpleasant scenes, suggesting a valence-specific effect. These findings indicate that proactive iterations between sensory processing and top-down predictions during scene recognition are reliably influenced by the rapidly extracted (positive) emotional valence of the visual stimuli. We interpret these findings in accordance with the notion of a genuine positivity offset during emotional scene recognition.

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<![CDATA[Reasoning and Reading in Adults. A New Reasoning Task for Detecting the Visual Impendance Effect]]> https://www.researchpad.co/article/N41ce4ec0-357b-4450-916c-221ea1af96a8

The visual impedance hypothesis states that at the time of reasoning, the reading context provokes visual images, which may add irrelevant details to an inference and thus could hamper reasoning. This study aims to create a new visual version of a reasoning task, similar to the traditional propositional task of relational syllogisms, but based on visuospatial components. Using such a task, it would be possible to investigate the deductive ability of relational inferences in tests without the need for reading. Two reasoning tasks were used and measures of working memory, visuospatial memory, intelligence, and reading comprehension were taken. The participants were 61 university students without reading difficulties. Results show that both versions of the reasoning task work similarly in finding the main reasoning effects expected. Findings support the visual impedance effect, that is, fewer correct responses in problems with imaginable contents than with neutral ones. They indicate that this new visual task could be used to explore reasoning skills without reading being involved, and this would be useful for testing reasoning in people both with and without reading difficulties.

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<![CDATA[Fingerprint evidence for the division of labour and learning pottery-making at Early Bronze Age Tell eṣ-Ṣâfi/Gath, Israel]]> https://www.researchpad.co/article/N5152a5b5-1b3f-41e8-b706-9ccd50f6a496

The organization of craft production has long been a marker for broader social, economic and political changes that accompanied urbanism. The identity of producers who comprised production groups, communities, or workshops is out of reach using conventional archaeological data. There has been some success using epidermal prints on artefacts to identify the age and sex of producers. However, forensic research indicates that a combination of ridge breadth and ridge density would best identify the age and sex of individuals. To this end, we combine mean ridge breadth (MRB) and mean ridge density (MRD) to distinguish the age and sex of 112 fingerprints on Early Bronze Age (EB) III pottery from the early urban neighbourhood at Tell eṣ-Ṣâfi/Gath, Israel, dating to a 100 year time span. Our analysis accounts for the shrinkage of calcareous fabrics used to make six type of vessels, applies a modified version of the Kamp et al. regression equation to the MRB for each individual print, and infers sex by correlating MRD data to appropriate modern reference populations. When the results are combined, our analyses indicate that most fingerprints were made by adult and young males and the remainder by adult and young females. Children’s prints are in evidence but only occur on handles. Multiple prints of different age and sex on the same vessels suggest they were impressed during the training of young potters. Production appears dominated by adult and young males working alone, together, and in cooperation with adult and/or young females. Vessels with prints exclusively by females of any age are rare. This male dominant cooperative labour pattern contrasts recent studies showing that adult women primarily made Neolithic figurines in Anatolia, and more females than males were making pottery prior to the rise of city-states in northern Mesopotamia.

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<![CDATA[Partition dependence in financial aid distribution to income categories]]> https://www.researchpad.co/article/N0611b39b-d559-4542-a5d9-a69c54a62df4

When allocating resources, people often diversify across categories even when those categories are arbitrary, such that allocations differ when identical sets of options are partitioned differently (“partition dependence”). The first goal of the present work (Experiment 1) was to replicate an experiment by Fox and colleagues in which graduate students exhibited partition dependence when asked how university financial aid should be allocated across arbitrarily partitioned income brackets. Our sample consisted of community members at a liberal arts college where financial aid practices have been recent topics of debate. Because stronger intrinsic preferences can reduce partition dependence, these participants might display little partition dependence with financial aid allocations. Alternatively, a demonstration of strong partition dependence in this population would emphasize the robustness of the effect. The second goal was to extend a “high transparency” modification to the present task context (Experiment 2) in which participants were shown both possible income partitions and randomly assigned themselves to one, to determine whether partition dependence in this paradigm would be reduced by revealing the study design (and the arbitrariness of income categories). Participants demonstrated clear partition dependence in both experiments. Results demonstrate the robustness of partition dependence in this context.

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<![CDATA[Tsinghua facial expression database – A database of facial expressions in Chinese young and older women and men: Development and validation]]> https://www.researchpad.co/article/Nf679a1e8-67cb-47b3-95b4-f3d293b80761

Perception of facial identity and emotional expressions is fundamental to social interactions. Recently, interest in age associated changes in the processing of faces has grown rapidly. Due to the lack of older faces stimuli, most previous age-comparative studies only used young faces stimuli, which might cause own-age advantage. None of the existing Eastern face stimuli databases contain face images of different age groups (e.g. older adult faces). In this study, a database that comprises images of 110 Chinese young and older adults displaying eight facial emotional expressions (Neutral, Happiness, Anger, Disgust, Surprise, Fear, Content, and Sadness) was constructed. To validate this database, each image was rated on the basis of perceived facial expressions, perceived emotional intensity, and perceived age by two different age groups. Results have shown an overall 79.08% correct identification rate in the validation. Access to the freely available database can be requested by emailing the corresponding authors.

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<![CDATA[Towards a fully automated surveillance of well-being status in laboratory mice using deep learning: Starting with facial expression analysis]]> https://www.researchpad.co/article/N201121b9-bfe0-423d-91d1-e349ea424365

Assessing the well-being of an animal is hindered by the limitations of efficient communication between humans and animals. Instead of direct communication, a variety of parameters are employed to evaluate the well-being of an animal. Especially in the field of biomedical research, scientifically sound tools to assess pain, suffering, and distress for experimental animals are highly demanded due to ethical and legal reasons. For mice, the most commonly used laboratory animals, a valuable tool is the Mouse Grimace Scale (MGS), a coding system for facial expressions of pain in mice. We aim to develop a fully automated system for the surveillance of post-surgical and post-anesthetic effects in mice. Our work introduces a semi-automated pipeline as a first step towards this goal. A new data set of images of black-furred laboratory mice that were moving freely is used and provided. Images were obtained after anesthesia (with isoflurane or ketamine/xylazine combination) and surgery (castration). We deploy two pre-trained state of the art deep convolutional neural network (CNN) architectures (ResNet50 and InceptionV3) and compare to a third CNN architecture without pre-training. Depending on the particular treatment, we achieve an accuracy of up to 99% for the recognition of the absence or presence of post-surgical and/or post-anesthetic effects on the facial expression.

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<![CDATA[Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain]]> https://www.researchpad.co/article/N48fe9543-bf7a-4bb3-b7f3-098351efee5f

Background

Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and help to optimize pain management.

Methods

We used a multiple criteria decision analysis (MCDA) approach to consider the organizational impact of methoxyflurane (self-administered) in the ED, introduced alone or supported by a trauma care pathway. A MCDA experiment was designed for this specific context, 8 experts in emergency trauma care pathways (leading physicians and pharmacists working in French urban tertiary hospitals) were recruited. The study involved four steps: (i) Selection of organizational criteria for evaluating the innovation’s impact; (ii) assessment of the relative weight of each criterion; (iii) choice of appropriate scenarios for exploring the organizational impact of MEOX under various contexts; and (iv) software-assisted simulation based on pairwise comparisons of the scenarios. The final outcome measure was the expected overall organizational impact of methoxyflurane on a 0-to-100 scale (score >50: positive impact).

Results

Nine organizational criteria were selected. "Mean length of stay in the ED" was the most weighted. Methoxyflurane alone obtained 59 as a total score, with a putative positive impact for eight criteria, and a neutral effect on one. When a trauma care pathway was introduced concomitantly, the impact of methoxyflurane was greater overall (score: 75) and for each individual criterion.

Conclusions

Our model highlighted the putative positive organizational impact of methoxyflurane in the ED—particularly when supported by a trauma care pathway—and the relevance of expert consensus in this particular pharmacoeconomic context. The MCDA approach could be extended to other research fields and healthcare challenges in emergency medicine.

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<![CDATA[Beware of vested interests: Epistemic vigilance improves reasoning about scientific evidence (for some people)]]> https://www.researchpad.co/article/Na4c1a7a8-d330-434e-b120-e60e98785391

In public disputes, stakeholders sometimes misrepresent statistics or other types of scientific evidence to support their claims. One of the reasons this is problematic is that citizens often do not have the motivation nor the cognitive skills to accurately judge the meaning of statistics and thus run the risk of being misinformed. This study reports an experiment investigating the conditions under which people become vigilant towards a source’s claim and thus reason more carefully about the supporting evidence. For this, participants were presented with a claim by a vested-interest or a neutral source and with statistical evidence which was cited by the source as being in support of the claim. However, this statistical evidence actually contradicted the source’s claim but was presented as a contingency table, which are typically difficult for people to interpret correctly. When the source was a lobbyist arguing for his company’s product people were better at interpreting the evidence compared to when the same source argued against the product. This was not the case for a different vested-interests source nor for the neutral source. Further, while all sources were rated as less trustworthy when participants realized that the source had misrepresented the evidence, only for the lobbyist source was this seen as a deliberate attempt at deception. Implications for research on epistemic trust, source credibility effects and science communication are discussed.

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<![CDATA[Children’s descriptions of playing and learning as related processes]]> https://www.researchpad.co/article/Nb68d6bfc-75c6-4e1a-9b4b-3dced51d37df

Many studies have examined children’s understanding of playing and learning as separate concepts, but the ways that children relate playing and learning to one another remain relatively unexplored. The current study asked 5- to 8-year-olds (N = 92) to define playing and learning, and examined whether children defined them as abstract processes or merely as labels for particular types of activities. We also asked children to state whether playing and learning can occur simultaneously, and examined whether they could give examples of playing and learning with attributes either congruent or incongruent with those activities. Older children were more likely to define both playing and learning in terms of abstract processes, rather than by describing particular topics or activities. Children who defined both playing and learning in this way were able to generate more examples of situations where they were simultaneously playing and learning, and were better able to generate examples of learning with characteristics of play, and examples of playing with characteristics of learning. These data suggest that children develop an understanding that learning and playing can coincide. These results are critical to researchers and educators who seek to integrate play and learning, as children’s beliefs about these concepts can influence how they reflect on playful learning opportunities.

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<![CDATA[A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients]]> https://www.researchpad.co/article/N8fecd5fe-2073-4d74-805a-6132ddca5eea

Background

Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients.

Methods

This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0–4) and attention task (0–6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden’s index.

Results

A total of 187 patients were recruited, mean age 83.8 (range 67–98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6).

Conclusion

Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.

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<![CDATA[Readiness to prescribe: Using educational design to untie the Gordian Knot]]> https://www.researchpad.co/article/Nd54ed6a5-cf2b-4df7-b723-1be3eaed6fb5

Introduction

Junior residents routinely prescribe medications for hospitalised patients with only arms-length supervision, which compromises patient safety. A cardinal example is insulin prescribing, which is commonplace, routinely delegated to very junior doctors, difficult, potentially very dangerous, and getting no better. Our aim was to operationalise the concept of ‘readiness to prescribe’ by validating an instrument to quality-improve residents’ workplace prescribing education.

Methods

Guided by theories of behaviour change, implementation, and error, and by empirical evidence, we developed and refined a mixed-methods 24-item evaluation instrument, and analysed numerical responses from Foundation Trainees (junior residents) in Northern Ireland, UK using principal axis factoring, and conducted a framework analysis of participants’ free-text responses.

Results

255 trainees participated, 54% women and 46% men, 80% of whom were in the second foundation year. The analysis converged on a 4-factor solution explaining 57% of the variance. Participants rated their capability to prescribe higher (79%) than their capability to learn to prescribe (69%; p<0.001) and rated the support to their prescribing education lower still (43%; p<0.001). The findings were similar in men and women, first and second year trainees, and in different hospitals. Free text responses described an unreflective type of learning from experience in which participants tended to 'get by' when faced with complex problems.

Discussion

Operationalising readiness to prescribe as a duality, comprising residents’ capability and the fitness of their educational environments, demonstrated room for improvement in both. We offer the instrument to help clinical educators improve the two in tandem.

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