PubMed · 14255274
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A MORGON, J C LAFON, J P PRELOT. 1964-12-06. [AUDIO-PHONATORY CONTROL].. https://pubmed.ncbi.nlm.nih.gov/14255274/
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Norris et al. recently reported experimental evidence that listeners learn phoneme categories in response to lexical feedback. To reconcile these findings with their modular account of speech perception, the authors argue that top-down feedback can be used to support phoneme learning, but not to influence on-line phonemic processing. We suggest that these findings have broader implications than the authors assume, and we discuss potential challenges for integrating a modular theory with top-down learning.
End-stage renal disease (ESRD) Networks are quality improvement organizations that collect, analyze, and report information to clinicians and allied health providers about discrepancies between observed patterns of care of ESRD patients and what has been recommended by clinical practice guidelines. The Networks facilitate response to this information by assisting ESRD treatment centers to develop quality improvement programs to redress inadequate care. The authors evaluated this process of quality improvement by selecting 42 treatment centers in a single ESRD Network with the lowest facility-specific mean urea reduction ratio (URR). The treatment centers were randomly assigned to two intervention strategies: (1) feedback alone; (2) an intensive intervention that included feedback, workshops, distribution of educational materials and clinical practice guidelines, technical assistance with the development of quality improvement plans, and continued monitoring. The intensive intervention had greater improvement in the increased proportions of patients dialyzed with prescribed blood flow (P = 0.02) and documented review of prescription (P = 0.01). Furthermore, the mean center URR increased nearly 3% among intensive intervention centers (from 68.1 to 70.9) but only 0.09% among the feedback centers (68.2 to 69.1) (P = 0.002). Similarly, time on dialysis increased 7.5 min on average among patients in intervention centers but decreased 2 min for patients in comparison centers (P = 0.03). These results demonstrate that Network feedback, coupled with the intensive intervention, resulted in improvement in care that would otherwise not have occurred.
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