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PubMedDate not supplied

Anatomy of the auditory cortex.

Cortical auditory areas located in the superior temporal region (STR) in monkey and human. The primary auditory area (AI) occupies the cortex of the supratemporal plane (STP) and is surrounded by auditory association areas in circular sulcus and superior temporal gyrus (STG). Architectonic studies have parcellated auditory areas into a number of subregions. Beginning from the temporal polar proisocortex up to the parietal cortex, these areas shows progressive laminar differentiation, and are arranged into three parallel lines. The most medial line occupies the cortex of the circular sulcus. The regions of this line maintains limbic features and is termed as root line. Another line is located in STG. The regions of this line show progressive emphasis in the third and fourth layer neurons and is termed as belt line. Interposed between root and belt line is a core line located in STP. In this line there is greater accumulation of fourth layer neurons. Recent physiological studies have outlined several auditory representations surrounding AI. These auditory representations correspond to above mentioned architectonic subregions of STR. The subregions within each line have bidirectional connectional laminar specificity. The feedforward connections originate from the supragranular layer III and terminate in the around layer IV of the rostrally adjacent region. Feedback projections in contrast stem from the infragranular layers and terminate in layer I. The long association connections of auditory areas are with the prefrontal cortex (PFC), the multimodal areas and the limbic regions, and are derived from belt and root line areas of STR. These projections follow the rostro-caudal architectonic differentiation of STR. Thus the rostral STG areas are mainly connected with orbital and medial PFC areas whereas the caudal STG areas are connected with caudal PFC. The intermediate STG areas are preferentially related to the lateral PFC regions. It seems that STG-PFC connections are between the areas with similar level of architectonic differentiation. The thalamic connections of the subregions of STR also follow the architectonic organizations. The core line areas are preferentially related to ventral nucleus (MGv) of medial geniculate nucleus (MGN) whereas the root and belt line areas are connected respectively to magnocellular (MGmc) and dorsal (MGd) subdivisions of MGN. The root and belt areas share some connections and are also related to pulvinar, suprageniculate, dorsomedial and intralaminar nuclei. It seems therefore that progressive laminar and tripartrate organization of auditory regions of STR is reflected in intrinsic, association and thalamic connections. The feedforward connections may be engaged in analysis of external environmental cues whereas feedback connections may have a role in matching learned or stored information with incoming auditory signals. The preferential core line connectivity with MGv may be involved in spectral analysis of sound whereas the connections of the belt and root areas with MGmc, MGd, and pulvinar may have role in sound pattern recognition, auditory memory, the localization of sound in space as well as matching auditory information with other modalities.

Animals↗

PubMed2005

Opposing roles for GABAA and GABAC receptors in short-term memory formation in young chicks.

The inhibitory neurotransmitter GABA has both inhibitory and enhancing effects on short-term memory for a bead discrimination task in the young chick. Low doses of GABA (1-3 pmol/hemisphere) injected into the multimodal association area of the chick forebrain, inhibit strongly reinforced memory, whereas higher doses (30-100 pmol/hemisphere) enhance weakly reinforced memory. The effect of both high and low doses of GABA is clearly on short-term memory in terms of both the time of injection and in the time that the memory loss occurs. We argue on the basis of relative sensitivities to GABA and to selective GABA receptor antagonists that low doses of GABA act at GABAC receptors (EC50 approximately 1 microM) and the higher doses of GABA act via GABAA receptors (EC50 approximately 10 microM). The selective GABAA receptor antagonist bicuculline inhibited strongly reinforced memory in a dose and time dependent manner, whereas the selective GABAC receptor antagonists TPMPA and P4MPA enhanced weakly reinforced in a dose and time dependent manner. Confirmation that different levels of GABA affect different receptor subtypes was demonstrated by the shift in the GABA dose-response curves to the selective antagonists. It is clear that GABA is involved in the control of short-term memory formation and its action, enhancing or inhibiting, depends on the level of GABA released at the time of learning.

Animals↗

PubMed2001

[15 years experience with the ileal neobladder. What have we learned?].

During the past 15 years, orthotopic bladder reconstruction has evolved from experimental surgery over "standard of care at larger medical centers" to become the preferred method of urinary diversion in both sexes. The paradigm for choosing a urinary diversion has changed substantially over that time. In 2001, all cystectomy patients are candidates for a neobladder, and we should identify those patients in whom orthotopic reconstruction may be less ideal, noting that the percentage of patients receiving a neobladder today averages 60 to 70 percent. Relative contraindications and comorbidity now play a smaller role in choosing the neobladder option. Patient selection criteria include both patient factors and cancer factors. The primary patient factor being the patient's desire for a neobladder. The psychologically damaging stigma to the patient who enters surgery expecting a neobladder but awakens with a stoma now plays an increasing role. Nevertheless, there are patients who are better served with a conduit. Among that are patients whose main motivation is to "get out of the hospital as soon as possible", and patients who will be happy to resume a normal, relatively sedentary life and who have no concerns about body image. Two important criteria that must be maintained when contemplating a neobladder procedure--the urethral sphincter must remain intact and the cancer operation must not be compromised. However, increasing experience has forced less restrictiveness as far as tumor stage is concerned. A recent study of 435 bladder cancer patients who had bladder replacements after cystectomy, experienced a local recurrence rate of 10 percent. Interference of the local recurrence with the neobladder occurred in just 11 patients--infiltration in six, and obstruction in five. Survival was limited despite multimodality therapy. The option of a neobladder reduced the physician and patient reluctance to perform cystectomy early in the disease process, thereby increasing the survival rate, and patients can anticipate normal neobladder function until time of death. It can be concluded that a neobladder for locally advanced cancer and positive nodes is no more problematic than a conduit. The structural and ultrastructural changes which occur in neobladder mucosa are biphasic. The early phase is inflammatory, showing an infiltration of the lamina propria and a reduction in microvilli. After one year the late regressive phase starts, ending up in a flat mucosa and a stratified epithelium. The structure and response of the implanted ileum change to a detrusor-type: response. The structural and ultrastructural changes an ileal mucosa lead to a primitive surface and glandular epithelium similar to urothelium. This transformation of the ileal mucosa minimizes the risk of metabolic complications. We conclude that mother nature engineers a new bladder almost as good as the one given by God initially. The risk of obstruction of non refluxing techniques is at least twice that following a direct anastomosis. There is no longer a justification of any antireflux mechanism. Ileum seems to be clearly superial to colon when continence rates, metabolic safety and surgeons's issues are considered.

Female↗

PubMed1977

Temporal extrapolation of unimodal and multimodal stimulus sequences in retarded and nonretarded persons.

Retarded adolescents, CA-matched nonretarded adolescents, and MA-matched nonretarded children attempted to match the repetition rate of 10-second stimulus sequences presented under four modality switching conditions and at two pusle frequencies. Error magnitudes were least for the CA-matched subjects and under the faster pulse rate increased from the no-switching to maximum-switching condition in all groups. Error increases from the no-switching to maximum-switching condition were preponderantly underestimations. No differences between groups were obtained for a switching condition in which the modality-sequence pattern was aperiodic. A hypothesis of longer psycholoical refractory periods in retarded adolescents was rejected in favor of one explaining their inferior performance on sequential enumeration and tracking tasks in terms of inefficient organizational abilities.

Acoustic Stimulation↗

PubMed1987

Behavioural and anatomical studies of the posterior parietal cortex in the rat.

Primates have an area of posterior cortex characterized by multimodal sensory projections to and from the frontal association cortex and a clear behavioural syndrome resulting from lesions to this zone. The posterior association cortex of the rat was examined in two series of experiments, one anatomical and one behavioural, to see if an analogous region could be found. The anatomical connections of Krieg's area 7 in the rat were examined by placing the retrograde tracer, True blue, into the frontal or posterior cortex, and the behaviour of rats with this cortex removed was studied on a variety of tasks. This area appears to be a multimodal sensory association region. It receives projections from striate (area 17), extrastriate (areas 18a and 18b), and somatosensory cortex (area 3). It is also reciprocally connected with the posterior cingulate cortex and two frontal association zones in the medial frontal cortex, namely the anterior cingulate cortex and the frontal eye fields. Lesions produced deficits on tasks of tactile discrimination, and walking a narrow beam, two tasks requiring animals to navigate accurately to a point in space, and a task requiring the association of two spatially discontiguous cues. The animals were not impaired at navigating to a cue or in opening puzzle latches. Overall, the results show that the rat has a sensory association zone that may be analogous to the posterior parietal cortex of primates.

Animals↗

PubMed1998

Image registration: an essential part of radiation therapy treatment planning.

PURPOSE: We believe that a three-dimensional (3D) registration of nonplanning (diagnostic) imaging data with the planning computed tomography (CT) offers a substantial improvement in tumor target identification for many radiation therapy patients. The purpose of this article is to review and discuss our experience to date. METHODS AND MATERIALS: We reviewed the charts and treatment planning records of all patients that underwent 3D radiation treatment planning in our department from June 1994 to December 1995, to learn which patients had image registration performed and why it was thought they would benefit from this approach. We also measured how much error would have been introduced into the target definition if the nonplanning imaging data had not been available and only the planning CT had been used. RESULTS: Between June 1994 and December 1995, 106 of 246 (43%) of patients undergoing 3D treatment planning had image registration. Four reasons for performing registration were identified. First, some tumor volumes have better definition on magnetic resonance imaging (MRI) than on CT. Second, a properly contrasted diagnostic CT sometimes can show the tumor target better than can the planning CT. Third, the diagnostic CT or MR may have been preoperative, with the postoperative planning CT no longer showing the tumor. Fourth, the patient may have undergone cytoreductive chemotherapy so that the postchemotherapy planning CT no longer showed the original tumor volume. In patients in whom the planning CT did not show the tumor volume well an analysis was done to determine how the treatment plan was changed with the addition of a better tumor-defining nonplanning CT or MR. We have found that the use of this additional imaging modality changed the tumor location in the treatment plan at least 1.5 cm for half of the patients, and up to 3.0 cm for 1/4 of the patients. CONCLUSIONS: Multimodality and/or sequential imaging can substantially aid in better tumor definition in many patients undergoing 3D treatment planning. In some patients the appropriate nonplanning imaging source can change the perceived tumor location by several centimeters and is thus essential for proper treatment planning.

Humans↗

PubMed2004

Infants' perception of rhythm and tempo in unimodal and multimodal stimulation: a developmental test of the intersensory redundancy hypothesis.

Research has demonstrated that young infants can detect a change in the tempo and the rhythm of an event when they experience the event bimodally (audiovisually), but not when they experience it unimodally (acoustically or visually). According to Bahrick and Lickliter (2000, 2002), intersensory redundancy available in bimodal, but not in unimodal, stimulation directs attention to the amodal properties of events in early development. Later in development, as infants become more experienced perceivers, attention becomes more flexible and can be directed toward amodal properties in unimodal and bimodal stimulation. The present study tested this developmental hypothesis by assessing the ability of older, more perceptually experienced infants to discriminate the tempo or rhythm of an event, using procedures identical to those in prior studies. The results indicated that older infants can detect a change in the rhythm and the tempo of an event following both bimodal (audiovisual) and unimodal (visual) stimulation. These results provide further support for the intersensory redundancy hypothesis and are consistent with a pattern of increasing specificity in perceptual development.

Acoustic Stimulation↗

PubMed2026

Cancer of unknown primary: the evolution of tissue of origin identification in the artificial intelligence era.

Cancer of Unknown Primary (CUP) presents substantial diagnostic and therapeutic challenges owing to its heterogeneous nature and the absence of an identifiable primary tumor site. This review provides a structured search of the pathogenesis, epidemiological characteristics, and limitations of traditional diagnostic and therapeutic approaches for CUP, with an emphasis on the evolution of Tissue of Origin (TOO) identification techniques. Recent advances in precision medicine have accelerated the development of machine learning-based TOO identification tools, representing a paradigm shift in CUP diagnostics. Deep learning (DL) algorithms that integrate multi-omics data (such as genomics and transcriptomics) with clinical features have markedly enhanced the accuracy of tracing tumor origin, and artificial intelligence (AI) driven TOO models are increasingly being incorporated into clinical practice, offering new insights for pathological diagnosis, treatment selection, and prognostic evaluation. Nevertheless, several challenges remain, including issues of data standardization, model generalizability, and interpretability. Ethical considerations related to data privacy, algorithmic fairness, and clinical implementation also warrant careful attention. Future research should focus on establishing standardized multi-center databases, developing more interpretable AI models, and fostering multidisciplinary collaborative strategies for CUP management. Through continued refinement of technical solutions and regulatory guidelines, TOO identification is anticipated to progress from research to routine clinical application, ultimately supporting precise and personalized care for patients with CUP.

Artificial intelligence↗

PubMed2006

Body inversion effect without body sense: insights from deafferentation.

Like faces, human bodies are recognized via the configuration of their parts; their recognition is impaired by inversion. Processing of configural relations has been shown to depend on perceptual expertise with certain classes of objects. Because people see their own body and others' bodies frequently, humans are experts in the visual processing of human body postures. In addition, the observer's own on-line, multimodal body representation which heavily relies on current proprioception may play a crucial role in recognizing human body postures. We investigated whether static body posture recognition relied on current proprioceptive inputs or whether visual familiarity and stored body representations were sufficient. IW, who is deafferented (lost cutaneous touch and proprioception from his body), was tested on the recognition of upright and inverted human body postures, faces, and houses. As controls, IW showed an inversion effect for abstract, common, and rare human body postures as well as faces, but not houses. Results rule out a strong contribution of current afferent inputs to the recognition of human postures. The findings are discussed in terms of the role of the body schema in body posture recognition and how other contributions from one's own body may be involved in the visual processing of human bodies.

Adult↗

PubMed2005

Effects of music training on the child's brain and cognitive development.

Research has revealed structural and functional differences in the brains of adult instrumental musicians compared to those of matched nonmusician controls, with intensity/duration of instrumental training and practice being important predictors of these differences. Nevertheless, the differential contributions of nature and nurture to these differences are not yet clear. The musician-nonmusician comparison is an ideal model for examining whether and, if so, where such functional and structural brain plasticity occurs, because musicians acquire and continuously practice a variety of complex motor, auditory, and multimodal skills (e.g., translating visually perceived musical symbols into motor commands while simultaneously monitoring instrumental output and receiving multisensory feedback). Research has also demonstrated that music training in children results in long-term enhancement of visual-spatial, verbal, and mathematical performance. However, the underlying neural bases of such enhancements and whether the intensity and duration of instrumental training or other factors, such as extracurricular activities, attention, motivation, or instructional methods can contribute to or predict these enhancements are yet unknown. Here we report the initial results from our studies examining the brain and cognitive effects of instrumental music training on young children in a longitudinal study and a cross-sectional comparison in older children. Further, we present a comparison of the results in these children's studies with observations from our cross-sectional studies with adults.

Adolescent↗

PubMed2006

A new combination treatment for premature ejaculation: a sex therapist's perspective.

This article describes the diagnosis and treatment of premature ejaculation (PE) from a sex therapist's perspective and proposes that combination therapy integrating sex therapy and sexual pharmaceuticals is frequently the best treatment approach. Failure to appreciate the multimodal etiology and pathophysiology of PE makes the condition more difficult to diagnose and treat. Many physicians have tried pharmacologic approaches, but are limited to providing topical anesthetics or suggesting off-label uses of antidepressant and erectile dysfunction medications, because no medication is currently indicated specifically for PE. Furthermore, patients frequently relapse after discontinuation of the pharmaceutical. Sex therapists appreciate the multidimensional nature of PE for the patient and partner, but few patients seek out this approach, which is labor-intensive and often lacking long-term follow-up success. Most men with PE are not receiving treatment, secondary to their embarrassment about discussing their condition and a lack of clinician inquiry about sexual dysfunction. Even for those who do engage in discussion, diagnoses may be inconsistent, because a universally accepted definition of the condition and diagnostic criteria are nonexistent. Men with PE experience anxiety and lack sexual self-confidence; subsequently, their sexual and overall relationship frequently suffer. Because PE involves psychosocial and physiologic factors, treatment that addresses both should yield the best balance of function. There is interest in new agents designed specifically for PE to provide an improved pharmacotherapeutic opportunity. Yet, a combination treatment integrating pharmaceuticals and sex therapy would provide an optimized approach. Besides increasing coital latency directly, sexual pharmaceuticals could be used to provide greater opportunity for men to recognize their premonitory sensations to ejaculation more readily, facilitating a "choice point", which is key to facilitating behavioral change and learning. Such a combination approach would result in prolonged ejaculatory latency, improved treatment satisfaction, and superior long-term outcome.

Clinical Competence↗

PubMed2006

Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder.

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.

Affect↗

PubMed2006

Pain management today - what have we learned?

Pain is a leading cause of morbidity worldwide, with published data showing its prevalence as high as 50% for chronic pain in the European population. This prevalence is likely to continue to rise, particularly in elderly people with comorbid conditions and complex aetiologies of pain. There is thus a rapidly growing demand for safe and effective pain management. Management of mild-to-moderate pain has traditionally been based upon the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the synthetic non-opioid analgesic paracetamol (acetaminophen), the latter of which acts centrally, inhibiting brain cyclo-oxygenase (COX) and nitric oxide synthase. Both the NSAIDs and paracetamol are effective for mild-to-moderate pain and are widely recommended and used. However, NSAIDs may not be tolerated due to gastrointestinal (GI) symptoms and can result in potentially fatal peptic ulceration and bleeding. Selective COX-2 inhibitors were developed to reduce the GI side effects and complications, but large-scale studies have highlighted another serious potential effect of anti-inflammatory drugs: cardiovascular events. Both the European Medicines Agency (EMEA) and the Food and Drugs Administration (FDA) in the US have issued advice to apply cautions and restrictions when prescribing COX-2 inhibitors, particularly for patients at increased cardiovascular risk and for long-term use. The FDA also applied cardiovascular warnings with regard to nonselective NSAIDs. Both the EMEA and the FDA have recommended using the lowest effective dose for the shortest duration. These concerns and warnings have left physicians seeking safe alternatives to anti-inflammatory drugs for both short- and long-term uses in many patients. These developments have generated a climate of uncertainty in the absence of official guidance on the selection of alternative analgesic regimens. Amongst the possible strategies, combinations of drugs that provide analgesic efficacy at reduced individual doses may confer the optimal risk-benefit ratio for pain management in the long term or in patients at increased cardiovascular risk. Weak opioids devoid of serious organ-damaging effects combined with paracetamol may well be safer for long-term therapy. Fixed-dose combinations of paracetamol with weak opioids, such as codeine, dextropropoxyphene or tramadol are currently available. Paracetamol plus tramadol is an effective and safe multimodal analgesic regimen for the management of both acute and chronic moderate-to-severe pain. Re-evaluating the role of weak opioids, such as tramadol, and combinations in pain management may prove a valuable option for prescribers seeking alternatives to anti-inflammatory drugs.

Analgesics↗

PubMed2005

Reversal of neuromotor and cognitive dysfunction in an enriched environment combined with multimodal early onset stimulation after traumatic brain injury in rats.

This study was designed to investigate the additional benefits of a multimodal early onset stimulation (MEOS) paradigm when combined with enriched environment (EE) versus EE only and standard housing (SH) on the recovery after experimental traumatic brain injury (TBI). Male Sprague- Dawley rats were subjected to moderate lateral fluid percussion (LFP) brain injury (n = 40) or sham operation (n = 6). Thereafter, the injured and sham/EE + MEOS and EE only groups were placed into a complex EE consisting of tunnel-connected wide-bodied cages with various beddings, inclining platforms, and toys. Along with group living and environmental complexity, injured and sham/EE + MEOS animals were additionally exposed to a standardized paradigm of multimodal stimulation including auditory, visual, olfactory, and motor stimuli. In contrast, injured and sham/SH groups were housed individually without stimulation. A standardized composite neuroscore (NS) test was used to assess acute post-traumatic neuromotor deficits (24 h after injury) and recovery on days 7 and 15; recovery of cognitive function was assessed on days 11-15 using the Barnes maze. Neuromotor impairment was comparable in all injured animals at 24 h post-injury, but braininjured EE + MEOS rats performed significantly better than both brain-injured SH and EE groups when tested on post-injury days 7 and 15 (p = 0.004). Similarly, latencies to locate the hidden box under the Barnes maze platform were significantly shortened in EE + MEOS animals at day 15 (p = 0.003). These results indicate that the reversal of neuromotor and cognitive dysfunction after TBI can be substantially enhanced when MEOS is added to EE.

Acoustic Stimulation↗

PubMed2003

Designing tailored Web-based instruction to improve practicing physicians' preventive practices.

BACKGROUND: The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important. OBJECTIVE: Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. METHODS: We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials. RESULTS: In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group. CONCLUSIONS: The application of theory in the development and evaluation of a Web-based continuing medical education intervention offers valuable insight into World Wide Web technology's influence on physician performance and the quality of medical care.

Adolescent↗

PubMed2004

Perceptual biases for multimodal cues in chimpanzee (Pan troglodytes) affect recognition.

The ability of organisms to discriminate social signals, such as affective displays, using different sensory modalities is important for social communication. However, a major problem for understanding the evolution and integration of multimodal signals is determining how humans and animals attend to different sensory modalities, and these different modalities contribute to the perception and categorization of social signals. Using a matching-to-sample procedure, chimpanzees discriminated videos of conspecifics' facial expressions that contained only auditory or only visual cues by selecting one of two facial expression photographs that matched the expression category represented by the sample. Other videos were edited to contain incongruent sensory cues, i.e., visual features of one expression but auditory features of another. In these cases, subjects were free to select the expression that matched either the auditory or visual modality, whichever was more salient for that expression type. Results showed that chimpanzees were able to discriminate facial expressions using only auditory or visual cues, and when these modalities were mixed. However, in these latter trials, depending on the expression category, clear preferences for either the visual or auditory modality emerged. Pant-hoots and play faces were discriminated preferentially using the auditory modality, while screams were discriminated preferentially using the visual modality. Therefore, depending on the type of expressive display, the auditory and visual modalities were differentially salient in ways that appear consistent with the ethological importance of that display's social function.

Acoustic Stimulation↗

PubMed2005

The development, validity and reliability of a multimodality objective structured clinical examination in psychiatry.

OBJECTIVES: To evaluate the development, validity and reliability of a multimodality objective structured clinical examination (OSCE) in undergraduate psychiatry, integrating interactive face-to-face and telephone history taking and communication skills stations, videotape mental state examinations and problem-oriented written stations. METHODS: The development of the OSCE on a restricted budget is described. This study evaluates the validity and reliability of 4 15-18-station OSCEs for 128 students over 1 year. Face and content validity were assessed by a panel of clinicians and from feedback from OSCE participants. Correlations with consultant clinical 'firm grades' were performed. Interrater reliability and internal consistency (interstation reliability) were assessed using generalisability theory. RESULTS: The OSCE was feasible to conduct and had a high level of high perceived face and content validity. Consultant firm grades correlated moderately with scores on interactive stations and poorly with written and video stations. Overall reliability was moderate to good, with G-coefficients in the range 0.55-0.68 for the 4 OSCEs. CONCLUSIONS: Integrating a range of modalities into an OSCE in psychiatry appears to represent a feasible, generally valid and reliable method of examination on a restricted budget. Different types of stations appear to have different advantages and disadvantages, supporting the integration of both interactive and written components into the OSCE format.

Clinical Competence↗

PubMed2006

Emotion experience and expression across the adult life span: insights from a multimodal assessment study.

This investigation represents a multimodal study of age-related differences in experienced and expressed affect and in emotion regulatory skills in a sample of young, middle-aged, and older adults (N=96), testing formulations derived from differential emotions theory. The experimental session consisted of a 10-min anger induction and a 10-min sadness induction using a relived emotion task; participants were also randomly assigned to an inhibition or noninhibition condition. In addition to subjective ratings of emotional experience provided by participants, their facial behavior was coded using an objective facial affect coding system; a content analysis also was applied to the emotion narratives. Separate repeated measures analyses of variance applied to each emotion domain indicated age differences in the co-occurrence of negative emotions and co-occurrence of positive and negative emotions across domains, thus extending the finding of emotion heterogeneity or complexity in emotion experience to facial behavior and verbal narratives. The authors also found that the inhibition condition resulted in a different pattern of results in the older versus middle-aged and younger adults. The intensity and frequency of discrete emotions were similar across age groups, with a few exceptions. Overall, the findings were generally consistent with differential emotions theory.

Adult↗